Thursday 21 February 2013

Private Parts

"79 year old female, abdo pain"

For a change from the norm, I wasn't working on an ambulance. Tonight I was on the FRU (Fast Response Unit) car on my lonesome. A typical 12 hour car shift generally consists of sitting on standby waiting for the higher priority of calls to come through. You generally stay in your area so that you can be on scene quickly for the patients (and to stop the clock before the 7 minute 59 second deadline). Unlike the ambulance you are not sent to anything and everything which is a pleasant change but you do often have to wait some time, often with a sick patient, for an ambulance to arrive. When the ambulance arrives you hand over and leave your patient in their more than capable hands. If there is no paramedic on the ambulance and you either have concerns about the patient or need to administer drugs etc  then you may travel with the crew but more often than not it's a simple handover and off you go.

I arrived within about 3 minutes of the call coming in, grabbed all my kit (so much heavier on your own) and trundled up to the front door. Once inside I was taken to the patient who was sat on the toilet. She was obviously in pain so offered her some Entonox which worked well. The basic aim for the FRU is to a) stabilise the patient and get us much information, history and observations as possible before the crew arrives. I checked her over and most of her observations were OK. Her heart rate was raised a little and her temperature was a little high but other than that it was just a pain problem. I suspected from the way she was describing it, it was an inflamed stomach ulcer or something similar and she had a history and medication list to match that. I couldn't give morphine as she had a known sensitivity to it so it was a case of waiting for a crew to take her in. Simples!

Then, the crew arrived. Not a crew from my NHS Ambulance trust but a private ambulance service. The two middle ages guys were rude to the relatives who were trying to tell them what was happening on their way up the stairs. 

"We'll find out what going from the car driver if it's OK."

What a douche bag! Sure, clinically, you'll find out what is happening from the FRU but there is no harm is at least pretending to be interested in what the family have to say. Also, 'car driver'?! Seriously?! Two middle aged guys stood in the door to the bathroom, the one who appeared to be attending had his arms in his pockets and was chewing gum in a hugely grotesque way. I started my handover with full history, observations and differential diagnosis and it was clear he wasn't listening to a word I was saying. In fact, half way through, he turned to his crew mate to say 'reckon she can walk'. I ended my handover with, 'so if one of you could grab a chair that would be great'.

"I reckon she'll be alright on her feet"

"Well I'd like her to go in chair, so could you get a chair please."

He didn't bother hiding his displeasure and rolled his eyes. They BOTH went to go and get the chair, clearly to have a bitch about me. I've been on scene for 25 minutes, if they had listened to my handover they would have heard me describe her pain and would have heard me say that the Entonox is helping but is making her dizzy. They would have also heard me mention her usual mobility is slow and she uses a frame. A lifetime of tax and national insurance and being unwell entitles a 79 year old to god dam chair in my opinion. These numpties would just have to suck it up. 

After helping carry her down the stairs because one of them 'had a bad back' we got her onto the ambulance. The driver got in the front and the attendant sat behind the head of the patient. I find this impersonal and rude but that didn't surprise me from these two. 

"Are you going to monitor her and give her some more Entonox?"

"We don't have any and what are supposed to monitor?"

"Her pulse, oxygen saturation, her blood pressure etc."

"But you've said they were OK"

"But it could change!"

Again he rolled his eyes and reached for a blood pressure cuff. I'd had enough, I didn't want to spend any more time with them but I also didn't want to leave this lovely elderly lady in their 'care'. I decided to travel with them, bring my Entonox and monitor the patient myself much to the annoyance of Tweedle Dum and Tweedle Dee. Eventually, we go to hospital, I handed over to the nurse and managed to grab another FRU to take me back to my car. Before I left I told the private crew what I thought of their lacking professionalism and told them in no uncertain terms I'd be lodging a complaint. They didn't seem to care one iota. 

