After seemingly years of grappling with the problem the Wales Government is no nearer to having a fit for purpose service. This latest episode illustrates the lies that their management feed the pbulic (see the press report on some suit being questionned by the Coroner)
www.bbc.co.uk/news/uk-wales-north-east-wales-25777574
There was a clip on yesterday's news of some Ambulance technician (as they called him) turning up at the inquest in an ill-fitting, if rather snug, green overall. He now denies telling the Police at the home that if they'd managed to roll up sooner the person who died could have been saved.
The guy's shambolic turn out is a metaphor for a seemingly shambolic service. These guys need sorting out.
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Transcript of Mrs Pring's last (of 4) calls to the ambulance service, at the bottom of the article:
www.dailymail.co.uk/news/article-2540838/Womans-desperate-999-call-husband-ill-died.html
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Ambulance service or hospital?
If they're waiting at the Maelor then presumably that's because the hospital won't take the patient?
Inevitably one's heart goes out to the widow but outlook for COPD patients is rarely good.
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Of some of the problems with the modern ambulance service..
.......one is, as in this case, being queued up at hospitals for hours on end, because hospitals can't take patients...which isn't really the fault of the ambulance service.
Another is a culture that has crept in of not going to some calls without support (either extra ambulance staff or police) because of either the nature of the venue (e.g. busy pub) or previous history kept on file (e.g. previously abusive patient).
The trouble is, the worries about the venue can easily be over sensitive perceptions.. and.. previous history can be out of date, over egged, etc.
There doesn't seem, at times, to be a 'can do' mentality any more...I wonder if the worker bees are dictated to by card reading civilian managers in control rooms..as is the problem with modern policing.
Is it really a problem going to some mad old biddy, who was abusive on the phone last time?..or going to a city centre pub that has families in it?
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My mother was a nurse and part-time ambulance driver and my father was a company director and part time Police ( Special Constable ) officer.
He recalled being required to attend to a punch up in a rough pub during which a large part of a man's nose had been removed and was temporarily attached to the stilletto heel of a woman's shoe. Apparently during the earlier stages of the fracas she had been using the shoe as a weapon and in a well aimed side swipe had collected the guy's nose and having done so, decided to put the shoe back on.
It was sort of how my parents first got to know each other a bit better in so far as she was interested in recovering the nose and attending to its erstwhile owner and he was concerned with calming the still exceptionally lively situation in the pub.
I never did get to know if the nose was ever reunited with its original proprietor.
My parents however, married a year or so later.
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I was sure you were an Edinburgh man Humph. The nose incident sounds a bit, well, Cumbernauld or Kirkintilloch...
Had a gym teacher at one of my schools, ex RAF I think, the bridge of whose nose had been taken off by a bullet or bit of shrapnel. He was a tough character and popular. The nose looked like a very badly cocked-up cosmetic nose job.
The late Seymour Krim, New York hipster and beat writer from the forties and fifties who lived in London for a while in the sixties and became a friend, had had a nose job when young because he thought he had a big Jewish conk (it's all in his autobiography). That hadn't been cocked up, but the resulting nose looked slightly odd because it was too small and straight for the rest of his face.
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They were living in Sheffield at the time but fairly swiftly retreated back to civilisation...
;-)
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Apologies if this is appears to be straight from mind to keyboard.
Over sensitive perceptions of certain venues are sometimes not so easy for ambulance staff to overcome. They have no protection, whereas the police have at the very least sticks. Indeed only on Thursday, there was an incident where it seems ambulance staff went in to a situation prior to police arriving and were held hostage -
www.manchestereveningnews.co.uk/news/greater-manchester-news/paramedics-held-hostage-knifepoint-inside-6520968.
I can refer to two other incidents in recent months where ambulance staff display a can do attitude and received a baseball bat over the head and punches in the face for their troubles. Funnily enough, the ambulance bashing Daily Mail don’t seem to want to report these.
This case being 'reported' by the Daily Mail has several inaccuracies in the report. For one, ambulance staff do not have to have a break of 30 minutes every 3 hours. They receive an unpaid break of 30 minutes at some point during their 12 hour shift. Staff have to have a break by the end of their 6th hour on shift. If not, as soon as able afterwards they are stood down and returned to their base for their 30 minute unpaid break.
It is also unlikely the crew that had not had a break in 6 hours even knew what they were not going to respond to. In my area of the country, crews can opt to be 'disturbable' during their 30 minute unpaid break, for which compensatory amount is paid. If crews opt to not be disturbed, then no details of calls even reach them.
Some of the DM comments are laughable. "Can the crew not eat at the wheel? I do.."
Yes, it is wrong that this individual did not receive an ambulance in a timely manner to be able to give him a chance of extended life. However, to solely blame the ambulance service is wrong. Surely, some culpability is with the hospital systems, the scrotes who abuse the ambulance service and the other health care professionals who abuse the ambulance service.
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I blamed the Welsh Government specifically. The Ambulance Service senior management has a history of being rather inept. The troops, no doubt, do a great job.
