UKH

I think the wheels are no longer coming off. They have been filched and it's up on bricks.

All week there have been reports in our local paper of long delays for ambulances, including one where an elderly woman was kept at the side of the road for 6 hours in the rain waiting for an ambulance.

However the cherry on the cake was yesterday's paper when a 999 call was made by a neighbour for a man with chest pains who died before the ambulance reached him THE NEXT DAY!

If anything happens to me I've told my wife to flag down a passing motorist

Sadly, as much as Iike / respect / believe in the NHS, this is my thinking too. I'd rather grab a lift or taxi to hospital rather than call 999 for myself

I know this might also cost me my life

Would it help if we all stood around and clapped for a while ?

Give it a couple of years with this level of service, and don't be surprised if the solution is private investment.  Increase the number of people dying/suffering/inconvenienced because of waiting times, then offer private investment, and people will be more favourable to the concept of privatising a part of the health service.

I gather patients were being told to wait in their cars - alongside the ambulances - in the car park before getting into A&E a few days ago in my local hospital.

Aren't most ambulance services already private businesses but "funded" by the NHS.

Like a lot of NHS services quietly being pushed out to private companies but carefully putting large NHS logos on their signs etc

The ambulance service is up on bricks  it is but party due to the need to discharged passengers into the hospitals,  The backlog is clear to any eyes that get close to a A&E

Thanks for that. I didn't know that. 

PS, when I or my family have had an ambulance in the past, we've had great service from the crews. For which I'm so grateful 

I think they do perform a great service. However it is being stretched to breaking point at the minute

It's the 3rd of November. This winter is going to be bad

I wasn't aware of this, a friend is an EMT on the ambulances, I'll have a chat with them

By complete contrast, the Spanish NHS functions well. I had to attend the " Urgencias " last week at Calpe, and had to wait an hour, due to several road accidents This was by far the longest I have ever waited to be seen in any clinic in Spain.

I realise that is not much comfort to the long-suffering British public.

No. All the ambulance services are wholly NHS, but private companies are creeping in. South East is currently the furthest along this path with around a third of 999 calls getting a private company responding. Typically cat 1 and cat 2 calls still get an NHS crew attending.

If the crew's uniform has an NHS logo, they're an NHS crew. Private company vehicles will sometimes have "NHS" in large letters, adjacent to "working in partnership with" in tiny letters.

 The NHS is being dismembered under our noses with the plan seemingly being to gradually demoralise the staff and degrade the service until the point where nobody will miss it when it's gone.

The ambulance service gets press as the visible point in a failure cascade. Our local 999 service is more than equipped to deal with current demand. Pre-covid it would be expected to see 8-10 patients in a shift. A&E might be rammed but moderately unwell patients would be left in the corridor under supervision of a hospital nurse. It was rubbish and undignified but the machine creaked on. Now if you have a patient who almost certainly has good ole fashioned pneumonia (but potentially could be covid) it's considered, quite reasonably, unacceptable to leave a possible covid patient in a corridor with other sick people so they get held on an ambulance. It's entirely normal to wait 5-8 hours with 1 patient parked up outside a&e. So now it's pretty routine to see 2-3 patients in a shift... But the other 5 people you should have seen are still as sick. There are horror stories of people whose 999 calls go unanswered. The pinch point is a&e departments are massively underfunded, understaffed and have very cautious covid protocols but the visible failure is the ambulance service because they are picking up the slack from a&e. It's all still the NHS so kind of swings and roundabouts but the headlines don't reflect the issues. Basically it's 20% abuse by people misusing services and 80% 13 years of underfunding and hamstringing by a Tory government. 

It's not just the A&E though. Having worked there and on the wards it's the whole system

You can't get patients out of the (underfunded) emergency department until beds become available on the wards. Beds have slowly reduced over the years due to cuts and "efficiency savings". There is a team in the hospital that is dedicated to trying to find free beds, get patients discharged early etc. Of course these people bumped out quickly frequently then get readmitted a few days later, as they weren't fully sorted out, by the same ambulance service that is struggling for capacity. Old people requiring social care are stuck on the wards for weeks and weeks, sometimes months, because social care isn't sufficiently funded (One memorable patient was on a ward awaiting care, and then still there when I returned to the same hospital 2 years later, although it was quite specialised care they were waiting for)

 The whole system backs up until the symptom is ambulances queueing outside, and this is what people notice. This was happening all the time pre-pandemic locally - so much so that they increased the target response time to heart attacks/strokes.  Covid has just exacerbated things.

Father in law, retired ambulance driver for several years, was concerned about the use of private ambulances in Cornwall when he was still working.

I won't go in to details about the private NHS ambulance losing their way while transporting my mum 4 miles to the hospital or their use of taxi firms for what was previously ambulance transport.

Currently in Hartlepool and have been passed by a few ambulances run by private companies (maybe private hospital, but doubt it). 

I agree. It rings true for a lot of other businesses too. Cut back, cut back, cut back. Initially you may well be making savings and increasing efficiencey, I know my area of work had a lot of inefficiencies back in the 70s. However as cash dwindles the savings become starvation to the business and different inefficiencies kcik in, ones where there is no slack in the system. By the time I left we had gone to full on crisis mode but were still required to make annual cuts. It which point "throwing cash" at the problem doesn't work because you've lost all the skills it took years to built up and sold off all the space you need for the extra equipment that would have been useful. You can sell off a building quickly but then it becomes harder to replace it, same for a nurse, a doctor, etc

There are loads of private ambulance companies, I used to work for one when I was a student. They perform a range of duties from covering big festivals like Glastonbury, to smaller events like amateur boxing nights. They then moved into patient transport roles (discharge from hospital, transport for scheduled procedures), Recent years have seen some NHS trusts contracting out lower grade 999 calls but most people just see a big yellow bus and a green uniform and know no difference. The actual difference in training, experience, oversight and clinical support is often enormous. 
Some private crews are highly experienced former NHS with degree level training, many are part timers who’ve done a first aid course. If a member of my family called 999 I’m in absolutely no doubt that I’d want an NHS crew attending.

