|
At last…
… the sound of the wailing two-tone and the blue light, lighting up the wintry afternoon sky…
… the ambulance had arrived.
On the way back from her visit to the day centre, Doreen had somehow managed to trip on her door step, fall over her shopping trolley and by the looks of it, broken her hip.
For over an hour neighbours had done their best. A duvet appeared, some cushions. A hot water bottle.
‘Should we give her a drink?’
‘Should we try and move her?’
'Put her in the back of my cab, I'll take her...'
A community nurse, finishing a routine visit opposite, saw the knot of anxious people around the door. Curiosity drew her across the road.
One look told her this would be a Category 2 response from the ambulance service.
She knew they were in for the long-haul.
She also knew, the shock of a fall can cause body temperature to drop. Especially in the cold hallway.
Politely, she fended off a determined neighbour, with offers of a hot drink.
‘She will probably need surgery quickly. Having food or drink in her stomach might complicate anaesthesia.’
The clock was ticking...
... an hour and a half in, Doreen, still wedged against the open door, was becoming confused and seemed to have difficulty breathing. The nurse called 999 again and explained the situation to the dispatcher.
Just as it started to rain, the Ambulance drew up and Doreen was on her way.
Three weeks later the neighbours were at the crematorium. Doreen, their sprightly neighbour, didn’t survive.
There was talk of, ‘suing the bloody NHS’… ’disgusting’, ‘what have we come to?’, ‘no one gives a damn any more’, ‘this isn’t safe…’
Yes, it is ‘disgusting’ and no, ‘it isn’t safe’, and there will be more questions about ‘who cares’ … when the public decode the mumbo-jumbo plan in the making;
'...putting more weight on care quality indicators and less on response time.'
... and realise, in plain English, it can only mean reducing the service level of our ambulance services, even more.
Tier two responses will become Tier 2a and 2b.
The fundamental purpose of an ambulance is simple; arrive quickly, get patients to the right care, quickly.
Anything that slows or limits this, undermines public safety... end of.
Ambulances are the lightening rod, the litmus test, the yardstick and the public's gold-standard measure of NHS performance.
We might wait for an appointment but we can't make an appointment for an ambulance.
Now, means now.
Increasingly, ambulances (about 40%) fix up a patient and never take them to A&E.
Between, 11% and 14.5% calls are resolved over the phone.
Both are key strategies for reducing ‘handover delays’ … the single biggest cause of ambulance unavailability. Fix that and you won't have to fiddle with Tier responses.
Business guru, Russell Ackoff warned about system 'push-back'... when you treat symptoms rather than constraints.
Handover delays are avoided, or, 'pushed back' by turning ambulances into treatment rooms, when we can't solve hospital upstream problems.
There is a row brewing over Trusts treating patients in ambulances. Professional liability. Patients' safety appears to come second.
The prospect to once again, fiddle with response targets, runs the risk of formalising a diminution of service that irrefutably will have long-term consequences for patient outcomes.
Ambulance crews are already stretched to breaking point by; record demand, hospital handover delays and 'see-n-treat' policies, which tie vehicles up and prevent them responding to other emergencies.
Redefining success as something other than speed may sound clinically sophisticated, but in reality it signals that slower responses are acceptable.
A 999 call is a moment of acute need. Fear, desperation. What you might be able to cope with, I might not.
We are all different but we all centre on one thing… when we are scared, at our wit's-end, we trust the NHS to solve our problems.
The day it stops doing that is the day the public wonders; can it trust the NHS.
Lose public confidence and uncertainty ricochets through the service.
Support ebbs away and the incoming tide buoys loss of support, unwillingness to fund it universally.
People look for alternatives. Fragmentation becomes, break-up.
We must have confidence that when we call for help, an ambulance will reach us, in time to cause no harm...
... physically and to the reputation of the NHS.
Any move that compromises this principle is not just a policy change… it’s a step back from the basic contract of trust between the public and our NHS.
If the purpose of the ambulance service is not to give us that peace of mind, then what is it?
The focus should be on supporting and investing in ambulance services to meet demand. Not dodge demand with dodgy policies.
Changing the goalposts on response times is not a solution. It’s managing a quiet acceptance of a declining standard of care.
Redefining ambulance response targets is a classic example of when the measure becomes the target, it ceases to be a reliable indicator of quality, safety or performance.
This is known as Goodhart’s Law...
... when goals are instantiated as metrics and the metrics are the measurement of success…
... and we stop thinking about Doreen.
| 