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>> Yes, it is wrong that this individual did not receive an ambulance in a timely
>> manner to be able to give him a chance of extended life. However, to solely
>> blame the ambulance service is wrong. Surely, some culpability is with the hospital systems, the
>> scrotes who abuse the ambulance service and the other health care professionals who abuse the
>> ambulance service.
Can't argue with any of that.
Just before I left the police, I noticed an increase in demand from other services...and tried to rein some of them in.
One of them was an increase in demand from LAS (London Ambulance Service) for police assistance to their calls..so no need for police per se, other than LAS wanted it...when we dug deeper, we found out there was a change of guidance to LAS despatchers and a change in system, in that they had more access to intel from previous calls etc...the downside was a degree of corporate timidity not there before.
I don't think anyone can argue with ambulance staff wishing/needing to properly look after themselves...but I suspect there's been some heavy handed or unthinking application of SOP's (Standard Operating Procedures).
As an aside, I have a very high regard for ambulance staff...and genuinely think they are the poor relation to the main three.
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Reading between some line son this particular incident the Police were there before the ambulance. The local news report discussed the "mandatory breaks" thing in some depth. Clearly it featured in the inquest and wasn't just made up by the Daily Mail.
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I love the 'stacking' of ambulances outside A&E as the 4-hour timer for A&E disposal doesn't start until the patient enters the department.
Utter scandal.
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>> 4-hour timer for A&E disposal doesn't start until the patient enters the department.
What's 'disposal' Lygonos, and what are the stacked ambulances waiting for? I'm curious, I simply don't know.
I've already mentioned the Nigerian press story about ambulance crews extracting bribes from road crash victims before starting treatment... but I don't know how true it is. It doesn't seem unlikely that some emergency services staff become, not just given to black humour, but actually callous and cynical. Not many perhaps, but some.
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A&E have 4 hours from the time a patient enters the department to when they are ejected (home/to a ward/to the morgue) or they get a smack on the wrist.
To facilitate this when busy, it appears some hospitals don't let ambulances drop off their contents until they are ready to deal with them.
Thus, similar to a stack of 'planes waiting to land at an airport circling round until a slot opens up, ambulances can wait 15...20...30...+++ minutes before they can dump said cargo and go off on their next call (or teabreak).
Good old targets manipulating clinical behaviour, rather than the other way around.
From a swift 'google':
tinyurl.com/nve6ma2
"In the first weekend of January there were 151 incidents of patients having to wait more than 30 minutes in an ambulance before being handed into Dudley NHS Trust care, the total for that week was 255. "
Last edited by: Lygonos on Sat 18 Jan 14 at 01:08
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>>What's 'disposal' ...., and what are the stacked ambulances waiting for?
>> I'm curious, I simply don't know.
>>
IIRC Disposal is after initial examination/treatment it is off to a ward or off home.
Stacking is waiting on board an ambulance in their parking bay until the patient is accepted and only then they are wheeled in.
The alternative is instead of an ambulance patient being delivered into a bay ( with a curtain at the end) they might get parked on a trolley.
Once on a trolley they are in the system and the four hour countdown starts.
So staying in the ambulance with a paramedic or put on a trolley with a risk of being forgotten are the alternatives. Not the patients choice.
Of course just because the patient arrives by ambulance does not automatically mean they are a really urgent case.
Stacking makes the stats look better.
edit
Glad I got it sort of right :-)
Last edited by: henry k on Sat 18 Jan 14 at 01:09
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>>Of course just because the patient arrives by ambulance does not automatically mean they are a really urgent case
Absolutely true.... but the ambulances next call may well be (hence the tragicomic stories of people waiting 30-40minutes for a 999 ambulance)
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>> >>Of course just because the patient arrives by ambulance does not automatically mean they are a really urgent case
>>
>> Absolutely true.... but the ambulances next call may well be (hence the tragicomic stories of people waiting 30-40minutes for a 999 ambulance)
>>
I wish folks would understand the knock on effects.
I have been to A&E on several occasions with SWMBO and also my daughter.
My daughter has worked in A&E and been called from ward to treat patients so I have info from both sides.
A recent visit to my local hospital with concern re DVT was very protracted.
Wait, triage, wait, triage for bloods, wait for lab results, see GP, wait, bloods test no good, triage, more bloods and eventually get to a bay.
A very long worrying time before getting any treatment.
Even with a very recent visit to a major hospital ( jumping the queue - GP facilitated it) ) to A&E the process was not very quick but a major eye opener as to how many police were their with their " charges"
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Our local A&E does not stack ambulances, there simply isn't room, they all go through whats called "the pits stop" (if its not pre warned on the red phone that its life and death by the ambulance crews) where trollies are off loaded into a kind of receiving ward.
Used 999 recently for my mother, (after giving up on the NHS direct phone line help service)
Assesses on the phone, not critical but urgent, ambulance arrived in 12 minutes, into the pit stop, there triaged, seen by A&E consultant in an hour, in medical assessment ward in three. All excellent stuff. (it all went to rats hit after that - seperate story).