This job is not an isolated case unfortunately. If you speak to any FRU who has come across one of the ever increasing amount of private ambulance services you will hear similar tales. At busy periods, my service is becoming more and more reliant on them rather than using the money to staff their own ambulances. There is little or no quality control and you also have a situation where vast numbers of staff who have been sacked for a wide number of reasons from drink driving, drug offences, misconduct, patient complaints and having sex in ambulance service vehicles are now working for the service again through the private companies who's only motivation is money. 

This is having an effect on patient care and it is only getting worse. The training these private ambulance services provide to their staff is minimal at best, they are generally staffed with much less qualified members of staff because it is cheaper that way. They also are picking from a much smaller talent pool because generally, and there are exemptions, the people looking for work in the private sector are not qualified or not allowed to work for NHS trusts. i.e.: criminal records and those previously struck off by the HCPC. As the role of Emergency Medical Technician, Emergency Care Assistant etc are not protected or registered titles, anyone can do them. I met one crew who between them had had 6 days of training before stepping foot on the ambulance. It's a liability. They are a bunch of cowboys and chancers. 

In my opinion these companies need to be irradiated. Where money is the primary focus, patient care will suffer. That's a fact. Sure, it may be cheaper for the government to gradually privatise the ambulance services but at what cost. I certainly wouldn't want these imbeciles to go to a member of my family. Would you want them to come to yours? It seems that the budget cuts are being used to undermine the ambulance services for the ulterior motive of future privatisation. If you cut our staff and cut our budgets we cannot work as efficiently with the ever increasing call volume. Then, to blame us and say private ambulances are the way forward because we are not providing the level of cover required is absurd. Put the money to where it is needed. Well trained staff on well equipped ambulances. What do I know, I'm just a bum on a seat, I probably can't see the big picture. 

By the way, that 'Big Picture' the Tories tell you all about is this...... A picture of our elected MPs and our unelected Lords sitting round a big table, raising a glass to the stroke of genius that led them to all own shares in private medical companies and then sell of the NHS to the highest bidder, thus making them all richer than they were. Great picture from down here.


  1. Two things, 1) They get paid more than you too so how is it cheaper to use them?
    2) I think the public will be surprised to know that it's not unusual for an NHS ambulance to be crewed by other than a paramedic. In fact they assume you're all paramedics. In fact, they think a para,edic is anyone working for ambulance service. How wrong can you be?!

    1. It's much cheaper for an NHS trust to use private providers than their own staff. There's no sick leave to pay, no maternity leave to pay, and no AfC to adhere to. Often the private providers bid at amounts ridiculously lower than the contract is actually worth just so that they win it.

      The public do assume that everyone on an ambulance is a paramedic, granted. But at least with NHS Ambulance Services all technicians will be ICHD technicians, and all ECAs/APs/Whatever the term for them this week is should be crewed with a qualified member of staff. Private services can call whatever they like a tech, and regularly send out DECA crews. It's unusual for an A&E tier ambulance in the NHS to be crewed by a DECA crew.

      NHS Trusts also have quality control in their employment. I can give you hundreds of examples where people sacked from NHS trusts for such things as Ella has pointed out who have immediately been given private jobs and have been contracted back to the same service they were sacked from!

    2. Helen, in addition, just because a service is private, it doesn't mean the staff are paid more. I suspect you are thinking of bank staff provided by private companies, but usually in things like physio(the one I know most about), although you are private, your wages are the same as people in the NHS - but we don't have the perks like a pension or extra days of holiday after ten years and so on. I'm actually not against contracting out where there is a need (like physio, where most departments have massive waiting lists). It can also mean BETTER treatment for patients, certainly in physio. Many trusts put restrictions on hands-on treatment etc, whereas our only restriction is we are limited to 5 treatment sessions (and even that is discretionary). This sort of contract has been going on since GP fundholding AGES ago - there was no need to change the rules (and the fact that they are changing makes me think it is to lead to full privatisation).

      I think protection of title would make a HUGE difference and stop this sort of malpractice - it's worked with physio, which only became protected relatively recently. It means then that staff HAVE to be properly registered.

  2. Hey Ella, great post as usual! You are probably my most read blog at the moment! Just a quick these private ambulances have NHS signage/NHS uniforms...I'm guessing not? And is there different contractors within the NHS?

