It's pretty obvious that delays in handover result in longer wait times for people, plus further deterioration of patients waiting on a trolley. My mother died alone waiting for an ambulance in 2015. They did not keep her on the phone, I heard she'd phoned twice. I wrote asking to listen to the call(s) but they denied me. A first responder was first on the scene but my mum was either dead or unconcious and he could not gain entry so police then called to break down the door. She was pronounced dead in hospital. Although coming up to 9 years next month, her dying alone still haunts me today.
No, it doesn't. I'm sad/angry that she didn't phone me or my brother as when we had the door replaced after it was boarded up for 3 weeks, it was obvious on entry, how things left, and her attire handed to me at the hospital, that her normal routine had been disrupted for at least a couple of hours. She probably thought it may go away, rather than something serious. The only blessing is that she went they way she wanted, rather than be incapacited in a nursing home. Two days earlier when I visited, she was up the step ladders, cleaning the top of her cupboards, not bad for an 87 year old!
Nursing homes are actually not that bad - well, many of them are pretty good. Now, imagine that you had a stroke or dementia, and did not have a child willing or able to provide you with round the clock care? Of course, you might be lucky and afford a live in carer (almost always from some other country) but if you wanted 24/7 support, this would cost around £160,000 per annum, and the quality might be rather variable - often a rather bored low-skilled person who spends more time on their phone than wiping your bum.
Nursing homes vary a lot in quality and cost, but do not dismiss them all out of hand.
I agree Rob, they have a very important role to play in both elderly and other care provision. I have many years experience working in what used to be called Part 3 accommodation - public funded care and also working in the private sector. My comment was purely in the context of the Convid situation where some nursing homes provided helpless residents less care, hydration and humane treatment than a Rule 43 prisoner.
Not living in England, I can only offer personal and therefore anecdotal 'evidence' of deteriorating ambulance services. Living close to two main routes to the huge University Hospitals, before lockdowns I could hear ambulance sirens rushing to and fro. Now: not a peep. No, the streets haven't vanished. If what happened to me is what is going on across the Welsh Capital, then the answer is: people are told by the nice triage nurses answering 111 calls that they should go by private car or taxi unless they are prepared to wait for three, four hours for an ambulance.
Meanwhile - and I suspect this is happening across England as well - the local MSM are no longer publishing stories about people having to wait for ambulances, therefore, that problem clearly can't exist any longer.
Not just 111. When we call to request an ambulance for a patient the ambulance service now have a similar standard advisory sentence. I can't remember the exact wording but something along the lines of 'high demand response times can mean up to 4 hours delay so if the patient may want to consider alternative forms of transport'. They also advise that if the patient's condition deteriorates we should ring back.
The fact of us requesting an ambulance generally means we have already considered alternatives as unsuitable or unavailable. Try calling paramedics or technician crews 'ambulance drivers' and you will soon learn the distinction between their service and alternatives!
It was only recently I realised members of the public receive the same advisory about delays even when they ring a '999' (category 1) ambulance. Imagine sitting at home alone in a rural setting with crushing chest pain, ringing 999 and being advised an ambulance has been requested but might take over an hour due to high demand on services - terrifying. Where we live this sort of advice has unexpected consequences, as some decide not to risk the wait and drive themselves to hospital with their crushing chest pain.
yes; and many more cancers; and many cancers that are of very rapid onset; (some call them turbocancers); and rise in excess death rates; and seemingly more strokes and heart attacks; doctors are of course baffled;
Money wasted on administration doesn't surprise me,but on a purely practical level I am amazed at the waste of resources. Each patient who waits on a trolley to be admitted is accompanied by two ambulance officers for the entire wait,in my mother's case around 5 hrs.
The Budget announced an increase of funding to the tune of £22bn. I would like to know (1) how much of this will be consumed by the recent (exorbitant) pay rises for junior doctors and (2) how much will go to writing down the deficits as, for example, those seen in this post.
I can only speculate that Tom‘s news may be quite terrifying. Three weeks ago, my 89 year old uncle waited 14 hours for an ambulance/1st responder after a fall in Norfolk. He lives independently with his 87-year-old wife who managed to drag him off to the floor on her knees and push him into an armchair. He managed to sleep whilst she kept checking he wasn’t dead - she stayed awake all night waiting for the ambulance and it materialised he had fractured two bones at the base of his spine.
