Thursday, 28 April 2011

Goodbye JT

Some of you already knew this but my wife and I were expecting another child - another son, due in August. Sadly, he died on Tuesday morning and, although this is a very painful and private time for us, I feel its best that all who know me are told so that there is no awkwardness or repeated explanations necessary in the future.

I will be taking a break from everything to be with my family and will get back here as soon as I am able.

Thursday, 21 April 2011

The Station - the new book

The novel is finished (just about - about 500 words to go) but it's an uphill struggle getting a publisher because nobody is spending on books any more. So, I have put the first five chapters up on an e-book for you all to read and comment on.

There is a plot and a twist in the story ( a few twists in fact) and yes, for the sake of art and reality I have had to use profanity (I know some of you will disapprove - especially my mother) but please read what I have offered and give me feedback.

I still have to re-read to refine this draft but it's nearly there. The e-book will only be up on this link for 7 days, so there is limited time to read it.

If you are a publisher - get in touch! Otherwise I will publish it myself and put it on ebay as an e-book.

Thanks all!


End of days - part 2

The 'P' word certainly stirred  up some heated debate and I'm glad that, for once, something I've raised for discussion hasn't descended into abuse just because I have an opinion.

Your arguments against the privatisation of the NHS were largely sound but I wasn't arguing in favour of the slicing up of an entire system. Rather, I was looking for a debate on the removal of those parts that are costing us so much and which achieve, for the money we pay in, so little. A private company, employing medical professionals, to scrape up the drunk and wasteful from our street would be one idea. They could be taken to a hospital that has 'opted in' to the scheme to recover. Once it had been established that they had just been drunk, a fee would be imposed for the cost of their care. It's a work-in-progress idea but it's not very different from the principle of the 'Booze Bus' that my colleagues currently run, except that there is no penalty imposed and so a lot of youngsters think it's a badge of honour to get on it - like an ASBO - due to it's fame after lots of TV coverage.

And yes, some of the great unwashed would simply not pay and a solution to that problem would have to be found but, just like charging a fine for calling out the Fire Service inappropriately, most people would pay it and probably learn a lesson from it too. If the cost of getting drunk is going to be exceeded by the cost of recovery, then it may be best to temper your drinking behaviour. It's not ideal but it's never been tried, so it might be worth a go.

And for those of you who argued that health workers would be poorly paid in the private sector, you were obviously thinking of large companies with shareholders. I was not. Doctors, Nurses and Paramedics continue to earn more working for small, private companies, that's why so many of them can be found attending sports events and the like.

Nevertheless, it is very worrying that we have reached this juncture; where we cannot see, one way or the other, how our great health system can be fixed. There is a Utopian ideal and it's one in which the hospitals are efficient and clean. where staff are well paid, happy and dedicated to the care of their patients. One in which the person in charge is not a suit-wearing Manager but a senior Doctor with the right qualifications to understand the basics of economy and team-work. That, unfortunately, is a 'Carry-on' movie.

Now, to more nitty-gritty that you won't like.

I have received more and more emails by young people (and some not so young) who want to start University and get a degree in Paramedic Science. I get a lot of requests for information and advice but, unlike a few years ago, my recent feedback has been rather negative.

I have been saying for some time that the over-recruiting of new student paramedics in the UK would lead to a glut and that, sooner or later, there'd be too many cooks and not enough broth. This is now happening. There are not enough jobs for them and with the economy in its current state, there will be less prospect in the near future for those embarking on a career as a paramedic, or nearing the end of their course.

University fees are rising, with most of the establishments demanding the maximum amount (£9,000) for certain courses. So, things look even more bleak for a new generation of paramedics and it's a damned shame.

Sure, there will be retirement vacancies and 'dead man' shoes to fill but most Trusts won't be recruiting into those posts because it will save money not to... and they all have to save money.

I still believe this is one of the best jobs on Earth and I encourage those who want to become paramedics to fight on but the reality of the situation must be considered first. It's become an expensive career to embark upon; the cost of getting a C1 licence, which is a necessity, is almost £1,000... then there's the annual Uni fees and living expenses for 2 - 3 years. After all that, you may not even have a job to go to.

The private sector may still be an option and some services are filling posts that were unfillable during the good old days, when services like London were favoured by new paramedics, so all hope is not yet lost!

My advice to those of you who wish to become paramedics is this: think it through, talk to paramedics you know and find out about your local ambulance service - test the water and remember you are looking at the future, not now. What's it going to be like in two or three years time?