The simple truth with A&E is that its stuffed with too many patients who simply shouldn't be there. Try getting an appointment at my doctor? you have to battle your way past the automatic phone system, then if you break you way out of that maze you have the battle-axe receptionist who may, if you are lucky, offer you an appointment in three days time. Try getting an out of hours doctor!
No wonder A&E is full up with non urgent patients. Doctors collect patients like bitcoins cos they get the money for them, and then try and spend as little as possible on them. Around here, our local GPs are appalling, based on knowledge of two separate surgeries 8 miles apart. Have reported my mothers GP to the GMC for diagnosing a necrotising toe as "a bruise" and not following up. She even told my mother not to check her blood glucose level too often as the strips cost 3p each.
Last edited by: Zero on Sat 18 Jan 14 at 09:21
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You can get a doctor's appointment in 3 days!!! - It would be worth a trip over to Surrey for me.
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>> You can get a doctor's appointment in 3 days!!! - It would be worth a
>> trip over to Surrey for me.
>>
Pah!
Recently, having become fed up with a pain in my shoulder, I decided to see my GP etc.
I telephoned the surgery soon after 8am, I got an appointment to see the GP for something after 9am the same morning. The doctor examined my shoulder and decided that it should be x-rayed and gave me a form to have an x-ray at a local hospital.
I telephoned the hospital and said - a little tongue in cheek, I must admit - that I was free that morning if they had a space. The hospital said they could give me an x-ray at 11.30am the same morning, I arrived a little early, was seen early, x-rayed and back outside by 11.30. All done within four hours of my first phone call.
It may or may not be coincidental that the hospital was privately run, but within and under the NHS.
Where was this?
Surrey.
One satisfied patient!
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>> She even told my mother not to check her blood glucose level too often as the strips cost 3p each.
For most diabetics (type 2) it is simply unnecessary to check the sugar very frequently.
The strips cost £15 for 50 roughly, so about 30p each.
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see told you, all a doctor cares about these days is ruddy money.
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'twas always so, but at least you were only an order of magnitude out.
But back in the real world, for many diabetics there is no clinical need whatsoever for them to check their blood sugar routinely.
Last edited by: Lygonos on Sat 18 Jan 14 at 11:06
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Back in the real world you find 83 year old women suffering from hypoglycaemia and have to call out ambulances for them because they have been told by the doctor only to check blood glucose levels infrequently because they cost 30 pence each.
Thats the trouble with a lot of local doctors now, the real world simply doesn't exist.
Last edited by: Zero on Sat 18 Jan 14 at 11:20
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The time to always check blood glucose is when you aren't well.
It may be very high, it may be very low.
Checking it 'just because' is usually not appropriate or necessary to someone who feels well and is diet controlled, or using metformin.
Hypos are more common in those using gliclazide, and especially insulin.
I was happily giving one of my patients his monthly £700 anti-cancer injection yesterday - doesn't bother me a toot.
In England, of course, GPs have been placed as the purseholders for local medical trusts, and I agree entirely with your sentiment here: this is, IMO, an horrific conflict of interests.
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My local surgery is, generally very good, as are the doctors.
I do wish, however that I had been fully warned about Tramadol before being prescribed it for chronic back pain!
Make you feel happy for awhile though!
In my case I quickly escalated to the 4 X 2 X 50mg capsules per day, as the effect seemed to be waning.
Not being a fan of strong painkillers I stopped taking them last Wednesday.
I can tell you that the withdrawal symptoms are not nice :-(
Having, belatedly, researched the stuff I wonder whether to suffer my aches or to remain on a semi-high for ever!
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I suffered compression fractures to my lower back after inadvertently parting company with a horse. It was a long time ago but I find excercise more effective than pills in controlling the chronic pain.
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Quite a detailed report in today's local rag. The meal breaks were a factor in this. The Chief Executive of the Wales Ambulance Service talks blandly of a "few" deaths because of "issues" the man needs to go. Put Brunstrom in charge.
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>> Put Brunstrom in charge.
>>
Hell....you must be worked up about it...or is he at the same lodge and you're all pals now...;-)
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Well whatever anyone says - he got things done !! He is a virulent anti-mason and I chucked them when I found they were not for me....tell you what though the shower that have run the service over last few years need sorting. The Health Trust that covers this area is much the same - absolute rubbish management has destroyed it article in yesterday's paper on how they mis-spelt their own name in three different ways....
I am wound up about it - tax-payers money has been thrown at this for year, seemingly to no avail...The Wales Government has just spent £52m on buying a failing airport in Cardiff....is there no limit to lack of competence ?
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The thing that annoys me is no one is held responsible. A few (or preferably a lot) of people held criminally responsible or even being fired would concentrate a few minds.
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>> I am wound up about it -
I'm glad about that..not in an unpleasant way, but because:
A, I sometimes get like that..and it makes me more normal (ish)
B, People need to get wound up by things like this..and kick ass to change things
>> is there no limit to lack of competence ?
Sadly, when it comes to public money..no.
I used to despair at my lot..but I kid you not...compared to the local authority they were saints. And furthermore on salaries about a 1/3rd of the council's.
Why would a chief exec of a council be on double the prime minister?