I encouraged her to complain and she refused - she said the NHS works so hard! My uncle has been housebound for two years yet my auntie has only recently given up driving. They are both still totally with it. Surprisingly, or maybe not…… there has been a steady stream of people coming to their home over the last 2 to 3 years to make sure they have all their vaccinations, Covid ( several), shingles, ( 2 each I think) RSV, and of course, ubiquitous flu (3 each) and on it goes…….. Despite it all they refuse to die!
Perhaps at a minimum, Rachel should have asked the two old geezers for their data. Do you think she knows about you? It is a scary world out there when the real world data is ignored.
To put some of this data into context, the number of NHS (consultant lead) beds has halved over the past 30 years while spending increased from £131 billion in 2010 to £185 billion in 2023. Demand for services fell during the pandemic but has now returned to pre-pandemic levels. There were just over 13 million calls for an ambulance in 2023, which is an increase of about 20% since 2019
The costs of the ambulance service can vary. For instance, I think the London Ambulance Service serves a population of approximately 8.6 million with 3287 'professionally qualified clinical staff' (about 40 per 100,000) costing about £690 million or roughly £80 per person.
South Western serves 5.8 million with, 2559 clinical staff (44 per 100,000) costing about £400 million or roughly £70 each. Similarly, the West Midlands serves about 5.6 million with, 2836 clinical staff (50 per 100,000) costing about £400 million or very roughly £70 each.
The increased demand for the service coupled with significantly reduced hospital backup has provoked a crisis in morale as employees increasing suffer from poor mental health caused by inconvenient shift patterns and unpredictable late finishes, work intensification, and lack of control and autonomy.
In my opinion, the substantial budgetary increase over recent years has not addressed the increased demand for emergency services. The hospital bed reduction has provoked a crisis and ambulance services are struggling.
Some years ago a colleague(GP) was asked to undertake a multidisciplinary investigation into emergency care. One module involved the ambulance service. Everyone was dumbfounded to hear that all 999 calls have to be attended, irrespective of the clinical need. I don't think this applies today ,having recently contacted the ambulance service their call handling is most protracted. They now include" in the next 2 hours a nurse will contact you to assess the need for an ambulance"
I have sympathy with the service as their performance is dictated by the bottleneck at A+E but this has gone on since the mid 90's.
Management has failed to overcome theproblems of the whole NHS, in other words if reduced in number their loss wouldn't be noticed
as a retired NHS manager, I can only comment on my own experiences.
In 1985 I was given responsibility as an administrator on a salary of £7400 per annum for a north western learning disability unit for young people.
I borrowed a computer and started to examine our metrics. I was puzzled that we only had 94% bed occupancy, and started to look into it.
It turned out that our long-stay beds had 100% occupancy, and our very expensive respite beds had only 33% occupancy.
WHY? I asked myself?
Well, they were not being promoted very well to families, and also, most families did not actually want respite during the week, only at peak holiday times, because their children were at school.
Also, the staff had zero incentive to encourage uptake - as they enjoyed an easy life.
Solutions?
I'll hand that to the wisdom of the crowd .. suggestions below, please.
Paramedic staff care (who are on the front line) often overlooked (as mentioned above). Shift work, very stressful days - hours of boredom/hours of emergencies, terrified and therefore very complex patients in your face, poor diet (related to shift work) & health, burnout often. I'm imagining fire and police have similar problems but individual healthcare is a further step up the stress levels?
talk to ambulance staff; some thrive on the work; some don't; those that thrive are not callous; they just do a good job and perhaps can be said to enjoy the excitement; those that get stressed move on; ambulance services have traditionally offered "volunteer" roles; so prospective folks can ride and see if it is for them;
"I'm imagining fire and police have similar problems"; friends explained to me years ago that fire services are active for perhaps 5% of the working day; in contrast, ambulances may run continuously; (which is why some comment that EV ambulances may be problematic, as a diesel truck can be refilled in minutes:)
Where I work in a rural setting we are 1h from the nearest A and E and 3h from the nearest acute hospital.If they anticipate delayed response for emergency calls we have an in-hours 'dual response' informal arrangement whereby the ambulance service rings the GP and asks if anyone is available to attend the scene until the ambulance arrives. It is a mixed bag - we can be called to seizures, strokes, myocardial infarctions, cardiac arrests, road traffic accidents, overdoses. They are often not even our patients, especially the road accidents.
