Thursday, 1 January 2015

Are five-hour waits for ambulances the sad state of our healthcare system?

A teenager lay in the road, groaning in pain. The response from the ambulance service raised troubling questions.
The London Ambulance Service insists a dip in performance is nothing to do with a cut in funding. Photograph: Graham Turner for the Guardian

The first sign of trouble was the sound of a smash. There on my street in Kentish Town, north London, was a sheepish looking teenager on a moped, another sitting down, and a third lying in the road, groaning.
Otherwise the street was deserted. At first it appeared the boy on his back, who I’ll call Nathan, was just drunk and embarrassed. But the scream when he tried to move his leg suggested otherwise. So I called 999. It was 1.12am on Monday morning, and three degrees below freezing.
The events that followed are small in the scheme of things. But the inadequacies of the response to Nathan’s accident raise troubling questions about the state of our ambulance services, and the ground-level consequences of cuts that can often seem like a political abstraction.
Once the situation was explained, the operator said he couldn’t be sure when an ambulance would be available. Nathan’s mates left. (Police believe the moped was stolen.) Two other neighbours brought blankets and pillows. Operators called back a few times, to little effect. Nathan, who’s 16, seemed to be in shock. He required repeated reassurance that he wasn’t going to die. 
After half an hour, the police arrived. Initially, they seemed more concerned about the alleged moped theft – they’d had a run-in with Nathan and his mates earlier that night – than about his injury. But as they realised that he wasn’t putting it on, their focus changed. And they were clearly exasperated.
Over the radio, they were told that an ambulance was out of the question. The service was in a “surge purple enhanced” state, once vanishingly rare, now quite common, and, the London ambulance service (LAS) says, particularly so in the last month. That status means that only life or death calls will get an ambulance.
The best estimate they could give on an arrival time for Nathan was five hours. It wasn’t even a Friday or a Saturday night, one dismayed officer pointed out. “This is the only real incident we’re dealing with in the whole borough right now,” he said, “and we still can’t get an ambulance.” But what could they do? Nathan was getting colder.
One of the officers was a trained emergency medical technician (EMT), and he was concerned that the boy was showing signs of hypothermia. He wanted to get him to hospital as quickly as possible, before things got worse.
They tried to move him, but his screams were so severe that they gave that up pretty fast. The trained EMT radioed to ask if he could go and pick up gas and air from the local hospital to administer himself, but the request was denied. Nathan’s mum arrived. At first she was angry with her son. “If you were at home in bed and not out on the street this wouldn’t be happening,” she said. But she soon softened, kneeling to stroke her son’s hair as he moaned and shivered.
Still no ambulance. No pain relief. Eventually, one of the officers puffed out his cheeks. “OK, mate,” he said. “It looks like you’re going to have to man up.” Just after 2.50 am, seven police officers surrounded Nathan, unwrapped his duvet swaddling, and tried, as tenderly as they could, to move him into the back of their van. Nathan did his best to man up, but he’s not actually a man yet, and he had been lying in the road with a badly broken leg for an hour and 38 minutes. As he screamed, his mother wept a few feet away.
Statistics published by LAS hint at why this has happened: after years of reaching their benchmark of getting to 75% or more of the most serious calls within eight minutes, performance has dipped markedly. In May the figure across London was 69%; in October, it was 58%.
LAS insists this has nothing to do with a cut in funding of 19% between 2011 and 2015. They blame a skills shortage, and an unexplained growth in serious calls – 10% up on last year. They say they’re on a recruitment drive. Unison, who represent ambulance staff, are not impressed – the local branch secretary says paramedics are leaving London because they can get more money elsewhere, and talks about a “tidal wave” of departures – and neither were the police officers on my street. More and more ambulance services were being put on their shoulders, they said, making it harder for them to do the work that is more properly theirs.
Nathan was given morphine as soon as he arrived at hospital. He turned out to have fractures to his femur and his kneecap. On Monday afternoon he was in surgery. He was never in danger of dying, it’s true, and if he had been, an ambulance would have come. In a statement, LAS said they were sorry that no ambulance could attend, blaming a high number of life-or-death calls.
But is that the standard we now set? And if we now accept that children with multiple fractures are to be left to lie freezing cold in the road in the middle of the night, shouldn’t we be asking how our expectations got so low?
• This article was amended on 30 December. An earlier version said the growth in serious calls was up 27% on last year. That proportion was in fact 10%.

1 comment:

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