    I guess what I'm getting at, is if they're in an NHS uniform and NHS ambulance - are they an NHS EMT/para?

    1. If their uniform has the NHS logo on, then yes, they are an NHS crew. Private providers try and look very much like NHS crews (god knows why!) but aren't allowed to use the NHS logo or the crest.

    2. Just to be aware. Not all NHS services have the NHS logo.
      Wales does not, for example.
      Pretty sure West Midlands do not, either :)

  3. Hi,
    Just read your blog, I don't work for the ambulance service but I find it disgraceful that this is going on. I didn't realize private ambulance crews were being sent out to 999 calls.
    When you are not feeling your best even a little compassion goes a way to making you feel better, a concept the above two twats don't seem to have grasped.
    How unprofessional chewing gum and not even to acknowledge the patient.
    Totally agree with you, Money shouldn't be the primary focus, patient care and well being is surely the most important factor, This government has it so wrong.
    You need the money to continue the great job you do, on a daily basis - To provide the Training, Equipment, Vehicles, CPD's don't give the money to private companies.
    You all provide a great service just wish these pen pushes would do one and let you get on with the job you do best - Helping others in need.

  4. This makes me annoyed as I work for a well known charity that also does Support and PTS work for the NHS and we are very highly regarded in our area for the work we do. However there are so many private ambulance services ruining our reputation because we're placed under the same umbrella as them. In my area we can drive NHS cars if a para travels with a patient in the truck, we've built up a good relationship with the local trust and also with local hospitals.

    1. I volunteer for a well-known charity -probably the same one, maybe the other one, and occasionally do A&E support at the weekends.
      I enjoy it as it keeps my ambulance skills up to date, and makes me think about what to do in situations I'm not so likely to encounter at events.
      We have our charity name on our uniform - I'm proud to be working with the NHS on this work, but would never claim to be a Technician or Paramedic, as I'm not.
      We could quite easily have been sent to assist at the above job, and would be happy doing so - backing up RRVs/FRUs is a standard bit of our work. I'd like to hope Ella would be willing to hand over to us!

    2. Probably the same one, not sure "the other one" does Support. I'm in my Ambulance Aid training at the moment but have been out 3rd manning a few times recently and am good friends with several of our full time crews.
      I correct anyone who calls me a paramedic, my current reply of "actually I'm a first aider and am doing this voluntarily" usually shuts them up :P

    3. both organisations do support work in London

  5. I'm curious, what was the alleged skill level of this crew ECA / "tech" / Para ?

  6. its common practice for privates to put on cad with skill level EMT3 . I don't like it.

  7. try not to tar us all with the same brush. some private providers have much much better training/CPD etc than tweedle dee and tweedle dumb recieved. infact i have known NHS crews to just walk in and ignore my handover purely because i work in the private sector.

    can't we all just learn to get along and not assume everyone to be completely incompetent until proven otherwise?

  8. Private crews aren't necessarily bad, in the same way that NHS crews aren't necessarily good. I don't think there is a separation in motive between them, especially now in the foundation trust world, where every NHS ambulance finance director is looking to maximise profits (and this is why we see ECAs replacing techs etc.).

  9. I agree with Ella on this- cracking post. There have been some unbelievable things done by private crews in our area - things that in anyone's language are bad..even with a bit of common sense you wouldn't do. Some are good. Don't forget that, alot are bad.
    Our Service was 'exposed' by the local news paper as using private providers to hit targets a while back. Unfortunately, due to the Government's ridiculous response targets, call connect and a massive increase in call volume, our service had to do it. I'm sure the public had/have absolutely no idea who was looking after them. I also agree on the misconception that the word 'paramedic' is now a generic reference to ambulance staff- it doesn't signify a skill level to them, just another 'ambulance driver' !!!!!.

    A little off tangent but the public seemingly don't even know we are classed as an essential service and not an emergency service. More Government crap

  10. I wholeheartedly agree with what you say. However I also have to say I've come across a small number of the pair you describe above in the NHS too. There are good and bad in all services unfortunately. The problem is the recruitment processes used in the private companies allow more of the bad to filter in.

