Do people realise how bad the Ambulance service is right now?

Soldato
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Shropshire
Conjoin the Chinese virus, "long" Chinese virus, the age old staple, bad backs and useful imaginings of "mental health issues" and the feckless, NHS staff and patients alike, are having a paid for bonanza of idleness.

On top of which GP's are discussing threatening strike action unless they get even less working hours....

I am not entirely sure what a real live GP looks like any more, as they now seem to be a very reticent species, approachable only after the long vetting of your needs, and solely by telephone unless one is skilled at cajoling and threatening them into a markedly reluctant personal appearance.
 
Soldato
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Yes he is and its thinking like this which will end up with the service being privatised to win a trade deal with the USA. I privatised NHS will allow for a massive increase in wages. We will then be able to tempt staff from the USA.

It may well be the best thing for the NHS, get rid of the lazy and unnecessary levels of managers, poor outsourcing decisions for over priced services.
 
Associate
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I doubt many, including those of us who work in Ambulance Services, really understand the issues at play but I have a few observations:

1: Demand has increased, though I suspect that staffing numbers have increased too. I don't think it's fair to blame users of the service for the problems. At least not exclusively.
2: Ambulance Services are under greater pressure than ever to treat at scene. When I started over 11 years ago the main focus was on safely transporting patients to hospital. If you were a diabetic having a hypo you quite possibly went to hospital. Now you'll quite likely be treated at home. This is usually great for those patients, and should be recognised as good patient care but it does mean crews spend longer on scene than they used to and may mean that additional staff attend to facilitate treatment the first crew on scene recognise is likely to allow the patient to be left at home but can't administer themselves, thus reducing the nu!bet of available resources.
3: As mentioned turn around times at A/E are longer than they have been. If there are no beds in A/E for patients arriving by ambulance and they're too unwell or vulnerable to wait in the waiting room crews can't free up. There's no space in A/E because there's no beds for the patients in A/E to be moved into and those beds aren't free, in part, because social care is a mess and those requiring it spend longer than clinically necessary in hospitals while it is arranged.
4: Demand and (at least perceived) disinterest and unacceptable delays accessing primary health care either from NHS111/NHS24 or GPs is 'forcing' some to call 999 for things they perhaps wouldn't otherwise call for. This could also be said for social problems too. While these calls don't always generate an ambulance response they do take up service time and resources regardless. This is partly down to a lack of GPS and other primary health care practitioners.
5: A higher percentage of patients are more ill than they perhaps need to be. Whether that's because chronic condition management and routine testing stopped during the early Covid pandemic and therefore problems went unnoticed until they became emergencies or for other reasons I don't know.
6: Staff sickness and retention is a problem. I make roughly the living wage and I have delivered babies, I have talked people through CPR more times than I can count, including on babies and children and in a variety of horrific circumstances. Working overnight at Tesco stacking shelves would be a lot less responsibility and stress for not really that much less money. I know of many people in my service who have left or are actively looking to leave. Vocation or not, there comes a point when enough is enough. I
7: Poverty with its associated poor mental, substance misuse, crime, poor diet and low exercise levels, is also a factor I think. Poor people are really struggling and that affects their health.

I'm not sure how you fix things. Addressing some of these things, or all of them would help I think. It takes money but it also takes a longer term, joined up approach - something government's are poor at. You can't look at any one part of our social matrix in isolation. You can't fix the ambulance service with improving social care, without improving social equality, without improving education etc. It's all connected
 
Soldato
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Privatising will go a long way in deterring them from coming here. Government needs to use the channel crossing as a tool in getting the public to accept privatisation of the NHS.

A private company will shake the NHS up as it needs to be with mass redundancies that governments are usually too afraid to get involved in doing.
 