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>> Why would a chief exec of a council be on double the prime minister?
Because by any rational standard we massively underpay the PM at least in terms of his cash salary. OTOH when you add in the free use of grand houses, food and transport DC's on hell of a lot more than the headline £142k
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>> Because by any rational standard we massively underpay the PM at least in terms of
>> his cash salary. OTOH when you add in the free use of grand houses, food
>> and transport DC's on hell of a lot more than the headline £142k
>>
Yes..but you understand my point. Council executive salaries are obscene.
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>> Yes..but you understand my point. Council executive salaries are obscene.
They may or may not be. I'd want more than £140k for responsibility of being say Director of Child Services in a big city. However good you are you're a heartbeat away from having (a) the next Daniel Pelka on your patch or (b) the press camping on your lawn 'cos a kid has been removed from her 'loving' parents.
The problem is that Cameron's 'reward package' (or rather an absurdly low proxy for it) is being used a a yardstick for ALL public sector salaries.
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>> >> Yes..but you understand my point. Council executive salaries are obscene.
>>
>>
>> They may or may not be. I'd want more than £140k for responsibility of being
>> say Director of Child Services in a big city. However good you are you're a
>> heartbeat away from having (a) the next Daniel Pelka on your patch or (b) the
>> press camping on your lawn 'cos a kid has been removed from her 'loving' parents.
>>
>> The problem is that Cameron's 'reward package' (or rather an absurdly low proxy for it)
>> is being used a a yardstick for ALL public sector salaries.
The PM's salary is merely a "holding" fee. Post PM-ship he is looking at fat directorship for nothing money in later years.
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>> The PM's salary is merely a "holding" fee. Post PM-ship he is looking at fat
>> directorship for nothing money in later years.
Certainly so in case of Blair. Major too albeit he's been more discerninig.
Brown OTOH seems to have followed his Calvinistic instincts and done much for charity.
Cameron and Clegg being millionaires already may or may not care.
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>> >> The PM's salary is merely a "holding" fee. Post PM-ship he is looking at
>> fat
>> >> directorship for nothing money in later years.
>>
>> Certainly so in case of Blair. Major too albeit he's been more discerninig.
>>
>> Brown OTOH seems to have followed his Calvinistic instincts and done much for charity.
>>
>> Cameron and Clegg being millionaires already may or may not care.
Brown was damaged goods. The stories of his instabilities and paranoia in office put paid to that.
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>> Brown was damaged goods. The stories of his instabilities and paranoia in office put paid
>> to that.
>>
He was key to keeping the western world's financial systems running in autumn 2008. If he wanted to exploit that for gain he could - instabilities and paranoia notwithstanding.
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He was also key to its near demise....if he hadn't have de-regulated the Banks perhaps things would have been difference.....
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>> >> Brown was damaged goods. The stories of his instabilities and paranoia in office put
>> paid
>> >> to that.
>> >>
>>
>> He was key to keeping the western world's financial systems running in autumn 2008. If
>> he wanted to exploit that for gain he could - instabilities and paranoia notwithstanding.
He had no input in the US financial bale out. All he did was rescue the UK banks. So he should as he was responsible for encouraging RBS to over reach itself, and for Lloyds bailing out BoS (and in the process dropping themselves in the mire)
Last edited by: Zero on Sat 18 Jan 14 at 20:40
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IIRC he had a significant role in co-ordinating consistent responses in Dollar, Pound and Eurozone responses.
His error with UK banking regulation was to go along, up to a point, with calls to remove 'red tape'. The Tories were telling him to go further rather than pull back.
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Remember the gold sell-off? That was to help keep US banking in business.
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>> Remember the gold sell-off? That was to help keep US banking in business.
No it wasn't. That was to fund increased borrowing to cover increased spending.
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>> Yes it was. At the request of Goldman Sachs. Link: blogs.telegraph.co.uk/finance/thomaspascoe/100018367/revealed-why-gordon-brown-sold-britains-gold-at-a-knock-down-price/
Well you just carefully avoid the word RUMOUR liberally sprinkled throughout the article then.
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>> Yes..but you understand my point. Council executive salaries are obscene.
>>
>>
>> They may or may not be. I'd want more than £140k for responsibility of being
>> say Director of Child Services in a big city. However good you are you're a
>> heartbeat away from having (a) the next Daniel Pelka on your patch or (b) the
>> press camping on your lawn 'cos a kid has been removed from her 'loving' parents.
>>
Listen chaps, I have to say that all salaries seem enormous to me and many are indeed positively obscene. Especially when you consider some of the jobsworthish crap some of these educators and care officials churn out for the money... no doubt there are others who try to give value.
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>> They may or may not be. I'd want more than £140k for responsibility of being
>> say Director of Child Services in a big city. However good you are you're a
>> heartbeat away from having (a) the next Daniel Pelka on your patch or (b) the
>> press camping on your lawn 'cos a kid has been removed from her 'loving' parents.
Why would you want/need £140K to be the Director of Children's Services at the council...when the local Police chief (Borough Commander as an example, Chief Supt)..is on £85K?