    Sadly NHS services are starting to go the way that social care has gone over the last few decades. Once upon a time if you needed care it was predominantly provided by public services. Then they started to outsource as they thought it was cheaper. Now most care is provided by private providers contracted by local authorities. For a long time the level of scrutiny was low, and there were good and bad in the industry, and far too much bad. I've seen some of the dreadful ones first hand, and am pleased to be able to say I've had a hand in closing some of the worst ones in my area.

    Thankfully things are on the up in terms of scrutiny, and much more monitoring goes on. This has taken some fairly horrific incidents to bring this to the top of the agenda, Castlebeck and other similar, but we are getting there at last.

    For me the key is the very starting point. Its the way the services are contracted and commissioned initially, its the detail in the contract and the spec. You can't hold a provider to anything you haven't written in the spec, so if you want a minimum standard of training, state it! If you want a minimum level of vehicle spec and equipment, put it in the spec. Minimum staffing levels etc, you get the picture. Put the work in initially and it will save you so much grief in the long run. And consult with the right people. I've just spent weeks and weeks doing a spec for a complex care service we are commissioning, its huge, but given that we are spending about 25 million I figure it needs to be right.

    I have a lot to do with NHS commissioners and I have to say, they are a long way behind in terms of the commissioning process and the scrutiny one. They use standard one size fits all contracts. Because historically most of their work is with other NHS providers they aren't used to monitoring as closely as you have to with the independent sector. They spend huge amounts with providers without even knowing how the money is spent. In terms of scrutiny of private care providers, our local PCT don't do any! I do it all for joint contracts, and even some of the purely health ones. Then when the proverbial hits the fan their Head of Quality is on the phone panicking.

    The NHS commissioners have a lot of catching up to do, and fast! Especially with the changes that are currently underway. Its going to be a steep learning curve, but unless they get their act together, more and more of what you describe above will continue to happen. They also need to become more accessible. If a social care professional has a complaint about a care services, they have no hesitation in picking up the phone for a rant I can tell you. Healthcare professionals need to be able to do the same to the people who are commissioning these services. Go on, do it........

    Sorry for the length of the response, but its something I'm passionate about. And can I just add the team I work in did win a national award for commissioning!

  11. For me it is simple. Why are they cheaper? Something isn't as good. Now, it may well be their terms and conditions but more likely it is training and equipment. If we look at the care home industry. The fees are hardly cheap. The staff are mainly untrained minimum wage on horrendous conditions. The residents share rooms with a curtain for a divider, eat poor food and have a TV as their only stimulation. So where is the money going? Into the owners pocket. Do we really think that private profit is a great way to run a healthcare system?

  12. Whaaat??!! I honestly had no idea that private ambulance services existed! That is shocking. Did d bloody good job of hiding that one didn't they... x

  13. If all these folk dont know about Private Providers, how many have heard of CFR's (Community First Responders) ?

    1. Hi,

      I have heard of Ambulance Community Responders ( Is this the same thing )volunteering to respond alongside ambulance services to life-threatening emergency calls.

  14. This incensed me - there's absolutely no excuse for such poor patient care and I hope that your complaint saw some action taken.

    I'm a volunteer for a charity that supports the Ambulance services (B&W, not Red!) and the training we receive and the processes and sense of duty drilled into us by not only our instructors but by the NHS Paramedics, Doctors and Nurses that train and assess us is evident in the support we provide and the excellent working relationship we have with the NHS in our area - we're frequently called to back up Paramedics and even, on occasion, provide a basic first response service. Not all non-NHS ambulances have idiots inside them.

    Equally, as someone pointed out, both my colleagues and the NHS staff we work with have their horror stories about crews and other staff who are clearly in the wrong profession. I've seen stress do strange things to good people, but occasionally you just get bad healthcare workers.

    Everyone deserves the best patient care we can offer them and its in all of our interests to try and make sure that happens.