There is no funding for this work, but also if we are not able to attend we have no contractual obligation to attend. We mostly do attend through goodwill because it is our community. We don't have the skills or training of the paramedics but have some use. It does also mean for quite a good working relationship with the local paramedics, and it helps that we often attend the same type of emergency care update courses, so have practiced scenarios together. Previously these dual response requests were infrequent but they are becoming far more common. That is a worry, with the various recruitment/retention/financial pressures on GP.
West Midland had a reputation throughout the 80s and 90s I understand as an innovative and well-regarded service; it still seems to be showing that; albeit having only 40% of staff as crews; when a CEO took over London ambulance back in the 90s, he with knowing irony, said they offered a "same-day service"; ...... ok for your drycleaning .. I understand a P Bradley did good work in improving services there after this CEO; PB was CEO but had come up "through the ranks"
"number of ambulance staff employed, .. 40.5% in the West Midlands Ambulance Trust"
what they seems to be saying is 40% of employees are ambulance staff: by that I mean emergency and elective movement staff;
that seems extraordinary; 40 yrs ago, one would guess 90+% were road crews; one can only call it bloat; bloat grows; some have been saying for years; in the future, you will get less; and it will cost you much, much more; when will it all fall over
“Tom is not, by nature, suspicious, but the evidence from this series points to one answer that Tom does not like at all. Not to ruin your day, Tom will keep it for himself—for now”
I am intrigued…..
Incompetence? Politicians too cowardly to change the NHS drastically? 42?
It's pretty obvious that delays in handover result in longer wait times for people, plus further deterioration of patients waiting on a trolley. My mother died alone waiting for an ambulance in 2015. They did not keep her on the phone, I heard she'd phoned twice. I wrote asking to listen to the call(s) but they denied me. A first responder was first on the scene but my mum was either dead or unconcious and he could not gain entry so police then called to break down the door. She was pronounced dead in hospital. Although coming up to 9 years next month, her dying alone still haunts me today.
I’m so sorry I lost my mother in similar circumstances. The pain never goes away.
No, it doesn't. I'm sad/angry that she didn't phone me or my brother as when we had the door replaced after it was boarded up for 3 weeks, it was obvious on entry, how things left, and her attire handed to me at the hospital, that her normal routine had been disrupted for at least a couple of hours. She probably thought it may go away, rather than something serious. The only blessing is that she went they way she wanted, rather than be incapacited in a nursing home. Two days earlier when I visited, she was up the step ladders, cleaning the top of her cupboards, not bad for an 87 year old!
Bless her as you say - small mercies that she wasn’t sentenced to a ‘nursing home’.
Nursing homes are actually not that bad - well, many of them are pretty good. Now, imagine that you had a stroke or dementia, and did not have a child willing or able to provide you with round the clock care? Of course, you might be lucky and afford a live in carer (almost always from some other country) but if you wanted 24/7 support, this would cost around £160,000 per annum, and the quality might be rather variable - often a rather bored low-skilled person who spends more time on their phone than wiping your bum.
Nursing homes vary a lot in quality and cost, but do not dismiss them all out of hand.
I agree Rob, they have a very important role to play in both elderly and other care provision. I have many years experience working in what used to be called Part 3 accommodation - public funded care and also working in the private sector. My comment was purely in the context of the Convid situation where some nursing homes provided helpless residents less care, hydration and humane treatment than a Rule 43 prisoner.
Not living in England, I can only offer personal and therefore anecdotal 'evidence' of deteriorating ambulance services. Living close to two main routes to the huge University Hospitals, before lockdowns I could hear ambulance sirens rushing to and fro. Now: not a peep. No, the streets haven't vanished. If what happened to me is what is going on across the Welsh Capital, then the answer is: people are told by the nice triage nurses answering 111 calls that they should go by private car or taxi unless they are prepared to wait for three, four hours for an ambulance.
