The perennial winter 'A&E Crisis' stories are with us again, this time with all-too-plausible rumours of targets and statistics about to be manipulated. Burnam's response for Labour was very nuanced and oblique, so he's obviously been told by Ed Balls to tread carefully and not make anything that might look like a costly promise to do better if Labour come to power.
One of my nearest and dearest had a 5-week involvement with the NHS a short while ago, including an ambulance service / A&E episode. I'm only too happy to acknowledge several aspects of the story that reflect well on the services we encountered (because there were some) but, from this very recent first-hand experience, there are some shockingly bad and wasteful practices in the emergency services that need sorting.
At a particular point in the saga a District Nursing team determined that 'immediate' hospitalisation was necessary. I was actively involved throughout what followed. The degree of urgency was, it is fair to say, below that of a heart-attack or ongoing stroke, but this was no leisurely admittance. The 999 call centre said that according to their prioritisation scheme an ambulance would be forthcoming in no more than 80 minutes (stated more than once, in a manner that conveyed a strong whiff of Statutory Target).
After 3 hours, two more 999 calls and no ambulance, a senior District Nurse attended and worked the 'phone to get a bit of priority. At 4 hours a team of 2 'first responders' showed up. They made a few simple tests, administered oxygen, and asked a heap of questions. Shortly thereafter a one-man 'ambulance' turned up - in an estate car jobber that wouldn't ever have been a suitable conveyance. The new man on the scene brought into the house even more portable equipment and had a load more questions - not directed to the DN or me, but to the first-responders. Finally, a 'proper' bed-ambulance arrived with two more operatives (and a load more questions, this time posed to the first ambulance man). More than 3 hours after the 'maximum 80 minutes' we now had 5 NHS staff and 3 emergency vehicles on site, to get one patient into one ambulance .
I'll maybe recount the A&E saga another time. For present purposes let it simply be noted that although the (uneventful) 15 minute drive to the hospital allowed the ambulance attendant to complete a raft of paperwork (I was sitting alongside the whole time, answering yet more questions), upon arrival the attendant went to a desk to be interrogated from square one by a reception nurse, going over all the same ground once more (the fourth time).
Let's put to one side the suffering and distress, and address the effectiveness of the operation.
The first lesson: despatch, deployment and coordination of vehicles, crews and resources wasn't just sub-optimal, it was appalling - how come that after 4 hours we wind up with 3 vehicles plus 'highly-trained' crews, only one of which is actually needed ? Somewhere in the worlds of, oh I dunno, Air Traffic Control ? RAF casevac mission control ? Minicab despatchers? 24-hour emergency plumbing firms? - there must be people and software that can marshall limited resources a damned sight better than that. Until the gross inefficiency is sorted, please don't tell us there is a shortage of anything.
Secondly, the transfer of information was worse than primitive, it was utterly ineffectual. The crazy sequence of chinese whispers conducted right under my nose was an outrage to any system of communication anywhere, any time. Why, during the first 3 hours, hadn't the District Nursing service equipped the ambulance and A&E services with all the basic info, if only by 'phone? Why were they asking each other all the same questions in turn? (Well, because they were all there, I guess - and all had log-books to complete in due course! I'd be interested to compare them all ...) Why didn't they direct the questions to the horse's mouth? Why was there such a low level of fidelity in successive verbal transfers? The number of times I had to correct inaccurate chinese whispers was well beyond a joke, and I shudder to think what might have happened if I hadn't been standing right there to do just that.
Finally, why was it all by word of mouth, when at several stages there were really obvious opportunities for bluetooth transfer of digitised info, or at least recourse to everyone using an SMS-based central system? We all know how quick those systems can be. The time in the ambulance was essentially wasted, not to mention the consequential waste of time at A&E when both the reception nurse and, perhaps more importantly the ambulance crew, could have moved onto the next job five minutes sooner. (I might add that within the hospital itself the 21st century has been embraced in this regard: they have got basic single-keystroke and direct-from-sensor info-transfer via hand-held devices down to a fairly fine art - so the understanding and technology do exist in the NHS.)
These basic process-and-systems deficiencies are grotesque, and must in some instances (though not directly so in this case) be life-threatening. 'Soft' issues like suffering and distress are much alleviated by slick, optimised processes. Costs are cut by eliminating waste - again, via slick, optimised processes. Everything screams out for this to be brought into line with readily available modern methods. Shame on the management that soaked up the billions pumped in by Blair and Brown without addressing these basic imperatives.