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| NHS ambulance service forces elite paramedics to take non-urgent calls NHS ambulance service forces elite paramedics to take non-urgent calls | |
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| An NHS ambulance service has been accused of endangering patients’ lives by scrapping a system under which specialist paramedics responded to the most urgent 999 calls, such as strokes, heart attacks and car crashes. | An NHS ambulance service has been accused of endangering patients’ lives by scrapping a system under which specialist paramedics responded to the most urgent 999 calls, such as strokes, heart attacks and car crashes. |
| A leaked memo from the South East Coast ambulance service (Secamb) shows its most highly trained paramedics will have to deal with minor ailments because it cannot cope with soaring demand for care and ambulances are taking too long to reach patients. | A leaked memo from the South East Coast ambulance service (Secamb) shows its most highly trained paramedics will have to deal with minor ailments because it cannot cope with soaring demand for care and ambulances are taking too long to reach patients. |
| The move has angered Secamb’s 60 critical care paramedics (CCPs), who warn that lives could be lost because they are busy dealing with non-urgent callouts, such as back pain, instead of life or death emergencies. | The move has angered Secamb’s 60 critical care paramedics (CCPs), who warn that lives could be lost because they are busy dealing with non-urgent callouts, such as back pain, instead of life or death emergencies. |
| The paramedics, who have all gained a postgraduate certificate in critical care after a year’s extra study, specialise in administering drugs and performing procedures that standard ambulance crews are not trained to do, including advanced resuscitation techniques. They have saved countless lives during the 10 years the CCP system has existed. | The paramedics, who have all gained a postgraduate certificate in critical care after a year’s extra study, specialise in administering drugs and performing procedures that standard ambulance crews are not trained to do, including advanced resuscitation techniques. They have saved countless lives during the 10 years the CCP system has existed. |
| Secamb, which provides NHS ambulance services in Surrey, Sussex, Kent and north-east Hampshire, has 725 general paramedics and 90 paramedic practitioners. The latter specialise in treating patients at home so they do not have to go to A&E. | Secamb, which provides NHS ambulance services in Surrey, Sussex, Kent and north-east Hampshire, has 725 general paramedics and 90 paramedic practitioners. The latter specialise in treating patients at home so they do not have to go to A&E. |
| In the memo sent last week, which the Guardian has obtained, Geraint Davies, the service’s acting chief executive, admitted the move “will cause some anxiety and uncertainty”. Unions representing Secamb ambulance crews have voiced deep unease and one CCP, who did not want to be named, criticised the change as “shortsighted, risky and not right”. | In the memo sent last week, which the Guardian has obtained, Geraint Davies, the service’s acting chief executive, admitted the move “will cause some anxiety and uncertainty”. Unions representing Secamb ambulance crews have voiced deep unease and one CCP, who did not want to be named, criticised the change as “shortsighted, risky and not right”. |
| “People will suffer because of it,” he said. “The risk is of death among patients who could have been saved, maybe because we were tied up dealing with a minor ailment such as a cold, toothache, period pain or any of the other rubbish that people dial 999 with [which obliges Secamb to respond]. | “People will suffer because of it,” he said. “The risk is of death among patients who could have been saved, maybe because we were tied up dealing with a minor ailment such as a cold, toothache, period pain or any of the other rubbish that people dial 999 with [which obliges Secamb to respond]. |
| “It could be that we’re with Mrs Jones who, after having back pain for four years, suddenly decides to call an ambulance about it. Secamb have kept us away from stuff like that for years; that system has worked, we have saved a lot of people as a result of that, including resuscitating people who were in effect dead, and now this.” | “It could be that we’re with Mrs Jones who, after having back pain for four years, suddenly decides to call an ambulance about it. Secamb have kept us away from stuff like that for years; that system has worked, we have saved a lot of people as a result of that, including resuscitating people who were in effect dead, and now this.” |
| Nigel Sweet, a Unison steward for Secamb, said: “There is always a possibility that in the case of a very serious incident such as a road traffic collision or cardiac arrest, where CCPs are crucial, they won’t be available. Instead they will be responding to a standard callout. That could threaten that patient in that situation. That’s the concern.” | Nigel Sweet, a Unison steward for Secamb, said: “There is always a possibility that in the case of a very serious incident such as a road traffic collision or cardiac arrest, where CCPs are crucial, they won’t be available. Instead they will be responding to a standard callout. That could threaten that patient in that situation. That’s the concern.” |
| In his email, sent on 20 December, Davies defended the change, saying: “It is essential that we utilise all of our resources to the maximum benefit of all of our patients. | In his email, sent on 20 December, Davies defended the change, saying: “It is essential that we utilise all of our resources to the maximum benefit of all of our patients. |
| “It has been agreed to remove the critical care paramedic regional cover plan and place CCPs back into the trust system status plan [general workforce]. This will mean that CCPs will now be available to respond to all categories of call.” | “It has been agreed to remove the critical care paramedic regional cover plan and place CCPs back into the trust system status plan [general workforce]. This will mean that CCPs will now be available to respond to all categories of call.” |