Associate
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London
I doubt many, including those of us who work in Ambulance Services, really understand the issues at play but I have a few observations:

1: Demand has increased, though I suspect that staffing numbers have increased too. I don't think it's fair to blame users of the service for the problems. At least not exclusively.
2: Ambulance Services are under greater pressure than ever to treat at scene. When I started over 11 years ago the main focus was on safely transporting patients to hospital. If you were a diabetic having a hypo you quite possibly went to hospital. Now you'll quite likely be treated at home. This is usually great for those patients, and should be recognised as good patient care but it does mean crews spend longer on scene than they used to and may mean that additional staff attend to facilitate treatment the first crew on scene recognise is likely to allow the patient to be left at home but can't administer themselves, thus reducing the nu!bet of available resources.
3: As mentioned turn around times at A/E are longer than they have been. If there are no beds in A/E for patients arriving by ambulance and they're too unwell or vulnerable to wait in the waiting room crews can't free up. There's no space in A/E because there's no beds for the patients in A/E to be moved into and those beds aren't free, in part, because social care is a mess and those requiring it spend longer than clinically necessary in hospitals while it is arranged.
4: Demand and (at least perceived) disinterest and unacceptable delays accessing primary health care either from NHS111/NHS24 or GPs is 'forcing' some to call 999 for things they perhaps wouldn't otherwise call for. This could also be said for social problems too. While these calls don't always generate an ambulance response they do take up service time and resources regardless. This is partly down to a lack of GPS and other primary health care practitioners.
5: A higher percentage of patients are more ill than they perhaps need to be. Whether that's because chronic condition management and routine testing stopped during the early Covid pandemic and therefore problems went unnoticed until they became emergencies or for other reasons I don't know.
6: Staff sickness and retention is a problem. I make roughly the living wage and I have delivered babies, I have talked people through CPR more times than I can count, including on babies and children and in a variety of horrific circumstances. Working overnight at Tesco stacking shelves would be a lot less responsibility and stress for not really that much less money. I know of many people in my service who have left or are actively looking to leave. Vocation or not, there comes a point when enough is enough. I
7: Poverty with its associated poor mental, substance misuse, crime, poor diet and low exercise levels, is also a factor I think. Poor people are really struggling and that affects their health.

I'm not sure how you fix things. Addressing some of these things, or all of them would help I think. It takes money but it also takes a longer term, joined up approach - something government's are poor at. You can't look at any one part of our social matrix in isolation. You can't fix the ambulance service with improving social care, without improving social equality, without improving education etc. It's all connected
Just privatise the entire service and let the American insurance companies run it.
 
Associate
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Also privatisation helps in increasing the cost of medicine which then allows for greater profits. A win win...
 
Associate
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Just privatise the entire service and let the American insurance companies run it.
That's certainly a way for governments to abdicate the responsibility for fixing it. I'm my opinion the jury is out on whether, on balance, that's best for patients. Certainly the evidence from America does not convince me its a more user friendly and efficient way of providing care.
 
Soldato
Joined
3 May 2012
Posts
5,406
I doubt many, including those of us who work in Ambulance Services, really understand the issues at play but I have a few observations:

1: Demand has increased, though I suspect that staffing numbers have increased too. I don't think it's fair to blame users of the service for the problems. At least not exclusively.
2: Ambulance Services are under greater pressure than ever to treat at scene. When I started over 11 years ago the main focus was on safely transporting patients to hospital. If you were a diabetic having a hypo you quite possibly went to hospital. Now you'll quite likely be treated at home. This is usually great for those patients, and should be recognised as good patient care but it does mean crews spend longer on scene than they used to and may mean that additional staff attend to facilitate treatment the first crew on scene recognise is likely to allow the patient to be left at home but can't administer themselves, thus reducing the nu!bet of available resources.
3: As mentioned turn around times at A/E are longer than they have been. If there are no beds in A/E for patients arriving by ambulance and they're too unwell or vulnerable to wait in the waiting room crews can't free up. There's no space in A/E because there's no beds for the patients in A/E to be moved into and those beds aren't free, in part, because social care is a mess and those requiring it spend longer than clinically necessary in hospitals while it is arranged.
4: Demand and (at least perceived) disinterest and unacceptable delays accessing primary health care either from NHS111/NHS24 or GPs is 'forcing' some to call 999 for things they perhaps wouldn't otherwise call for. This could also be said for social problems too. While these calls don't always generate an ambulance response they do take up service time and resources regardless. This is partly down to a lack of GPS and other primary health care practitioners.
5: A higher percentage of patients are more ill than they perhaps need to be. Whether that's because chronic condition management and routine testing stopped during the early Covid pandemic and therefore problems went unnoticed until they became emergencies or for other reasons I don't know.
6: Staff sickness and retention is a problem. I make roughly the living wage and I have delivered babies, I have talked people through CPR more times than I can count, including on babies and children and in a variety of horrific circumstances. Working overnight at Tesco stacking shelves would be a lot less responsibility and stress for not really that much less money. I know of many people in my service who have left or are actively looking to leave. Vocation or not, there comes a point when enough is enough. I
7: Poverty with its associated poor mental, substance misuse, crime, poor diet and low exercise levels, is also a factor I think. Poor people are really struggling and that affects their health.

