There is always room for improvement comrades!
“Comrades, from April next year your party expects an increase in potato production per hectare. Co-operatives failing to meet the new quotas will be permanently re-assigned to the mines of Siberia”.
Well, my hunting around the internet, in a serious search for the origins of the 8 minute response time “holy grail” has borne fruit and turned up a hitherto unknown testament (at least to my knowledge). No doubt Commissar Hewitt, in collusion with MI5, has already sought to have the authors permanently gagged under threat of a fatwa.
It seems the initial positing of an ‘8 minutes response to life threatening calls’ (read; out-of-hospital cardiac arrests) all came about in 1996 in a government sponsored paper by the ORCON study group, under the direction of R Chapman, entitled: “Review of Ambulance Performance Standards; Final report of steering group. NHS Executive 1996.
I wrote to the DoH in an attempt to get hold of a copy. A Mr Davie kindly responded.
“Currently we have no publicly-available copies of documents dating back from that time; any publication from that date would now be out of print. In sourcing copies, either print or electronic, I suggest that you contact the British Library.”
So, this catechism, that dictates the whole strategy of ambulance services up and down the land, is no longer available but is languishing in an archive somewhere slowly gathering dust. It’s findings; the current ORCON standards that are now ‘set in stone’ have gone unchallenged for nearly a decade.
Until now that is…..
I stumbled across this little gem; The Costs and Benefits of Changing Ambulance Service Response Time Performance Standards, Medical Care Research Unit, School of Health and Related Research at the University of Sheffield. May 2006– Download a PDF copy. This is another tome from the black arts of academia.
But first, a little recent history:
As mentioned, the ORCON standards are ‘set in stone’ and have been since that government report of 1996. It’s main commandment was that 75% of all Category A (life threatening calls) must be reached within 8 minutes. Of course the interpretation of 8 minutes was open to question. What exactly did ‘within’ mean; less than 8 minutes i.e. 7 mins 59 secs? or up to 8 mins 59 secs i.e. 9 minutes? And when did you start the clock running?; when the EMD in control picked up the phone?; when Control dispatched an ambulance?; when the ambulance left the yard? And when did the clock stop?; when the para/emt actually reached the patient?; when they pulled up outside the house?; when they got to the street? All these variables allowed managers to
cook the books, manipulate the times sorry, interpret the results in different ways.
Of course none of this has anything to do with patient care or clincial outcomes, it’s just become another way for the current oligarchy and their obsession with targets to ‘tick the right boxes’ allowing Comrade Hewitt to declare that the NHS is “having its best year ever.”
Last year the Department of Health published (another) document: Taking Healthcare to the Patient; Transforming NHS Ambulance Services. In it, the mantra of the 8 minute response time was reaffirmed only now:
“..for the purpose of measuring 999 Category A and Category B response times, the clock should start when the call is connected to the ambulance control room. This will more closely match the patient’s experience and can be consistently understood and applied by services. This change should be introduced from April 2007.”
This, ‘supposedly’ is great news for patients – the ambulance should reach them more quickly; and great news for ambulance services as we’re all starting the clock at the same time. In reality it means that crews will have less time to actually get to the call, response times for Cat ‘A’ calls will plummet and there’ll be the usual knee-jerk-we’ve-not-given-this-any-thought response from management.
As I blogged earlier, LAS are re-stucturing their whole fleet in order to meet these new, and more stringent targets; ‘Now you see us; soon you won’t‘. This was based on an article in the London Evening Standard. In it Mr Ian Todd, LAS assistant director of operations towed the party line and stated,
“the changes would mean significant improvements for patients such as heart attack victims, whose chances of survival drop by 10 per cent for every minute’s delay in getting treatment.”
Sounds grand doesn’t it? Where’s the evidence to back such a claim?
Tom Reynolds has also posted about it in What is an Ambulance?
So now let’s have a look at the conclusions of this new paper from the University of Sheffield;
Overall, rapid response in terms of an 8 minute target makes no discernible difference to survival to discharge. Nevertheless, we also know there are benefits – for the survival of a small number of out-of-hospital cardiac arrests, and in the short term in reducing levels of anxiety, pain and distress.
For all patients together there was no reliable evidence of an improvement in outcome with faster response, and we estimate that the odds of dying were only 1.4% less with responses ≤ 8 minutes compared to responses over 8 minutes.
Further developments in Ambulance service performance should be focused on better targeting and better clinical care rather than further response time improvements.
In addition, the ambulance services that the group reviewed were all using AMPDS, except one which used CBD. What did they think of computer assisted prioritisation?
The identification of life-threatening incidents was poor with over 40% of patients not needing admission to hospital.
So the Party has decreed that the yield per hectare of potatoes must increase, yet it’ll make no overall difference to the production quotas. Just more Labour lunacy in an effort to convince the great-unwashed that “things are improving”.