Targets shape future Ambulance Service

Submitted by Anon on 13 December, 2007 - 4:25 Author: Ambulance Worker

Recent reports in the press about Ambulance Trusts sending single handed response cars to emergency calls instead of ambulances came as no surprise to those working in the service. At local level trade unions have warned of the dangers for many years.
The use of ‘rapid response cars’ has become common since the target obsessed government decided that the standard on which to judge and rate ambulance services would be response times, ‘the ORCON target’.
ORCON says if someone calls 999 for a potentially life threatening emergency an ambulance person must arrive within 8 minutes to ‘reach the target.’ In April this target time will be reduced. The clock will start when the ‘call connects’, rather than when the responder is dispatched, as is currently the situation.
From the outside this may seem like a sensible standard to set for ambulance services. If you make a 999 call you want somebody there to help you as quickly as possible. The problem with this single target is that limited resources are organised to tick that box, while forgetting about the rest of the service.
In many cases the time taken to get vital treatment in hospital is the critical factor for patients, but with the single target culture there is no incentive for the Trust to actually get the patient to hospital and the care they need. As long as a car arrives in 8 minutes the job has been successful, no matter if the patient dies waiting around for an ambulance to arrive. Every day Trusts deploy single handed cars to ‘stop the clock’. Everyday ambulance workers are left on their own on scene with critically ill patients and limited ability to do anything to help them.
The 2005 Bradley report commissioned by the government to set the way forward for ambulance services highlighted a related issue that those working in the service have been aware of for years. People make 999 calls to get help in lots of different situations. Often the situation is not a life threatening emergency, sometimes it is used as a way of accessing general health care. The report said that in 70% of cases the patient did not need to go to hospital. This isn’t surprising in the context of reduced out of hours GP services, terrible mental health provision and a medical system which discourages people from understanding anything about their own health. The Bradley report recommended that Ambulance services be changed so that instead of just carting everyone off to an A&E department patients should be assessed and treated at home or referred directly to the relevant department for the care they need. This makes sense in many cases. Most people would prefer to stay at home rather than sitting around in a busy A&E department and ambulance workers would rather get patients the help they need rather than taking them to an A&E unit that isn’t set up to deal with their problem.
However there are two problems with this idea. Firstly to assess and treat someone at home safely you need much more training than most ambulance workers have. New roles are being introduced into the ambulance service but the service is historically bad at giving decent training and back up to workers. This is an NHS on the cheap – after all the job that these people will be doing has traditionally been the role of doctors. Secondly if a car is the standard response to a 999 call what happens if the person does need to be urgently transported to hospital. With limited resources and ORCON running the show this approach is bound to lead to life threatening delays.
Just like all other public services the Ambulance Service needs to have much more money spent on it, so decisions are not being made with vastly inadequate resources. To fight for this and to stand up to the ideology of the government and the managers in the NHS the unions need to put forward ideas about the sort of healthcare we want alongside the campaigns on immediate pay and conditions issues.

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