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Insight

The flashing warning light that is our Ambulance Service

In 2013, TV host and journalist Richard Madeley inadvertently sparked a storm of abuse on twitter over the case of 6-week-old Thomas Passant who, it was reported, risked permanent disability when a paramedic crew failed to answer a 999 call because they were on a break. The comments caused a furious debate between the public and paramedics – with even MP Anne Widdecombe getting involved. Just two years later similar stories seem to still be making headlines. In June 2015, a 21 year old woman who was 32 weeks pregnant was left for over an hour for an ambulance that never arrived, after she was badly assaulted by a man believed to be the baby's father. She was eventually taken to hospital by the police after 70 minutes but unfortunately her baby died. The London Ambulance Service issued an apology for an ambulance not reaching her and said the first 999 call, made by a member of the public, had been assessed as a "lower priority call".

So what is going on? In a recent report conducted by the BBC it was found that the ambulance service is near breaking point. With many paramedics having to endure extremely stressful working conditions and very long hours, there has been an exodus of front line staff. Pay bands for paramedics are also a cause for much debate with many feeling that the workload and level of responsibility is not reflected in a paramedic’s Band 5 pay packet. So it’s perhaps no surprise that paramedic recruitment is at an all-time low.

The truth is our ambulance crews are now so overstretched that many have not even been able to take a break in years. When questioned, one paramedic crew admitted to not having taken a break in 4 years. The law requires each paramedic to have at least one full un-interrupted half-hour break per 12-hour shift. Despite the fact that other trained medical staff receive more downtime than this, this minimal requirement is still not being met for paramedics. They are tired, they are overworked and they are stretched both mentally and physically to the extreme.

The ‘Surge Plan’ used by ambulance crews in an emergency is a perfect example of the growing stress on the system. Surge Amber means a small crisis, Surge Red means a serious incident and Surge Purple is for a major incident or catastrophe, for example a terrorist attack. Surge Purple means the whole front line of the London Ambulance team (999 phone operators, drivers and paramedics) are at full stretch. They are asked to work overtime and those on holiday or sick leave are asked to come in. This extreme measure should be reserved for only the most serious of situations. And yet, Surge Purples are now being called regularly. Why? Because, quite simply, the volume of calls is too large to handle. Managers are worried that they will be unable to hit their targets, so they up the emergency level and ambulance crews that were already under pressure are now stretched to near breaking point.

With a record number of 999 calls coming in, and a serious shortage of staff of all grades, surely it’s only a matter of time before more serious negligence cases are reported. The shortfall is nationwide and growing daily:

South West Ambulance Service

36% shortage of paramedics

150 new recruits required

North East Ambulance Service

20% shortage of paramedics

112 new recruits needed

East Midlands

16% shortage of paramedics

112 new recruits needed

South East Coast

16% shortage of paramedics

100 new recruits needed

Many areas are so desperate that they have been relying on the Red Cross and St John’s Ambulance services to plug the gaps. In London, the Ambulance Service has turned to Australia for help, with 200 Australians being recruited at the start of the year and another 800 due in September 2015. But the fact remains that in the event of a national emergency of some kind our current system would be unable to cope.

Public education also has a big role to play in ensuring that our ambulance service is fit for purpose. Between 2013 and 2014, there were 8.47 million calls made to 999. Just over half of these were not classed as urgent. And it’s widely known that a large number of NHS 111 calls are being referred to the ambulance service when they simply don’t need to be. The public should, of course, be able to rely on the fact that an ambulance will be there when they really need one. But surely the key is more education and a pay system that values the skill and professionalism of our paramedics – a tireless workforce that, currently, appears to be performing its duties despite, not because of, the system that employs it.

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