I'm not sure how you fix things. Addressing some of these things, or all of them would help I think. It takes money but it also takes a longer term, joined up approach - something government's are poor at. You can't look at any one part of our social matrix in isolation. You can't fix the ambulance service with improving social care, without improving social equality, without improving education etc. It's all connected

Sounds like what your saying is the country is just ******.
 
Associate
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And yet they have no funding or programmes to train people in this country to fill those positions.
That's a long term solution. It takes 5 years of medical school to qualify as a doctor, 3 or 4 to qualify as a nurse. Similar for a paramedic. Just training more people, assuming you could find them from the existing UK population is not going to fix the recruitment and retention problem.
 
Caporegime
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That's a long term solution. It takes 5 years of medical school to qualify as a doctor, 3 or 4 to qualify as a nurse. Similar for a paramedic. Just training more people, assuming you could find them from the existing UK population is not going to fix the recruitment and retention problem.

It is indeed long term. Why haven't they been doing it? The NHS has had staffing level issues for a very long time.
 
Caporegime
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It is indeed long term. Why haven't they been doing it? The NHS has had staffing level issues for a very long time.
Everyone wants a quick fix as it's cheaper, makes for good press and you don't want to invest long term for the opposition to look good when they come in. The Government kicks the NHS round every 5 years and has little vision beyond that it feels.

Need more GPs/nurses/hospital doctors etc - it's always import them, never invest in local training. Everyone is replaced with someone cheaper and less skilled - physicians associates, nursing associates. Nursing is broken, as soon as nurses get really experienced they're shuffled off into managerial or nursing specialist roles
 
Soldato
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And yet they have no funding or programmes to train people in this country to fill those positions.

They have budgets, they're just not good at putting front line worker requirements over unnecessary levels of managers, business consultants, project managers, over priced IT solutions etc.
 
Caporegime
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Everyone wants a quick fix as it's cheaper, makes for good press and you don't want to invest long term for the opposition to look good when they come in. The Government kicks the NHS round every 5 years and has little vision beyond that it feels.

Need more GPs/nurses/doctors etc - it's always import them, never invest in local training.

I looked in to retraining as a doctor about 6 or 7 years ago when oil and gas went to pot. I thankfully wasn't made redundant but many were.

50k uni fees, which because I already have a degree I would have to pay annually. Supporting myself throughout so let's say 10k per year. That's before you factor in anyone that might have a family to support.
Then there's the wage hit at the start and a potential posting to a hospital/practice far away. I think I worked out it would probably have cost me about 500k in lost salary alone before I was back on what I was earning. That was fine, I and others I worked with were happy to take that hit but it was the uni fees that were the crippling factor. Because of those costs it just wasn't financially possible.
 
Caporegime
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30,189
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Rutland
I looked in to retraining as a doctor about 6 or 7 years ago when oil and gas went to pot. I thankfully wasn't made redundant but many were.

50k uni fees, which because I already have a degree I would have to pay annually. Supporting myself throughout so let's say 10k per year. That's before you factor in anyone that might have a family to support.
Then there's the wage hit at the start and a potential posting to a hospital/practice far away. I think I worked out it would probably have cost me about 500k in lost salary alone before I was back on what I was earning. That was fine, I and others I worked with were happy to take that hit but it was the uni fees that were the crippling factor. Because of those costs it just wasn't financially possible.
Wasn't it yourself suggesting medics that really cared should be working for minimum wage just the other day?

Now your saying pay is a barrier to entry to medicine? :cry:
 
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