He/she has responsibility for the whole lot..not just children.
I see no reason why a director of services of the council could not be on £75K...and the head of the whole lot on £125K...it's OUR public money.
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>> Why would you want/need £140K to be the Director of Children's Services at the council...when
>> the local Police chief (Borough Commander as an example, Chief Supt)..is on £85K?
>>
>> He/she has responsibility for the whole lot..not just children.
> I see no reason why a director of services of the council could not be
>> on £75K...and the head of the whole lot on £125K...it's OUR public money.
You're comparing apples with oranges.
A Chief Super in London will be a career officer, indeed that's the only route to post. Unless he commits a serious disciplinary offence or is truly incompetent, he can expect to serve until due his pension. He'll have 'top cover' from Territorial command and the Commissioner see recent cases such as De Menezes and Gategate. Albeit subject to criticism by borough politicos the Commander is not under their control.
The only one I recall getting himself in the public eye was Brian Paddick over cannabis offences. Compare and contrast with Directors of Child Services.
Local authority posts probably used to be the same with Directors promoted from within or appointed from neighbouring councils . Not now; the fashion is to appoint outsiders or head-hunt nationally, there's a market for people seen as good*. Senior LA staff are exposed to Politics, not just governing v opposition but infighting between members of same party.
High profile sackings are a serious occupational hazard. A secure post at £80k is one thing, one where your out and pilloried by press on a politicians whim demands a significant risk premium.
*All too often that means they've made radical change and moved before the consequences hit but that's another story.
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>> High profile sackings are a serious occupational hazard. A secure post at £80k is one
>> thing, one where your out and pilloried by press on a politicians whim demands a
>> significant risk premium.
>>
>>
>> *All too often that means they've made radical change and moved before the consequences hit
>> but that's another story.
>>
So, are you saying they are paid a lot because of their job tenure (or lack of)..and.. the potential short term nature of their role if their incompetence is found out?
I'm not happy with my cash being spent on over inflated salaries, just to cover a lack of job security. If they are good at what they do, they'll remain in post..or be head-hunted elsewhere on another lucrative salary..... If not they'll be gone...and that's good for us, the public.
I still see no reason why their salaries should be so high in public service.
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>> i..or be head-hunted elsewhere on another lucrative salary.....
>> I still see no reason why their salaries should be so high in public service.
You just answered your own question.
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>>
>> >> i..or be head-hunted elsewhere on another lucrative salary.....
>>
>> >> I still see no reason why their salaries should be so high in public
>> service.
>>
>> You just answered your own question.
But it doesn't happen with super superintendents, does it?
Because there's a more or less common pay scale.
Central gov exerts considerable control on LA spending anyway. It could impose pay scales. I bet they'd still fill the jobs.
Very few people have a secure job when it comes down to it. Big jobs in LA look like a gravy train to me, with CEO's often under a cloud collecting giant pay offs and moving on to the next one. Dos that prove there's a shortage of suitable candidates? Not to me - it just suggests they keep recruiting the wrong ones, possibly because the gravy train is what interests them.
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>> >>
>> >> >> i..or be head-hunted elsewhere on another lucrative salary.....
>> >>
>> >> >> I still see no reason why their salaries should be so high in
>> public
>> >> service.
>> >>
>> >> You just answered your own question.
>>
>> But it doesn't happen with super superintendents, does it?
No, because no-one in industry wants them so they are not head hunted. (not being nasty about superintendents, but its just that the roles and skills are too specific and don't relate well to industry or commerce)
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>> I am wound up about it - tax-payers money has been thrown at this for
>> year, seemingly to no avail...The Wales Government has just spent £52m on buying a failing
>> airport in Cardiff....is there no limit to lack of competence ?
What do you expect when you put the sheep in charge of the field.
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Would you have a link to the story please? I would be interested to read that.
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The online version is pretty basic without the quote from the Chief Exec...I'll photo the downloaded version for you shortly.
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"UKIP candidate goes cold turkey after drugs binge?''
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Thank you.
Crews round this way have to be returned to base for their break. This does indeed mean they are unavailable if they have passed the sixth hour of their shift. This appears to be the same as Welsh ambulance service.
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Not sure whether that report covers it but the suit at the top who was summoned to the inquest - he was babbling on in a TV interview as to how practices will have to change and crews should be able to take their breaks in any NHS building. I am not a fan of public inquires, but I will be talking to my AM next week to try and push for an inquiry into the way the general mis-management of the NHS in Wales has been allowed to continue- this should really go back to Westminster I feel. There is scandal after scandal at the moment, I really find it most depressing.
I don't blame the troops one bit - it's the bosses.
My Police Officer wife was a bit surprised that Ambulance crews get mandatory breaks, no such luxury in her line of work.
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>> My Police Officer wife was a bit surprised that Ambulance crews get mandatory breaks, no
>> such luxury in her line of work.
>>
Or in the armed forces, OK they work to a routine but it very much depends on circumstances. Certainly in emergency situations work routines are very flexible, and yes we did still manage to eat and sleep.
