If you’ve had the briefest of scans through this post before actually reading, and seen the ambulance-related photo that I’ve used to break up the body of this piece, I probably know what you’re already thinking.  You’re probably thinking that this is going to be another one of those blog posts telling tales, possibly filled with blood, guts and gore, where I give details of my own personal heroism in the face of overwhelming obstacles but ultimately fail, someone dies, and I leave you with tears rolling down your face, muttering, “I couldn’t do your job”.  Well, you’re safe.  It’s not.  You should know me better than that by now.  It’s one of those other blog posts.  One of the ranty ones, where I go off on one, ad nauseam, about how the NHS is being battered by men in suits.  Another tale about your NHS, and what the pinstriped folk are doing with it.  I’m sorry, but that’s just the way I roll.

Sunday evening saw my new crewmate (possibly a Welsh chap that possibly goes by the unlikely moniker of “Gwyndaf”), and I working from 3pm to midnight(ish).  In the ambulance service, the shift always finishes at “-ish”.  For the record, it was relatively unexciting.  You’ve seen Casualty.  You know the sort of thing.  Running down hospital corridors while wearing florescent jackets, with bleeding people strapped to spinal boards, shouting blood pressures at doctors.  It’s just like that.  Honest.


Just like that?  For those that watch and, heaven forbid, enjoy the aforementioned televisual delight, and it’s subsequent spin-off, Holby City, I’m about to shatter your world.  It’s a right load of bollocks.  Every couple of months you might deal with something that comes close to approaching that level of drama, and when you do you’ll be talking about it with your colleagues for weeks.

In my last post, The Thin Green Line, I waffled on about closing Accident & Emergency departments, ambulances queuing to get in, waiting for beds and other such stuff.  I probably bored you to the point at which you gave up reading before the end.  I don’t really blame you.  Cycling is far more interesting.  What you’re unlikely to have appreciated from my last post, however, is that I was speaking with little actual experience.  Allow me to explain.  For the last five or so years, I’ve been one of those Paramedics that you see sat on his (in my case, obviously) or her own, in a car, in the town centre, while you’re out shopping, going to the bank, or whatever.  A “Billy-No-Mates”, who works alone.  Like James Bond, but in an ill-fitting green uniform manufactured from man-made fibres, and sans vodka Martini and a ciggie (Ian Fleming’s Bond was a chain-smoking alcoholic, in case you haven’t read any).  After five years of your own company, you start drawing faces onto your hand and talking to them, so I have recently made my return to a “proper” ambulance.  It’s only been two weeks, so I’m still talking to my hand, but the psychologists say that this should stop eventually.

Now…where was I?  I’ve gone off topic, and can’t remember.  I’ve been too busy padding this out into a blog post, when the 140-character limit of a tweet on Twitter would probably have sufficed, and have been softening you up for the undoubtedly dull facts and figures that will inevitably come.   Erm…  Oh yes.  The reality of Accident & Emergency departments.  I done gone seen them.  With my own two eyes.

The reality is this.  If you can find somewhere to park your ambulance at A&E, what with all the bloody ambulances in the way, you’ve made significant process in delivering your patient to hospital.  Then comes the queuing-in-the-corridor phase, behind the ambulance crews that arrived before you and are waiting, either in the same phase as yourself or phase three, the already-handed-over-to-the-nursing-staff-but-are-waiting-for-a-bed phase.  Phase two, if you were thinking my numeracy skills were a bit shit, is the hand-over, where you don’t shout blood pressures at doctors and nurses or run down corridors but, instead, calmly and profusely apologise for bringing yet another very drunk almost-teen into A&E.  Phase three has already been explained, and unsurprisingly comes after phase two.  With our final patient on Sunday night, phase three took two hours and thirty-six minutes.

Let’s get things clear, as once again I see myself being taken, hands bound and a hood over my head, into a misty wood by burly men carrying a rope with which to hang me, I’m not having a go at the ambulance services nor the hospitals.  I can only praise the work they do, and will do so until I’m blue in the face which, ironically, is how I would look if they hanged me.  In fact, it isn’t, as my left hand has a face with a very big mouth, through which I will continue to breathe, so the last laugh may be mine depending on how tightly the burly men bound my hands.  Once again, it’s the suits I’m having a go at.

Here’s the facts and figures bit.  The last time I looked, roughly 81% of patients presented at Accident & Emergency departments in England and Wales were seen, treated and discharged, with either a referral to their GP, an outpatients’ appointment, or without any further treatment being required.  That’s millions of patients.  Facts and figures dispensed with, we’re onto the logic bit of it.  The NHS Trust responsible for hospitals in the area in which I work had three hospitals, each with a busy A&E.  The Trust still runs three hospitals, but only one of those still has an A&E.  It now has a busy A&E that’s doing the work of three busy A&Es.  Now, I know as well as anyone old enough to understand the concept of money that running an A&E department costs money.  Equipment, staff, heating, lighting and all that gubbins doesn’t come for free, but the NHS is still paying out for these things when they “downgrade” an A&E to a Minor Injuries Unit.

So is it me?  Is it that I “can’t see the Big Picture” that they’re always talking about, or am I bordering on being a supreme being, with logic that would outwit Mr Spock on one of his best logic days?  I’ve seen The Jeremy Kyle Show so there’s a good argument for my being a supreme being, but I doubt that’s the answer.  Once again, it’s all about saving money.  The NHS saving money, to be precise, and I’m fine with that.  What I’m not fine about is the way they’re saving money.  The cuts, reduction of services, implementation of “care pathways”, etc. is all about saving money in the short-term.  It has nothing to do getting value for money, and it most certainly has fuck all to do with patient care.  I shall give you an example to illustrate my point.  A fictional ambulance service could buy a thousand poorly-made blood glucose measuring machines at a tenner each.  For an extra fifty pence each, they could have a far superior machine that does the same job, but will last twice as long before it breaks and needs replacing.  Now, they’ll buy the cheaper ones, saving five hundred quid.  High-fiving all round.  They’ve saved five hundred quid.  Didn’t they do well?  No.  They didn’t.  Two years later, they’re buying another one thousand machines.  And two years after that, they’re spending again.  It’s all fine though, because they saved five hundred quid each time, didn’t they?

Now, I’m beginning to bore even myself, so I shall leave you with this.  This is, after all, my blog, so I’ll say what I like.  I am a taxpayer and, since it’s supposed to make me a “tight bastard”, I’ll make mention of the fact that I’m also a Yorkshireman.  I give the government plenty of my money, and I’d like them to spend it wisely.  I don’t want short-term savings.  I want value for money.  I would be overjoyed if they’d spend that extra five hundred quid, and explained why they’d spent it.  I’m not an idiot, and I’d understand that, ultimately, it’s good value for money.  The difference is that it’s a sensible, well-reasoned saving, and not one that looks good for Tax Year 2012-13.

Told you I could’ve got this on a tweet.



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