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I am grateful for the opportunity to discuss issues surrounding Hampshire ambulance service. Although some of the examples that I shall cite give grave cause for concern, I have the greatest respect and admiration for those at the sharp end, who deliver the service every day under difficult conditions.
My interest in the local ambulance service was awakened not long after my election, when I was contacted by the clerk of Lockerley parish council. She described the tragic case of an elderly gentleman who had suffered a heart attack at home; an ambulance had been called. Hampshire's is a rural ambulance service, and the target then was that an ambulance should arrive within 19 minutes for 95 per cent. of calls. In this instance, the ambulance took over half an hour to arrive. It had been sent from Hythe, which is not local, as there was no nearer one available. The driver later admitted that he did not know where Lockerley was, and that he had come via Dunbridge because it was a village that he knew. He also said that, had someone not been waiting on the main road running through Lockerley Green to direct him to the property, he would not have been able to find it. There is no happy ending to this story. The patient died. We shall never know whether the early arrival of an ambulance would have made the crucial difference, but the situation of the delayed ambulance was stressful for everyone concerned.
Having spoken out on this issue, I was contacted by a number of concerned ambulance men. One letter said that it was
"far from unexpected, and not a rare occurrence. The problem stems from a shortage of vehicles, and how that shortage is used.
In 1990, ORH (Operational Research into the Health Service) carried out a survey of Hampshire Ambulance Service--the workload, available vehicles, their location in relation to the workload--and made recommendations as to how the vehicles should be deployed. This involved an element of re-deployment--which was accepted both by the management and staff-side (prior to the publication of the report)--and the main statement that stands out is that the level of vehicle cover, and its deployment would provide the minimum cover required to achieve the necessary response standards. Actual ambulance figures are available, but ranged from a total of 23 at night-time to a maximum of 47 between 11.00 and 17.00 during the week, with reductions at weekends, resulting in a...daily...average of 30.87.
Since that time there has been a progressive reduction in vehicle availability, with a drastic increase in workload".
The figures bear out the increased work load. In 1995-96, there were 62,800 emergency calls. That figure had risen to 85,500 by 1999-2000--a 35 per cent. increase in four years. I am told that the work load has increased by 50 per cent. in six years, but I have not checked the figures.
Vehicle availability is down to 20 at night. That is an average of one ambulance per 75,000 population. The maximum varies daily from 41 to 43 between 3 pm and 5 pm and the overall average has dropped to 30.45. That might not sound like a huge drop, but set against the background of increasing work load, it shows a highly stretched service. These figures are for the whole of Hampshire and in each case the number is the maximum rostered. The figure is frequently not achieved because of sickness, holidays and training.
Many people are concerned about the fact that, at night, Southampton city has only two vehicles to cover a population of 220,000. There are ambulance stations at Bursledon, Eastleigh and Totton, but they have their own catchment areas to serve.
It would seem that, in addition to the problem in rural areas, towns and cities are not receiving a five-star service. I witnessed an example of that when I was out with the police in Eastleigh and an ambulance had to be called. It came from Whitchurch. There are six or seven ambulance stations closer to Eastleigh than Whitchurch.
In June the national response times were published. They made grim reading, and not only in Hampshire. Hampshire is regarded as a rural trust and has rural targets. That means that 50 per cent. of calls should be responded to within eight minutes and 95 per cent. within 19 minutes. I want to make it clear that those targets are for the whole of Hampshire. Many people think that shorter target times apply for built-up areas such as Southampton or Portsmouth, but I am afraid that that is not so. Anywhere in Hampshire is regarded as rural. Targets are exactly the same for the towns as for the villages.
