Diagnosis? N.F.I.

Dirty Welsh Laundry

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The Auditor General’s Report

Back in June, the Welsh Assembly narrowly voted for an inquiry into the state of the Welsh Ambulance Service. The vote was only carried due to a mistake by one of the councillors who “pressed the wrong button”. The subsequent report by the Auditor General suggests that most, if not all, of the recommendations are already being addressed by the new Chief Executive Alan Murray and his team. Consequently, the report has become a public washing of some very dirty Welsh laundry.

As expected, the previous management end up getting a right good kicking, but then it’s always easy to blame errors on previous incumbents when they’re not around to argue the toss.

[The problems were caused by] severe managerial instability arising from the absence of the substantive Chief Executive, Mr Don Page.

..though the Trust blamed its failures on the government i.e. not getting enough dosh to cope with demand.

Historically, the Trust has consistently, and to a large extent inappropriately, attributed the failure to achieve targets to increases in demand and insufficient funding to accommodate it.

The report manages to kick that argument into touch early on:

although many people historically, including the Trust, believed that the Trust is underresourced, we found little evidence to support this. Our analysis suggests that the Trust has relatively high financial and human resources in comparison with other UK ambulance services. However, there are questions about the efficiency with which resources are used and people deployed.

Having a bunch of amateurs in the office, similar to so many other parts of the Health Service, meant that those in charge of procurement managed to make a complete and utter hash of things. How come these people never seem to get sacked or at the very least posted out to some backwater job where they can’t do any damage?

• high profile procurement failures such as the procurement of 46 ambulances that were not fully fit for purpose because the Trust did not provide a coherent specification;

• And there is no standard system for PCS [patient care service] even though a procurement exercise led to expenditure of around £500,000 on a system that could not be used because it was not fit for purpose.

• the postcode and address databases (gazetteers) used in the Trust’s four controls to locate incidents are not standardised, do not recognise all postcodes and do not conform to the British Standards for address databases;

Ambulance services are, at the end of the day, dependent primarily on their staff so if you want changes it’s always a good idea not to piss them off. So, first off the report’s authors build them up:

The Trust’s staff are highly regarded by the public, and the majority of staff recognise the need and scope for the Trust to modernise, and have practical ideas about how to change things.

And then knock ‘em down. Sickness is always a good stick to beat the staff with, although if the management of my service is anything to go by, they consistently fail to address the causes preferring to ‘discipline’ staff instead:

levels of sickness absence remain high and compromise operational efficiency. Following Agenda for Change, sickness absence is likely to present even greater direct costs to the Trust. Although basic principles of policy and approach are in place, application has been inconsistent and sickness rates have increased since April 2005. The Trust should refocus on applying its sickness absence management policies in a robust and consistent fashion, and to speed up benefits realisation in respect of the electronic staff record system, in areas such as manager self-service for sickness reporting and direct access to sickness records.

But, like so many ambulance services, staff morale is low, very low:

Staff do not feel valued or listened to by Trust managers, despite the evidence that they are very strongly valued by the public of Wales. The Trust should communicate more regularly and directly with individual employees, as well as with the Trade Unions. Management development should address the need to recognize and praise staff and to ensure that all employees realise that the Trust recognizes their contribution and commitment.

…but the one thing that is really guaranteed to piss staff off is changing their rosters:

Rosters, both for EMS and PCS, do not take account of demand, which has compromised service quality. The current rosters provide more capacity than is required overall, but not enough capacity at peak times. In some areas, rosters are eight years old and do not reflect recent changes in the demand profile or the context in which the ambulance service provides services. PCS rosters tend to focus on the hours of 8am to 4.30pm and therefore do not support the needs of the NHS or its patients. The Trust should urgently review its rosters and undertake fundamental changes to ensure that services are arranged around the needs of patients.

We can expect some trouble ahead then…

According to the report, one of the main problems for the Welsh Ambulance Service has been that

The trust transports a relatively higher proportion of patients to hospital than rural services in England, which adds to the pressure on Accident and Emergency Departments and the ambulance service, and contributes to long turnaround times for ambulance crews.

The solution, of course, is to increase the use of, and reliance upon, our good friends the Paramedic Quacktitioners as a way to sort out these problems.

The very serious problems providing adequate services in many rural areas reflect the scope to support ambulance capacity with community-based paramedics who could provide emergency services and whose advanced skills can enable them to see and treat the patient without them needing to be transported to hospital. CPOs* can also work in primary care and minor injuries units. In areas like Powys, where transporting patients to hospitals outside the county leads to a significant drain on capacity to deal with genuine emergencies, the development of such roles provides opportunities to improve the quality of services and response times.

Dr Crippen had better be careful on his next holiday to Anglesey.

*Community Paramedic Officers: based on East Anglia’s model. Why they have to be ‘officers’ is beyond me. Probably something to do with having more bird-shit, sorry, pips on their shoulders

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Finally there’s the small issue of (insane) Thayne’s highly charged comment that “500 lives were lost avoidably as a result of the way that the service operated.” Who knows where he plucked that figure from but, as there’s no smoke without fire apparently:

Healthcare Inspectorate Wales are undertaking a review of clinical governance, patient care services and specific investigative work to assess the claim that 500 lives were avoidably lost each year because of the way the service operates.

Their report is due out shortly.

Better get in some more packets of Persil to launder all that dirty washing.

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