Changes to health care provision, including the latest ‘Sustainability and Transformation Plan’, usually lead to increased demands on the ambulance service. But few if any increased resources are put in. Stuart Crichton, Assistant Director of Operations at Hanwell ambulance station, tells me that demand has increased greatly over the last 20 years. Staff now do not get any waiting time between jobs.
So ‘deficits’ begin to appear. These ‘deficits’ are due to lack of Government funding, not inefficiency on the part of the ambulance service. The London Ambulance Service (LAS) has been placed in ‘special measures’ following an ‘inadequate’ rating by the Care Quality Commission.
There is a Patients Forum for the LAS to put the patients’ side of the case. It is a lay organisation that has monitored the LAS for 10 years.
It organised a meeting on 11th July 2016 to try to address the problems. Its chair, Malcolm Alexander, has produced a useful report dated 18th May 2016 and addressed to London Clinical Commissioning Groups (CCG’s). It contains proposals to get the LAS out of special measures and “it is aware of the current negotiations regarding funding for the LAS”. This in my view is the crux of the matter. It also notes that “urgent and emergency care services will only radically improve to meet the needs of people in London if the weaknesses of primary care, community health and social care are dealt with”…”The LAS is often forced to take the patient to A&E even though we know this may be the worst option for patients whop have dementia or mental health problems”…”This can amount to a wait of 8-10 hours from 999 call to admission for an elderly vulnerable person”.
Stuart Crichton says that the increased pressure has led to staff morale becoming, in his words, “strained”. Qualified paramedics are in great demand. Urgent Care Centres and the 111 service draw staff out of the LAS. It takes three years to train a paramedic and Stuart acknowledges the need to improve the working environment. Staff shortages have led to the use of about 20 private emergency ambulances per day across London. They are staffed by qualified paramedics (trained by the LAS) though Stuart says the LAS is not losing staff to the private providers. Where do they get their staff then? They cover times of peak demand and unsocial hours. On a recent morning visit to Ealing Hospital I counted three private emergency ambulances on the ramp. LAS do plan to end the use of private ambulances but they do not say how or when. Retaining staff is described as “challenging”.
The LAS are “full partners” in ‘Shaping a Healthier Future’ and the STP. They agree with the process of developing ‘specialised pathways’ and are “satisfied” with the changes to the system. They are not “engaged” (their word) with Healthwatch but would be happy to be involved.
Graeme Crawford observes that the LAS Board seem to be ignoring the financial problems highlighted by the ‘special measures’. They are hoping that GP’s will substitute or help out with situations resulting from ambulance deficiencies. They are relying on increased self-help by patients, friends and family. Ambulances queueing for more than an hour at hospitals has become the norm Graeme says that there is a need to prioritise informed input to Scrutiny Panels and Healthwatch, and to monitor the impact of the closure of the Children’s Ward at Ealing Hospital on ambulances.
Performance figures are available on the LAS website