Last edited by: Uncle Albert on Sat 18 Jan 14 at 20:47
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Son works in a call centre. It is optional but they often take no meal breaks when it's busy.
If they can, ambulances surely can..
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Son works in a call centre. It is optional but they often take no meal breaks when it's busy.
If they can, ambulances surely can"
Yes, because they're two very similar jobs, aren't they?
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Surely this comes into play ...and if it doesn't, it should do.
>>In general the Working Time Regulations provide rights to:
•a limit of an average 48 hours a week on the hours a worker can be required to work, though individuals may choose to work longer by "opting out"
•5.6 weeks' paid leave a year
•11 consecutive hours' rest in any 24-hour period
•a 20-minute rest break if the working day is longer than six hours
•one day off each week
•a limit on the normal working hours of night workers to an average eight hours in any 24-hour period, and an entitlement for night workers to receive regular health assessments.
Pat
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>> Surely this comes into play ...and if it doesn't, it should do.
>>
>> >>In general the Working Time Regulations provide rights to: ..............
So in that case should they be stripped of their "Emergency Service" status and become a hospital transport service?
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A seriously tired and hungry emergency service is of no use to anyone and can't be expected to function properly...or answer to their failings when accidents happen.
Pat
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>> A seriously tired and hungry emergency service is of no use to anyone and can't
>> be expected to function properly...or answer to their failings when accidents happen.
>>
>> Pat
>>
I agree, but a bit of flexibility rather than "Its my rights" would go a long way. As would some decent management of the use of ambulance crews and vehicles, and the delivery of patients.
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>> I agree, but a bit of flexibility rather than "Its my rights" would go a
>> long way. As would some decent management of the use of ambulance crews and vehicles,
>> and the delivery of patients.
A bit of flexibility to meet exceptional circs is one thing. Trouble starts when the management treat that flexibility as the new norm.
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>> A bit of flexibility to meet exceptional circs is one thing. Trouble starts when the
>> management treat that flexibility as the new norm.
>>
Which points to it being a problem of management of, or a lack of, recourses rather than the crews. It would help if the hospitals A&E was used appropriately and promptly accepted customers arriving in ambulances. I am sure clinical priority prevails, it is the drunk or someone with a sprained wrist in an ambulance which do not help. Maybe the crews should have the authority and backup, legal and management, to refuse service to non emergency customers looking for a "taxi".
Last edited by: Uncle Albert on Sun 19 Jan 14 at 09:51
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>> A bit of flexibility to meet exceptional circs is one thing. Trouble starts when the
>> management treat that flexibility as the new norm.
>>
...and therein lies the problem.
Others have mentioned it..but..police officers, for example, are paid for all of their day at work and would seek to have a 45 minute break during their shift, if they can. If they cannot achieve it, they don't get it.
So, whilst they are sat on their backsides scoffing food..they are being paid...but, would be expected to hoof it out the door if something really serious happened...and the culture is such that generally they do.
If however the law says someone has to have at least a 20 minute break after 6 hours ..and ..they are not being paid whilst they take that break...then you'd assume most/many would do as they are told and not work during their own time.
Solution...pay ambulance staff for their whole shift.
The other angle is, if the workload is such that you are expecting your staff to regularly miss their breaks..(and the modern workloads are such that IMO that is the case)..then the reality is you need more staff to fulfil that role. Trouble is you do not have the budget to fulfil it.
So something has to give....and in the case of an emergency ambulance service..that means lives, doesn't it.
IMO the priorities of the very senior (director level) staff has to be focused on the absolute priorities..so if some HR staff/managers/trainers disappear, so be it..the front line staff should be the absolute priority...after all, why else is the whole outfit there?
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My benchmark WP is if someone does not turn in for an extended period and the job continues as normal then clearly their role is questionable.
Where I work the HR (spit) dept (sorry 'Function' is the new buzzword) is in the same building. Long term maternity etc etc. has the job ground to a halt. Err no.
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>> My benchmark WP is if someone does not turn in for an extended period and
>> the job continues as normal then clearly their role is questionable.
>>
>> Where I work the HR (spit) dept (sorry 'Function' is the new buzzword) is in
>> the same building. Long term maternity etc etc. has the job ground to a halt.
>> Err no.
Well we all know that the redundancy roundabout never stops at HR.
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That would be difficult as the Ambulance Service is not an Emergency Service. It is an Essential Service.
edit, this was in response to Uncle Albert saying why not remove the emergency service status. Why it ended up here I don't know.
Last edited by: Dieselboy on Mon 20 Jan 14 at 01:19
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>> edit, this was in response to Uncle Albert saying why not remove the emergency service
>> status. Why it ended up here I don't know.
See www.car4play.com/forum/post/index.htm?t=16212&v=t
Pat replied first, and there were lots of follow-ups.
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>>- this should really go back to Westminster I feel.
Isn't the NHS in Wales fully devolved to the Welsh Assembly (as it is in Jockland)?
Would mean the buck stops with whoever is the Welsh minister for health.
