“I don’t see the problem.”

“Everyone counts” …except staff. And patients.

When Neil Storey, East of England Ambulance Trust Director of Operations, presented his new rota system, road staff tried to point out the obvious flaws. The entire plan, now public knowledge, was predicated on the idea that existing resources had enough wiggle room to allow for a reduction in ambulances. Every operational staff member in the room knew from bitter daily experience that that was not the case. Sadly, Mr Storey was clearly not looking for advice, he simply wished to inform the staff of what was going to happen. His parting words were reported to be: “I don’t see the problem.”

Those five words highlight the very issue with Ambulance Trust leadership today. No doubt Mr. Storey knows his figures and has studied the “demand profiles” which the EEAST Board are so fond of exhorting. Everything that he has worked on is singularly focused on the ORCON model we discussed last week in The Cult of ORCON. But that laser-like focus simply underlines his flawed logic process. He is working on the precept that achievement of ORCON targets has real meaning which, in the current culture of achieving them by any means necessary, they evidently don’t.

Despite road crews speaking to him in an overwhelming, singular voice of dissent, he was content to dismiss that room full of know-nothings with the departing statement which damns his kind. Directors do not – cannot – see the problem. That problem is reality. But reality apparently just gets in the way of target achievement and therefore should be ignored. It is not productive to consider reality – instead The Board has incontrovertible evidence in the form of statistics and demand profiles which are far more useful than the daily experiences of everyone who is actually doing the job.

If nothing else, this proves that whistleblowing to the Care Quality Commission is the only way to get through to The Board. Direct communication from staff members has already been tried and fallen on deaf ears. Links to further information on contacting the CQC can be found on the right. —>

Selective Deafness and Systemic Insanity

In another example of institutionalised madness; with handover delays at over-run A&E departments being a huge contributor to lack of ambulance availability, a new punative system will see hospitals fined £70 for every delayed ambulance. There is a stunning lack of logic behind this system, which will remove funds from an already struggling system whilst applying more pressure and encouraging conflict between hospital and ambulance staff. But when Mr. Storey was asked about it, he simply explained “That’s how things are done.”

What chance is there of the foundering ship being righted when those in charge simply accept the status quo no matter how ridiculous it is. It makes as much sense as financially rewarding Ambulance Trusts who achieve their targets, whilst denying funding to those who do not. This actually happens. Neil Storey is correct, apparently that is how things are done. But it doesn’t mean it is right nor should it be accepted or encouraged. The total acceptance of such poisonous nonsense is maddening.

In last week’s Welwyn Hatfield Times, an ambulance spokesman was quoted as saying “The revisions follow a comprehensive analysis which shows there are currently places and times when we have too many vehicles and crews for the number of patients we see and places and times when we do not have enough, making inefficient use of taxpayers’ money.”

Yet every report I have received from road crews tells the opposite story. Just reading the deluge of comments from frontline clinicians elsewhere on this blog shows that staff are being crushed under the weight of constant calls, day and night. God forbid they might at any point have enough time to stop and rest. Despite this, EEAST’s “comprehensive analysis” has apparently determined that the existing staff aren’t presently working hard enough and this is clearly to the detriment of the “taxpayer” (an obvious, desperate attempt to get the public on side). By pouring further pressure on staff and removing more ambulance cover, this will somehow improve ambulance performance and clinical care? Delusion and lunacy.

The Ministry of Ambulance Propaganda

Elsewhere in the media, many other stories can be found covering the failures of the ambulance service. In almost every case, an ambulance spokesman can be found claiming that such incidents are “not the norm”. Yet any operational ambulance personnel will tell you otherwise. Single responders are regularly stranded on scene and ambulance crews will often be sent on journeys of 30 minutes or more to time critical patients. Faced with angry patients and relatives, crews are routinely being made apologists for a crippled system. Seriously ill patients are being transported in cars (and apparently passing haulage lorries!) due to a lack of resources.