| Then, in a passage that critics say shows Davies is ignoring the evidence for continuing to let CCPs concentrate only on life or death cases, he said: “While the quality impact assessment rightly recognises the valuable clinical contribution that CCPs make to seriously ill and injured patients, the [Secamb] executive [team] felt that, while demand is high and while our response performance is poor, we could not continue with the current CCP model that, in essence, ‘holds back’ CCPs from responding to some categories of patient.” | Then, in a passage that critics say shows Davies is ignoring the evidence for continuing to let CCPs concentrate only on life or death cases, he said: “While the quality impact assessment rightly recognises the valuable clinical contribution that CCPs make to seriously ill and injured patients, the [Secamb] executive [team] felt that, while demand is high and while our response performance is poor, we could not continue with the current CCP model that, in essence, ‘holds back’ CCPs from responding to some categories of patient.” |
| The change came into effect on Wednesday 21 December and will continue until the end of March, at which point it will be “reviewed”, he said. It is part of Secamb’s “trust recovery plan” after it was put into special measures in September. In July, the Care Quality Commission described it as inadequate and said the service’s urgent and emergency care was “unsafe”. | The change came into effect on Wednesday 21 December and will continue until the end of March, at which point it will be “reviewed”, he said. It is part of Secamb’s “trust recovery plan” after it was put into special measures in September. In July, the Care Quality Commission described it as inadequate and said the service’s urgent and emergency care was “unsafe”. |
| A Secamb spokeswoman said: “We have little evidence at this stage to know whether CCPs being in the plan or out of the plan will be more or less beneficial to our patients, which is why it was felt prudent, given the challenges the trust is facing and our shortage of paramedics, to look at this.” | A Secamb spokeswoman said: “We have little evidence at this stage to know whether CCPs being in the plan or out of the plan will be more or less beneficial to our patients, which is why it was felt prudent, given the challenges the trust is facing and our shortage of paramedics, to look at this.” |
| No final decision on the role of CCPs would be taken until March, she said. | No final decision on the role of CCPs would be taken until March, she said. |
| On Monday, Richard Webber, Secamb’s on-call strategic incident commander, said it is “struggling” to cope with a 10% year-on-year rise in the number of 999 calls. The situation is exacerbated by the service having 138 vacancies for paramedics, up from 105 last year. | On Monday, Richard Webber, Secamb’s on-call strategic incident commander, said it is “struggling” to cope with a 10% year-on-year rise in the number of 999 calls. The situation is exacerbated by the service having 138 vacancies for paramedics, up from 105 last year. |
| Secamb was revealed in February to have secretly brought in a pilot system for three months in 2014-15, under which it delayed sending an ambulance to some 999 calls transferred from the NHS 111 telephone service so it could assess their condition. The patients involved were at the level below those deemed to be in a life-threatening condition. | Secamb was revealed in February to have secretly brought in a pilot system for three months in 2014-15, under which it delayed sending an ambulance to some 999 calls transferred from the NHS 111 telephone service so it could assess their condition. The patients involved were at the level below those deemed to be in a life-threatening condition. |
| Jon Ashworth, the shadow health secretary, said: “In recent days I’ve been warning of the extent of the national paramedic shortage. And now we learn of the drastic action this trust is taking in order to cope. | Jon Ashworth, the shadow health secretary, said: “In recent days I’ve been warning of the extent of the national paramedic shortage. And now we learn of the drastic action this trust is taking in order to cope. |
| “The redirection of critical care paramedics will raise fears for patients in need of the most urgent, emergency attention and the trust must urgently explain its rationale for this decision.” | “The redirection of critical care paramedics will raise fears for patients in need of the most urgent, emergency attention and the trust must urgently explain its rationale for this decision.” |
| A Department of Health spokesperson said: “No patient should have to wait longer than necessary for an ambulance and NHS England is working closely with the services to improve response times. We’ve recruited 2,200 more paramedics since 2010 to reduce pressure on services and have increased the number of training places this year by 60%.” | A Department of Health spokesperson said: “No patient should have to wait longer than necessary for an ambulance and NHS England is working closely with the services to improve response times. We’ve recruited 2,200 more paramedics since 2010 to reduce pressure on services and have increased the number of training places this year by 60%.” |
| Meanwhile, the British Medical Association has warned that the NHS will struggle to cope if the government fails to tackle the social care crisis. | Meanwhile, the British Medical Association has warned that the NHS will struggle to cope if the government fails to tackle the social care crisis. |
| Health and social care services are “desperately trying to prop up” one another, but are “cracking under the weight”, said the BMA chair, Dr Mark Porter, in his new year message. | Health and social care services are “desperately trying to prop up” one another, but are “cracking under the weight”, said the BMA chair, Dr Mark Porter, in his new year message. |
| The warning comes as analysis by the doctors’ trade union showed there will need to be £26bn of cuts from health and social care costs by 2020-21 to balance spending. | The warning comes as analysis by the doctors’ trade union showed there will need to be £26bn of cuts from health and social care costs by 2020-21 to balance spending. |
| Health managers in 44 areas of England have been ordered to draw up strategies, setting out how they will cut costs, change services and reduce care after the NHS ran up a record £2.45bn deficit in the past financial year. | Health managers in 44 areas of England have been ordered to draw up strategies, setting out how they will cut costs, change services and reduce care after the NHS ran up a record £2.45bn deficit in the past financial year. |