(not too sure how devolved the Leeks have it though)
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It is. The new minister is from the NHS and seems to have the job in hand. There was a re-shuffle after their Education Minister made a fool of himself. It's Mark Drakeford - he seems to have some respect amongst those that matter.
www.bbc.co.uk/news/uk-wales-25305585
Some background on the local Health Trust....complete mess.
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Police Officers are paid for their refreshment breaks. It therefore becomes an entitlement and not a right. So if they miss out due to operational commitments that's tough.
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Well, just done something I've never done before - e-mailed my AM (Assembly Member) - he is young, keen and lives in the same village...this is a debate that needs to be had.
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>> Well, just done something I've never done before - e-mailed my AM (Assembly Member) -
>> he is young, keen and lives in the same village...this is a debate that needs
>> to be had.
Good on you RP. Do keep us posted.
Last edited by: Westpig on Sun 19 Jan 14 at 14:00
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Aha - small town politics work. Got a reply this afternoon, my AM is meeting with the Health Minister to discuss....he shares my view apparently, Public Enquiry....well well, you never know. He is a Plaid Cymru guy but they are in coalition with the Labour party. Hopefully something will happen.
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We get a tent when it gets to fifteen ambulances.
www.bbc.co.uk/news/uk-england-norfolk-21999859
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Known as a Field Hospital in war zones and disasters. We are rapidly becoming a country with third world facilities.
Or maybe we need some tough management of time wasters in an emergency facility, why isn't there a minor injuries unit where non emergency arrivals could be treated. (If there isn't).
Last edited by: Uncle Albert on Tue 21 Jan 14 at 12:38
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Around this neck of the woods, there are various initiatives to try and take the strain off A&E departments.
1. Use of GP referral schemes. Where there is no need for the patient to go to hospital and they are in their own homes, the patient can now be referred to a visiting GP service.
2. Referral to Urgent Care Centres. As above really, if the patient does not want a GP referral, in certain circumstances they can be taken to a UCC.
3. Telephone triage by a medically qualified member of staff - may result in advice, or a GP referral.
Unfortunately, if the patient is not in their own home, does not have capacity under the MCA, or simply demands to go to A&E, then they have to be taken.
Take an example of a waste of A&E. Young person in a bar gets obliterated on booze. Friends call 999. Ambulance crew pitch up and have no choice other than to take this person to A&E. Friends say they will take the person home, but crew cannot risk this. Imagine the DM headline of "Bungling ambulance crew send drunk person home to die". Result? A bed in A&E wasted for a number of hours until said person sobers up enough to look after themselves. Answer? Drunk tank.
Another example. Person rings 999 saying their contemplating suicide. Crew pitch up and have no choice other than to take the person to A&E. Result? A bed in A&E wasted for a number of hours until a MH referral can be made as ambulance crew do not and never will have a direct MH referral pathway. Answer? Who knows?
There was a report recently that over 12,000 people made more than 10 visits to A&E in a year. www.bbc.co.uk/news/health-25628009 This is the sort of thing that also needs to be tackled.
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1. 2. and 3. all sounds as if seeing a GP or getting a home visit is a serious issue where you are, unless I'm missing the point.
A&E should never be seen as a default for not being able to see a GP (unless it's obviously an A&E problem - broken bone, suspected heart attack [which should be 999 not a drive to A&E in the car], bad bleeding from injury, etc)
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"A&E should never be seen as a default for not being able to see a GP "
You know that, I know that. Unfortunately, the general population don't seem to.
There needs to be a national campaign. This in particular needs to be played on television regularly...
www.youtube.com/watch?feature=youtu.be&v=ffT1orYXdcI&desktop_uri=%2Fwatch%3Fv%3DffT1orYXdcI%26feature%3Dyoutu.be&app=desktop
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>> "A&E should never be seen as a default for not being able to see a
>> GP "
>>
>> You know that, I know that. Unfortunately, the general population don't seem to.
Tried to get an appointment for my mother at her doctor for tomorrow or thursday.
"You can have on on the 27th"
Not good enough says I
"Then you can phone up at 08:30 tomorrow morning and take your chance"
I'll ring the practice manager says I
Got an appointment at 4:40 this afternoon.
THAT is why the ruddy A&E is full of non urgent cases.
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>> THAT is why the ruddy A&E is full of non urgent cases.
>>
More likely because you used one of the GPs few emergency appointments for a non emergency and caused some other patient to go to A&E.
Last edited by: Uncle Albert on Tue 21 Jan 14 at 13:50
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I was accident prone as a kid. Any break or significant injury, of which I had many, required a trip to A&E.
That was *ALWAYS* a trip of many hours duration surrounded by crowds of people waiting for one issue or another.
I have taken both my children to A&E in the last 5 years - 3 or 4 times. In and out with treatment in a couple of hours - seems pretty reasonable to me.
I am an asthmatic. And when I was young there was no effective treatment for one as chronic as I. I used to spend a *lot* of time at the GP. The receptionist was mean and would do anything she could to stop you getting to the doctor, appointments were always ages in front, everything always ran late and the environment was horrible.
These days it seems clean, pleasant, efficient and predictable - and with my two I've been there a lot.