Meanwhile - and I suspect this is happening across England as well - the local MSM are no longer publishing stories about people having to wait for ambulances, therefore, that problem clearly can't exist any longer.
See how easy it all is?
Not just 111. When we call to request an ambulance for a patient the ambulance service now have a similar standard advisory sentence. I can't remember the exact wording but something along the lines of 'high demand response times can mean up to 4 hours delay so if the patient may want to consider alternative forms of transport'. They also advise that if the patient's condition deteriorates we should ring back.
The fact of us requesting an ambulance generally means we have already considered alternatives as unsuitable or unavailable. Try calling paramedics or technician crews 'ambulance drivers' and you will soon learn the distinction between their service and alternatives!
It was only recently I realised members of the public receive the same advisory about delays even when they ring a '999' (category 1) ambulance. Imagine sitting at home alone in a rural setting with crushing chest pain, ringing 999 and being advised an ambulance has been requested but might take over an hour due to high demand on services - terrifying. Where we live this sort of advice has unexpected consequences, as some decide not to risk the wait and drive themselves to hospital with their crushing chest pain.
Where I live, there is a huge increase in blue light ambulances, since 2021.
yes; and many more cancers; and many cancers that are of very rapid onset; (some call them turbocancers); and rise in excess death rates; and seemingly more strokes and heart attacks; doctors are of course baffled;
Money wasted on administration doesn't surprise me,but on a purely practical level I am amazed at the waste of resources. Each patient who waits on a trolley to be admitted is accompanied by two ambulance officers for the entire wait,in my mother's case around 5 hrs.
The Budget announced an increase of funding to the tune of £22bn. I would like to know (1) how much of this will be consumed by the recent (exorbitant) pay rises for junior doctors and (2) how much will go to writing down the deficits as, for example, those seen in this post.
Latest calculation, according to the MSM, is approx £16.5bn paying off previous salary promises.
I can only speculate that Tom‘s news may be quite terrifying. Three weeks ago, my 89 year old uncle waited 14 hours for an ambulance/1st responder after a fall in Norfolk. He lives independently with his 87-year-old wife who managed to drag him off to the floor on her knees and push him into an armchair. He managed to sleep whilst she kept checking he wasn’t dead - she stayed awake all night waiting for the ambulance and it materialised he had fractured two bones at the base of his spine.
I encouraged her to complain and she refused - she said the NHS works so hard! My uncle has been housebound for two years yet my auntie has only recently given up driving. They are both still totally with it. Surprisingly, or maybe not…… there has been a steady stream of people coming to their home over the last 2 to 3 years to make sure they have all their vaccinations, Covid ( several), shingles, ( 2 each I think) RSV, and of course, ubiquitous flu (3 each) and on it goes…….. Despite it all they refuse to die!
Perhaps at a minimum, Rachel should have asked the two old geezers for their data. Do you think she knows about you? It is a scary world out there when the real world data is ignored.
To put some of this data into context, the number of NHS (consultant lead) beds has halved over the past 30 years while spending increased from £131 billion in 2010 to £185 billion in 2023. Demand for services fell during the pandemic but has now returned to pre-pandemic levels. There were just over 13 million calls for an ambulance in 2023, which is an increase of about 20% since 2019
https://www.kingsfund.org.uk/insight-and-analysis/data-and-charts/key-facts-figures-nhs
The costs of the ambulance service can vary. For instance, I think the London Ambulance Service serves a population of approximately 8.6 million with 3287 'professionally qualified clinical staff' (about 40 per 100,000) costing about £690 million or roughly £80 per person.
South Western serves 5.8 million with, 2559 clinical staff (44 per 100,000) costing about £400 million or roughly £70 each. Similarly, the West Midlands serves about 5.6 million with, 2836 clinical staff (50 per 100,000) costing about £400 million or very roughly £70 each.
The increased demand for the service coupled with significantly reduced hospital backup has provoked a crisis in morale as employees increasing suffer from poor mental health caused by inconvenient shift patterns and unpredictable late finishes, work intensification, and lack of control and autonomy.