Faced with criticism over their failure to meet their own internal targets for stroke patients, rather than admit they have discovered they do not have the resources to provide an adequate service, a statement was published by EEAST, claiming they have been “wrongly criticised” and blame “the effect of geography on transport times”. According to this BBC report from last year, East of England had seen response times more than quadruple over the preceding 3 years. To my knowledge, there have been no earthquakes or other geography-changing events in the intervening period, so why are they suddenly confounded by the terrain? Geography is not the problem, it is once again the lack of ambulances. Yet Trust leadership continues to pump out inane propaganda skirting around this basic, obvious fact.

The last time an organisation showed this level of self-imposed delusion, the world watched Iraqi Information Minister ‘Comical Ali’ (Muhammad Saeed al-Sahhaf) claim Iraq was winning the war as American tanks rolled into shot behind him at Baghdad Airport.

Perhaps Ambulance Trust spokesmen would be more worthy of respect if they were honest about their situation. They have nowhere near the resources required to provide an effective service and all the measures currently being considered are simply a desperate attempt to squeeze more out of a woefully inadequate system. This will do little to stem the tide, but will increasingly abuse the workforce who are already labouring in medieval conditions. The Board should be standing together with patients and road staff and planting the problem firmly at the door of the government who insist on dangerous budget cuts and dubious arbitrary targets.

But instead, they want to be seen as the people who can deliver the impossible and will farcically continue to claim they “don’t see the problem.”

Their arrogance is ruining lives.

Addendum:

I have now obtained a copy of this week’s Welwyn Hatfield Times, for which I was asked to supply an article. Sadly, my submission didn’t make it to print, although a few quotes (most of which I don’t recall writing) did. To say I’ve been heavily paraphrased is an understatement, but I’m not great at writing short newspaper-sized pieces. I may publish my original submission later this week.

What is more relevant to this blogpost are the quotes from an ambulance service spokesman. It is a perfect example of the distorted tripe that EEAST pumps out to explain the sorry state of their organisation.

“We are all aware that paramedics, firefighters and police officers often work under pressure and work hard in the communities they serve, however our staff are only assigned to another call when they have informed the control room they are ready and available and we have robust break and rest policies in place to ensure they get the recuperation they need.”

TRANSLATION: Other emergency/essential services are also having a hard time at the moment, so why should we treat our staff any better? Ambulance crews are hounded out of hospitals and steps are often taken to prevent them from taking the opportunity for respite whilst there. The “robust break and rest policies” will see a crew get the opportunity for a single 30 minute period over 12 or more hours of otherwise constant work. Hardly “the recuperation they need”, more like the barest minimum so the Trust can claim to have fulfilled any legal obligation. Thank goodness for those Employment Law exemptions.

“If there are any individual issues then we would urge those concerned to speak to their line manager in the first instance so they can be properly resolved.”

TRANSLATION: We’re getting very concerned that the public are starting to hear about the realities facing the ambulance service and our propaganda is getting ignored in favour of the truth. Please keep it in-house so we can continue to hide our ineffectiveness from the public. Also please consider this a thinly veiled threat, as we would like to perpetuate the culture of fear that has kept you all quiet so far.

“We are also recruiting more frontline staff to help improve patient care and support staff.”

TRANSLATION: You’ll notice we didn’t use the word “paramedic” as we can’t afford any more of those, but we’re very proud to be sending hundreds of individuals out to do exactly the same job with almost none of the necessary skills and knowledge. They won’t be able to do much in terms of clinical patient care, but at least we’ve acknowledged that it’s something we need to improve, even if we’re not providing the means to do so. If it’s any consolation, we’ve saved a few bob.

I feel sorry for the people who are paid to write this kind of misleading rubbish. Not only are they selling their own colleagues down the river, they are covering up for the many sins of their superiors. Of course, it is possible that they actually believe what they write, but then they’re probably not frontline staff so don’t know any better.

Either that or Comical Ali has found a new job.