  15. Hi

    I too am discussed at the treatment this patient recieved and should never have happened, I hope you reported this crew and action was taken, If the NHS Trust in question has not taken action you can report this company to the Care Quality Commission under the whistle blowing service if you have a concern over its care levels.

    However lets not tar all independant ambulance services with a huge brush, working alongside the NHS as various independant services including St John and the Red Cross services and then Licenced and Registered CQC Independant Ambulance services, These should have recruitment, policies and procedures similar to the NHS and if they don't again this is a reason to report them to the CQC.

    There are good companies and bad companies as there are good and bad NHS trusts one trust in my area even was forced to merge with another trust as it could not meet clinical levels needed to become a foundation trust on its own, due to the state of its business.

    I am a firm believer that if using a private ambulance service NHS trusts should ensure that not only they are CQC registered but also members of the IAA which is the Independant Ambulance Association which gives another level of compliance and checks on the company and again another avenue for comlaint if a member is sub standard.


  16. As I understand it (I might be wrong) - NONE of the private providers are subject to the same checks, monitoring and so on as NHS staff.

    Above all when the company running it is not UK-based - oh yes, that can happen too. Something goes wrong - and they have disappeared in a cloud of dust, gone bust, been reincarnated under another name so they are a different business.

    The silicon implants fiasco is an example - and who is expected to pick up the tab? We, the taxpayers who pay for the NHS. Funny how people can afford the cosmetic surgery but are horrified when they are told they should also pay for sorting out what has gone wrong...

  17. That's shocking Ella. I'm a paramedic and in our area only NHS provide 999 responses thank god. Is your Trust onto it? If not they should be. I don't understand how standards can be so low, when the contracts awarded allegedly don't compromise patient care (we all know they will do, but that's another story). These private services must come under CQC, surely? And if not, why not?

  18. Firstly the story doesn't ring true - It looks to me like an American story badly re-written to "fit" the UK - The language is all wrong. Secondly, I've never had anything other than excellent service for UK ambulance crews. Anyone care actually verify this?????

    1. What do you want verifying? There are bad ambulance crews in every ambulance service all over the world. Like there are bad doctors and bad nurses. What doesn't 'ring true'?!

  19. Hi, Firstly I strongly suspect that you are LAS as I am also LAS. Im a FRU EMT4 and I am well aware that we are the trust utilising private and volunteer crews the most in the UK at the moment.

    I really want to make a point here that perhaps you are not going to like. As a constant FRU member of staff I have been backed up by hundreds of private and volunteer crews and although I have a few horror stories I really do feel that trust staff are unfairly and over-the-top critical of these guys. Some of the gripes that our guys hold are unfounded and down right ignorant! I have met some very good top class clinicians who are from the private sector and who are forced to work there through circumstance i.e. their rural trust hasn't recruited for a number of years but a private provider will board them feed them and pay them a wage to come and help us out... does this poor individual deserve the near constant snarky attitude from every trust member of staff they come they dont and whats more I am embarrassed by the attitude of a lot of my comrades! the majority are decent, there are a few who are exceptional and a few who are ridiculously sub standard, but guess what... I have also been backed up by NHS crews who have been appalling! in fact on one shift I was backed up all night by an awesome private crew and once by one of our own who were appalling! I was wishing for that private crew during that job! And lets see how many people are willing to admit this one.... from time to time I call it completely wrong... from time to time I may accidentally come accross as rude, perhaps its a bad day were Im sick of the job or have personal problems going on in the back of my mind, Im sure if we are ALL honest, we ALL fall short from time to time as humans, but I tell you this I ALWAYS try my best for anyone that needs me.
    As for their uniforms, hardly the fault of the staff what uniform they are provided is it?

    In short I think my colleagues should get off their high horse and realise how lucky they are to be the ones in the stable well paid, well benefitted job and stop being so nasty to the privates and volunteers.
    Personally I don't agree with private companies being involved in an emergency service, but I'm defo not going to take that on the crews. Perhaps if the government spends the money to create all the extra jobs within our trusts for these guys then the problem would be solved. I mean it is apparent that they are needed, just not by this route!


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