In my opinion, the substantial budgetary increase over recent years has not addressed the increased demand for emergency services. The hospital bed reduction has provoked a crisis and ambulance services are struggling.
Some years ago a colleague(GP) was asked to undertake a multidisciplinary investigation into emergency care. One module involved the ambulance service. Everyone was dumbfounded to hear that all 999 calls have to be attended, irrespective of the clinical need. I don't think this applies today ,having recently contacted the ambulance service their call handling is most protracted. They now include" in the next 2 hours a nurse will contact you to assess the need for an ambulance"
I have sympathy with the service as their performance is dictated by the bottleneck at A+E but this has gone on since the mid 90's.
Management has failed to overcome theproblems of the whole NHS, in other words if reduced in number their loss wouldn't be noticed
as a retired NHS manager, I can only comment on my own experiences.
In 1985 I was given responsibility as an administrator on a salary of £7400 per annum for a north western learning disability unit for young people.
I borrowed a computer and started to examine our metrics. I was puzzled that we only had 94% bed occupancy, and started to look into it.
It turned out that our long-stay beds had 100% occupancy, and our very expensive respite beds had only 33% occupancy.
WHY? I asked myself?
Well, they were not being promoted very well to families, and also, most families did not actually want respite during the week, only at peak holiday times, because their children were at school.
Also, the staff had zero incentive to encourage uptake - as they enjoyed an easy life.
Solutions?
I'll hand that to the wisdom of the crowd .. suggestions below, please.
Paramedic staff care (who are on the front line) often overlooked (as mentioned above). Shift work, very stressful days - hours of boredom/hours of emergencies, terrified and therefore very complex patients in your face, poor diet (related to shift work) & health, burnout often. I'm imagining fire and police have similar problems but individual healthcare is a further step up the stress levels?
talk to ambulance staff; some thrive on the work; some don't; those that thrive are not callous; they just do a good job and perhaps can be said to enjoy the excitement; those that get stressed move on; ambulance services have traditionally offered "volunteer" roles; so prospective folks can ride and see if it is for them;
"I'm imagining fire and police have similar problems"; friends explained to me years ago that fire services are active for perhaps 5% of the working day; in contrast, ambulances may run continuously; (which is why some comment that EV ambulances may be problematic, as a diesel truck can be refilled in minutes:)
Where I work in a rural setting we are 1h from the nearest A and E and 3h from the nearest acute hospital.If they anticipate delayed response for emergency calls we have an in-hours 'dual response' informal arrangement whereby the ambulance service rings the GP and asks if anyone is available to attend the scene until the ambulance arrives. It is a mixed bag - we can be called to seizures, strokes, myocardial infarctions, cardiac arrests, road traffic accidents, overdoses. They are often not even our patients, especially the road accidents.
There is no funding for this work, but also if we are not able to attend we have no contractual obligation to attend. We mostly do attend through goodwill because it is our community. We don't have the skills or training of the paramedics but have some use. It does also mean for quite a good working relationship with the local paramedics, and it helps that we often attend the same type of emergency care update courses, so have practiced scenarios together. Previously these dual response requests were infrequent but they are becoming far more common. That is a worry, with the various recruitment/retention/financial pressures on GP.
West Midland had a reputation throughout the 80s and 90s I understand as an innovative and well-regarded service; it still seems to be showing that; albeit having only 40% of staff as crews; when a CEO took over London ambulance back in the 90s, he with knowing irony, said they offered a "same-day service"; ...... ok for your drycleaning .. I understand a P Bradley did good work in improving services there after this CEO; PB was CEO but had come up "through the ranks"
"number of ambulance staff employed, .. 40.5% in the West Midlands Ambulance Trust"
what they seems to be saying is 40% of employees are ambulance staff: by that I mean emergency and elective movement staff;
that seems extraordinary; 40 yrs ago, one would guess 90+% were road crews; one can only call it bloat; bloat grows; some have been saying for years; in the future, you will get less; and it will cost you much, much more; when will it all fall over
“Tom is not, by nature, suspicious, but the evidence from this series points to one answer that Tom does not like at all. Not to ruin your day, Tom will keep it for himself—for now”
I am intrigued…..
Incompetence? Politicians too cowardly to change the NHS drastically? 42?