Hampshire ambulance authority previously had a good record of achieving targets, but in the past year the percentage of responses made within eight minutes dropped to 44.5 per cent. and that for responses within 19 minutes dropped to 92.6 per cent. Both figures are well below the targets. However, to be fair to Hampshire, the performance of a majority of ambulance trusts declined sharply. The results are very worrying. I learned of other relevant incidents in the Lockerley area. On
I have met the chief executive and chief ambulance officer of Hampshire Ambulance, who have been frank and open. Various problems are apparent, but the basic one is underfunding. I have a letter from Richard Mawson, the chief ambulance officer, in which he refers to the funding discussions with health authorities with respect to 1999-2000. He states:
"Despite having faced an increase in demand of over 36 per cent. over the previous 5 years the service has managed to exceed the performance outcome year on year without significant additional funding. However, it was recognised, prior to 1999/2000 that the service faced a 'step change' which required additional funding if an unacceptable further erosion of workplace conditions for staff was to be avoided, whilst attempting to maintain standards. Unfortunately...we were unable to secure adequate additional funding to meet our identified needs." That suggests that there is a problem with the morale of ambulance men and women. Since taking an interest in the subject, I have spoken to many of them, and some common themes emerge from the concerns that they express. I have been universally impressed by those people, who do a difficult job under extreme pressure. They do not like the feeling that, for various reasons, they have not been able to give of their best.
The work load is hectic, which means that meal breaks are constantly interrupted, if they happen at all. The staff do not mind, but the system is now so tightly run that it is an everyday occurrence. No one appears to have undertaken a risk assessment to show the effects on performance of long hours without food. None of the staff members minds working extra hours, but many of them described a trend towards being called out increasingly often just before the end of a shift.
I spent a day with the Hampshire ambulance service and witnessed some of the problems at first hand. The pace was constant and we were lucky that nothing too horrific happened. However, one ambulance man said: "The problem is, if we have a death or something unpleasant, we are often straight on to the next job. Sometimes you just need a quiet quarter of an hour to help to come to terms with something. If you can't do that, the stress just builds up and there are an increasing number of personnel suffering from stress-related illnesses."
The ambulance men and women in Hampshire were also universally scathing about the new command and control system; the falling standards were partly attributed to it. It is worth mentioning some of their concerns. The system looks very good. The ambulances keep in touch with the control centre by means of a satellite navigation system. The computer operators in the control centre can in theory see at a glance which ambulance is closest to any emergency. Unfortunately, back in the ambulance, the system is not very high tech. The ambulance is informed of the address of the emergency and given a page number and rough grid reference, such as A4, from the appropriate Ordnance Survey map book. Once the ambulance is mobile, the navigator has to trace the journey by turning over pages of the book. There is no ambulance navigation system. I have used those OS books myself, and it is not easy to work out a long distance when one has to turn over a number of pages.
In addition, the crews are no longer in radio contact with one another. That might not sound like much of a problem, but it means that ambulance crews can no longer help each other out. Previously, there were frequent occasions when an ambulance crew could point out to control that its ambulance was better placed to respond to a call than that of the designated ambulance. The system does not always take into account problems such as one-way systems or motorway hold-ups. Also, if an ambulance is dispatched slightly off its usual patch, an ambulance man with local knowledge might be able to supply additional verbal directions, which could be the difference between life and death. Another aspect to the lack of communication is that, on occasion, a crew will have prior knowledge that a potential patient could be dangerous or abusive. They might even advise police back-up before entering a property. A way of communicating such information seems to be missing from the new system.
I witnessed some of the problems at first hand. On one occasion, the control centre thought that we were in Winchester, when we were in fact in Southampton. That was closely followed by my crew's returning to base, only to cross the path of an ambulance going to an emergency, travelling in the direction that we had just come from. We should have been directed to that emergency, but were not, and the crew's response was, "At least you have seen it for yourself now." I am glad to say that the trust has now acknowledged some of the issues relating to command and control and has spent time and money on further training for staff.
Other issues relate to a lack of consultation and frequent references to a top-heavy management structure. Recently, ambulances have been deployed to strategic points around the county in an attempt to improve response times. Theoretically that is a good idea, but the knock-on effect on the staff is that, in the rare event of a short break, they must sit in a cold, uncomfortable ambulance with no access to refreshment.
When I visited the ambulance station, staff were also somewhat demoralised because the response times had not then been published for some months. Conspiracy theories abounded, but the common response was, "The times must be really bad now; otherwise, they would be put up on the notice-board."