There are undoubtedly problems with the NHS, but in my experience it doesn't seem to be A&E or the local GP system.
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>> >> THAT is why the ruddy A&E is full of non urgent cases.
>> >>
>>
>> More likely because you used one of the GPs few emergency appointments for a non
>> emergency and caused some other patient to go to A&E.
The A and E for is for emergencies. Get a grip.
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I have, today, asked NHS Direct (by email) for some medicine advice, only to be told to contact my prescriber!
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>> >> More likely because you used one of the GPs few emergency appointments for a
>> non
>> >> emergency and caused some other patient to go to A&E.
>>
>> The A and E for is for emergencies. Get a grip.
GPs will reserve a few appointments every day for urgent appointments. It allows them to deal with things like persistent diarrhoea or vomiting in kids (risk of dehydration etc) or panics in pregnancy (can't feel it moving?) where he can nip an A&E visit in the bud. Your Mother, given her age and health may of course come into that category as well.
Our practice are remarkably good. You ring and give basic details to the office who pass it on to one of the partners who call back yo to triage your complaint. Sometimes they prescribe on basis of call, other times you get a same day appointment with a Doctor or one of the nurses.
Last used in early Nov when my right big toe swelled up. Called at 09:00, GP senior partner called me back at 09:20. Seen by a GP registrar at 10:30 who thoroughly examined the offending digit, noted that it was not first time I'd presented with condition (it's a recurrent infection) and gave me a scrip for Flucloxacillin.
Pills in my hand from adjoining pharmacy by 10:45. I could have been on the 11:25 to Euston but chose to work at home.
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>
>> Pills in my hand from adjoining pharmacy by 10:45. I could have been on the
>> 11:25 to Euston but chose to work at home.
You could have hopped on a train.
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>> GPs will reserve a few appointments every day for urgent appointments.
The GP system works very well..but..only if you can get hold of them.
Yesterday my 6 year old son's primary school rang and informed my wife he'd fallen off a climbing frame and to come to collect him. When she arrived he looked like he'd been in a boxing ring..fat lip, big scrapes down his face, large cut near his nose and not really with it.
He'd fallen onto his stomach, badly winded himself, got up a bit too quickly to get help..and fainted, causing the above injuries.
When he told us he couldn't remember falling down and woke up on the floor..we obviously wondered about concussion, so wifey rang the surgery (outside of normal patient ringing in hours).
Phone was answered immediately, promise of triage doctor phone call back, 20 mins later GP rang, appointment made for 2 hours time ...both the GP on the phone and the one seen at the surgery were brilliant. Couldn't fault the system, the NHS at its' best.
Contrast that for my attempts about a month ago, when I got an infection in my eye (after a scheduled visit to the eye infirmary). I tried to ring during the morning patient free for all, but could not get through, despite constantly re-dialling on my mobile..so I drove down there and went in, in person...and got the hideous harridan on the desk..no appointments available.
That's it, none available.
So I stood my ground and said what do I do then, my eye is virtually closed and is painful, what's the score? I was asked "is it an emergency"..well in my thoughts 'no, not really', but it was pretty painful and I needed it sorting..so I said "Depends on your definition of emergency, I do have another one"...no hint of humour from the lady, no attempt at empathy, just plain obstruction...so I just stood there...and I got my appointment.
Why does it have to be like that?
My old surgery in London had a system whereby you could book non urgent appointments on line..which presumably frees up a bit of space for the phone lines..so it can be done.
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>>Why does it have to be like that?
Because too many peoples' idea of 'emergency' is what you or I would think of as simple 'more convenient for me'.
ps. swollen, closing eye is definitely a 'same day' offence, and kid fainting after falling onto their abdomen needs internal bleeding considered and is a proper 'emergency', as is a child who KO's themselves - phone advice would be ok initially but I'd probably want to give them a once over to help me sleep that night ;-)
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>> ps. swollen, closing eye is definitely a 'same day' offence,
Glad you said that...one part of me thought my bolshiness might have nicked someone else's slot who was more deserving...trouble was, I wanted an answer other than 'try calling again in the morning'.
What didn't help, was I'd rung the eye infirmary originally to ask what the score was, as I'd only been in there a couple of days prior..they told me to go to the chemist for some infected eye stuff...the chemist looked at me eye and said 'no way' see your doctor...so again rang the eye infirmary, who then said see your practice nurse at the GP surgery...couldn't get through to GP surgery, so went there...and was told the nurse wouldn't deal in those circumstances...by the end I'd well and truly run out of patience. It still rankles me that the receptionist was so offhand and unhelpful.
and kid fainting after falling
>> onto their abdomen needs internal bleeding considered and is a proper 'emergency', as is a
>> child who KO's themselves - phone advice would be ok initially but I'd probably want
>> to give them a once over to help me sleep that night ;-)
We were both on the ball with the head side of things, but didn't consider the abdomen internal bleeding if I'm honest. He's now got a tremendous bruise coming up on his cheek, so he did it good and proper.
There'll be more to come.
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Wales Ambulance Service.....(ranting alert) - Focusless