There will be lots of opportunities for private companies to make money filing in the gaps as a result of the NHS ambulance service being hollowed out, have no fear. Extends to 'charities' too such as St John Ambulance which has great ambitions for expanding its commercial ambulance service to fulfil more and more NHS contracts. Lower standards of competency, higher costs, what's not to like! 

Probably because they look across the channel at their sister organisation in Germany (the Johanitter) who operate 240+ emergency ambulance stations and 5 intensive-care helicopters and are one of Germanies leading suppliers of emergency ambulance care. The standards are the same for all the emergency ambulance services in Germany, private or public.

Quote possibly, I'm sure they would like to be in that position, or as in New Zealand where I believe they are the main ambulance service for most of the country. However, St John Ambulance in England is functionally a completely separate organisation, and although they might claim to reach the same standard as NHS crews at each competency level in reality that's not quite the case here - they meet the same minimum requirements imposed by the CQC, but that's not quite the same as being at the same standard. 

Do you really have that sort of issue with St Johns Ambulance? Its a bit like knocking the RNLI because its a  charity. I suspect most people think you are barking up the wrong tree there.

A very good point, I only see the pinch point between a&e and the ambulance service. Just read a BBC news article saying in my local hospital 25% of patients are totally fit for discharge but have no where to go or no package of care. It's not so much a case of under performance as the NHS over performing and picking up the slack from the decimated social care sector (anyone remember austerity?...) 

Not really.  Non NHS ambulances don’t respond to cat 1 and cat 2 calls. If you’ve no experience of attending stabbings, RTCs, delivering babies, etc, etc, then you can’t be expected to provide the same level of care.

Not an issue perhaps, if you’re just going to cat 3 and cat 4 calls but don’t be kidded into thinking any big yellow taxi is as good as any other, though I’m sure you’re local Tory MP might insist otherwise.

Taken as read.  

Although they do have a long history of being at public events where such incidents occur. 

I don't really have a particular issue with them beyond the same concerns I have about all organisations looking to benefit from expansion of NHS ambulance contracting. My second more specific comment was just in response to a comment about other organisations overseas. SJA in England are just the biggest example of an organisation that is looking to expand its commercial ambulance work that I'm aware of.

It may be a charity, but there are fairly separate charitable and commercial aspects to what it does (eg the paid crew that cover the majority of NHS contracts only rarely come into contact with the volunteers you see at football matches etc and are managed differently), and I don't think they're really comparable to the RNLI in that respect. I do volunteer with them which probably means I'm more aware of that, and not under any illusions about what they offer, or how the organisation is run.

Look, dido has been in charge of NHS improvement for 4 years now!  Are you saying she hasn't made things much better?

And when those incidents do occur can you guess who they call for back up?

You seem to have a gripe with SJA.........

As I said before " taken as read"

Nice one for volunteering with them.

However my comment was relating to remarks implying that if St Johns or the other large charitable organisations ( Red Cross for example) were supplying the ambulance service the quality and skills would be inferior to that of the NHS based on experience with the services they currently provide in the UK. Experience in other countries shows this may not be the case or are you seriously saying that the UK ambulance service is better than the German one for service quality?

I was purely commenting on posters drawing equivalency between U.K. private Vs NHS service provision. Having worked in both I’ve a half decent perspective from which to make such comments.

Nope

I was replying to the "But...."

To me I guess it depends entierly on if they can provide the same level of care and pain relief that the situation requires..

I would have been pretty upset after my motorbike accident if they rocked up and tried to transport me without some serious pain relief (my arm was in 12 different pieces so smarted some what). But equally if I was in my 90s had a tumble at home and just needed help back up I would would grateful to see anyone and not be on the floor for 12+ hours

Surely the paramedic calls in the emergency doctor if he thinks it's nescessary for your wellbeing ( if they aren't already there)?

Under that criteria, probably not. UK paramedics routinely administer morphine while in Germany you’d have to wait for a doctor to rock up.

Franco-German model is different from the Anglo-American. The former is predicated on getting a doctor on scene to stabilise before transport to definitive care, the later leaves it to the paramedics. The reality is not quite so clear cut, but it’s broadly accurate.

It varies because health is a devolved matter, some paramedics can give morphine etc and some have to get authorisation if the doctor isn't on site. Mostly the ones that can have 2 years experience (above the 3 years training) and have extra schooling. They are all trained to give pain relief but it depends on the region which drugs are allowed.

Around here the doctor is often on site before the ambulance crew if the first attender has called them in, they have faster cars! The ones with motorways in their area get snazzy 1250 BMW motorbikes as well.

The broader point, if you really want to compare UK with Germany, is that the Franco-German model heavily relies on having Doctors on scene. This is not a system we have any hope of emulating in the UK, where we haven't even got enough Doctors to staff hospitals and local surgeries.

4.2 doctors per 1000 population in Spain. 3 per 1000 here. 
our healthcare spending and staff numbers per 1000 population have been slipping for 10+ year c/W our own historical data and with our OECD peers. 
As a result our healthcare system is getting worse compared to what we are used to and compared to other countries.

No surprises and entirely predictable. Whether by design or by general government incapability is another question