Options (or ‘When I Became Instantly Unpopular’)

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This post will be unpopular amongst many cyclists.  And I don’t care.

London, in recent weeks, has been at the forefront of cycling-related Twitterings.  A number of terribly tragic deaths has had cyclists on the social media website screaming from every corner of the country about road safety in the capital, inequality between road users, Boris bloody Johnson, buses and, in particular, HGVs.

Comments range from the still-a-long-way-from-sublime to the utterly ridiculous.  Blame, by the online cycling community, at least, is hurled at everyone but the injured/deceased cyclist, but are they really entirely without some degree of blame?

Road Traffic Accidents are, in emergency services parlance, no longer called ‘accidents’.  They’re called ‘collisions’.  The reason behind this was that, regardless of intent, at least one party to the incident did something that resulted in a collision.  In studying these incidents more closely, it was found that, in almost every single case, more than one of the parties involved acted in a manner that contributed to the crash.  There exists degrees of culpability, but few are solely the fault of just one individual.

Few places demonstrate this better than the British motorway.  The unwitting three-in-a-bed, where C is in lane three, overtaking B in lane two, who is likewise overtaking A in lane one.  All at the same time.  Few experienced drivers will have ever considered the utter stupidity of such actions.  It’s normal, acceptable, safe every day motorway driving, isn’t it?  Normal and acceptable, yes.  Safe, not even close.  In the event of an incident where avoiding action may need to be taken, Drivers B and C have, by their actions, reduced their options by a third.  33.3%.  Accelerate or brake.  They do have new third, of course, but who deliberately crashes?

Cyclists aren’t allowed to ride bicycles on the motorway, so what’s my point?

It’s this.  Driving standards are poor in this country.  And so are cycling standards.  Systematic use of careful observation, early anticipation and planning, and the constant and consistent reassessment of such are huge factors is the staying alive process.  If cyclists in big cities were to think just what they’re doing, they would never, ever ride down the nearside of a stationary bus or lorry.  Think about it.  You can’t out-run it, and you’ve a whole truck to come past before braking is going to save you.  The railings on your left that you thought would be nice to hold on to, and save you taking a foot from your Keos, is the thing that’s taken away your only escape route.  All that’s left is to go under the wheels of the lorry that, through no fault of the driver who’s blind spot you’ve never been out of, kills you.

So, here’s a quid’s worth of free advice.  Up your game.  Observation is everything you can see, not just the next fifty or one hundred metres.  Never stop looking, never stop evaluating.  Everything is a hazard and, therefore, potentially dangerous, until proven otherwise. Think of it like this: reducing your culpability makes you safer (and, if things do go wrong, richer…although I’d prefer legs to a bulging bank balance).

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Give yourself options, and never, ever EVER cut off your escape routes.

STANDING IN CORRIDORS

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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.

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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.

The Thin Green Line

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There are few things in life about which I can speak (or write) with any kind of authority, and cycling certainly isn’t one of them.  Neither, for that matter is politics, nor the subject of this post: the current failings of the National Health Service.

To be fair, that’s a little bit unfair.  The NHS is not failing.  Given the kicking the NHS receives on a almost daily basis by the men in suits that control the money, it’s an absolute miracle that the UK has a health service at all.  Despite terrible funding cuts (or, no less difficult to manage, insufficient funding increases), inappropriate decisions made by people that have little idea what planet they’re on, and the ridiculous notion that healthcare is a profit-making scheme, the NHS still makes sick people well, and does so with dignity, professionalism and compassion.  I work for the NHS.  I’m one of those chaps in green outfits, as seen on Casualty.  No…not Jimmy the Porter…more like Josh Griffiths, but good-looking and with hair.  I’m frequently told, “Oh, I couldn’t do your job”, which clearly means I’m made of tougher stuff than some of you.  This, in turn, means that I could duff you up in a fight and, therefore, unless you wish to find your nose bloodied you should stop what you’re doing and pay attention.  This is your NHS, and like the punch-drunk boxer struggling to stay standing, it’ll only be a matter of time before a suited politician comes along to put it out of its misery.

Earlier in this post, I told a lie.  It was unintentional, but a lie nevertheless.  This isn’t about the failings of the NHS per se, but a small part of it.  In fact, that’s probably a little inaccurate, too.  This post is about inadequacies, not failings, yet such inadequacy will invariably lead to failure for the unfortunate minority.  Sadly, such failure doesn’t mean that a business folds, a shop closes, or someone has to go back to working on the bins.  Without being even slightly melodramatic, it means people die.  Actual proper death.  Gone.  Brown bread.  It could be you, your mum or dad, your wife or husband, brother, sister, girlfriend, boyfriend, etc.  I think you probably get the picture without me listing all possible relationship statuses.  Dead.   To your terrible sorrow is now added bucketsful of anger.  You watch, helpless to save your loved one dying, still waiting for the ambulance three hours after you called.

Ambulance delays are now an everyday occurrence.  Fact.  Lengthy delays.  Life-threatening delays.

There are always occasions when delays are inevitable.  Ambulance services are not immune to bad weather, heavy traffic, or the overwhelming desire of the general public to get pissed, then have a fight on New Year’s Eve.  Heavy snow can turn a six-mile journey into a three-hour affair, but this isn’t the shit I’m talking about.  I’m talking about your average day.  A Tuesday, perhaps, because nothing of note ever happens on Tuesday.  On every single average day, many lengthy delays can and do occur.

 

Bad weather won't stop these babies.

Bad weather won’t stop these babies.

 

By now, an Ambulance Service manager, hot under the collar and fuming at my words, may be preparing to lynch me.  That’s fine, but I suggest that he or she reads on first.  I have a point to make before I swing.  The point is that such terrible delays are not our fault.  On paper, provision of ambulance cover is just about adequate.  In practice, it would be equally be just about adequate were it not for closing Accident and Emergency departments, false or shelved promises of new super-hospitals, reductions in hospital beds, forced redundancies of hospital staff, and a whole host of other problems created purely by penny-pinching, blinkered civil servants, keen to make a saving that ultimately ensures their job security in the next reshuffle.  The city in which I work does not have an A&E department, and hasn’t had one for over ten years.  In the last two years, the towns on either side have also lost their A&E departments.  The super-hospital that was promised prior to closing those A&E departments is invisible or, more probably, unbuilt.  So where do ambulance patients go now?  Very simply, they go to an Accident & Emergency department.  An Accident & Emergency department that can not, for very obviously-logical reasons, cope with the additional influx of the sick, dying and dead.  An Accident and Emergency department in a hospital that has had the number of beds, nurses and doctors reduced.  An Accident & Emergency department that has ambulances queuing for hours outside it’s doors.  The ambulance simply pushes the first domino, and they just keep on falling.

If you’re expecting me to have the answers to all these problems, you’ll be disappointed.  Clearly, running the NHS as if it were a business, rather than as a publicly-funded healthcare-providing service, doesn’t work.  Beyond massive cash injections, restoration (or an increase) of the pre-existing healthcare provision, u-turns in political policy, careful and considered spending, and people having the balls to admit that not all the implemented changes work, I fail to see how or when the NHS can pull itself away from the ropes and come out fighting.