Remove thoughts of glamour or excitement from your mind and focus on the cost of becoming a paramedic, the possibility of failing the course at any stage and the reality of qualifying without a job to practice in. Then do what you think is best for you and if that means continuing on the path to becoming a paramedic, then at least you were very sure of your course.

I'm very proud to have been the reason many people became paramedics, including my own son. At least a dozen of you have told me that this blog has influenced your decision to join an ambulance service and help others... that's all great but I won't be the one who tells more of you to carry on without thinking it over.

I'm back on the road for a shift soon and will be reporting back more stories from the front-line. It's a weekend night shift, so expect the word 'drunk' to be used frequently

Be safe.

Sunday, 17 April 2011

End of days?

The NHS is facing a major challenge. Cuts across the board may soon erode frontline emergency services to the point where privatisation of certain key parts becomes inevitable. But the raging arguments for and against out-sourcing patient care often lose focus when politically-motivated speakers debate the issues.

Looking at it from a pragmatic view, there is something to be said for opting out of a publicly-funded, publicly-driven service. Private companies exist to make profits, that much is true. That means they can be seen as less inclined to care about the service they provide, but in any competitive market and for the majority of companies, this is not actually the case. How can they expect to keep their customers if they provide a poor standard of service? You find many more examples of poor service in areas where competition is weak or non-existent; nationalisation proved that and, although we still have a lot to complain about with respect to our railways due to the fact that customers are tied to routes, rather than having much in the way of choice, it’s a world better than the ‘don’t give a damn’ attitude that pervaded staff back in those days.

Public services have an advantage in that they are not subject to profiteering but, unless the people working within them really care about what they do, there is no motivation for them, or their bosses, to bother about the level of service they provide. As long as there is a pay cheque and a pension at the end of the day, just doing the job to the minimum required level and no more is adequate.

I would argue that most people who need medical care would prefer to be treated with the highest level of professionalism and the best equipment money can buy, rather than any service where they are seen as a nuisance, or a mere cog in the big wheel of a State funded organisation.

I’m not for one single minute suggesting that we are surrounded by people who don’t care but I think there are far too many managers, there is far too much red tape and far too few opportunities for good clinicians to shine. There is not enough development in healthcare because the money vital to driving it forward simply isn’t there. A corporate framework, promoted by commercial competition, could create cleaner, wealthier hospitals and surgeries, with happier, more motivated staff. It may even help to build new hospitals across the country.

You will have other ideas, I’m just spouting mine. Your politics will differ from mine but I work on the inside of a machine that I honestly see as dysfunctional at times. Too many people call ambulances for nonsense things because it is free and very easy to do. If there was a charge, even to dial 999, I wonder how many lives we’d save.

Obviously, there are those among you – there always are – who will nit-pick this and argue that people would die if they had to pay to make that 999 call… or they’d simply not call us if there exists the possibility of being charged because their problem was deemed ‘not an emergency’.

I agree that there is a risk here; the vulnerable would probably suffer. But what if we charged the drunk, the drugged up, the violent and abusive among us for their care, instead of passing the cost to tax paying Joe P? They all still go to hospital, they all get the care they require but when they sober up, straighten out and calm down, they get a bill for the services rendered.

Would we discourage enough of these calls to stimulate a better service for those who actually need us?

My own boss, the Chief Executive, stated on the news that we were receiving too many inappropriate 999 calls – it is universally understood, from the top down, that public services such as ours cannot continue to be abused at the cost of it’s core function.

The cost of it all is what needs to be re-assessed – the pure, dirty financial cost. It’s always about money – even when it comes to public services. Those at the top of the tree of public services benefit from tax pounds and their job is to run the service and save more tax pounds from being spent if possible but there is no commercial impetus to do this; there is no competition. The public have no choice but to use what exists, whether that service is good enough or not. Try to bear in mind that public services do not generate money, they spend it.

It’s ironic that the public sector is being slashed to the bone and jobs are being lost but that the private sector is reportedly thriving and jobs are being created. I think it says something about the state of affairs in the UK. We get poorer by not making things for profit; we get poorer by using tax money paid in by those who generate new money to create jobs for the public sector, whilst allowing surplus and waste to leak much of the benefit out of them. A lot of that money is used by councils to employ private companies anyway – such as refuse disposal companies because it’s cheaper than using directly employed staff, with all the vehicles and equipment that goes with them. There’s also no chance of union action shutting it down and holding the very people it serves to ransom (like the London Underground does on a regular basis).

When I was growing up, I experienced a lot of the negative aspects of public service and nationalised industry; the power would be cut every night for hours at a time whenever the coal industry went on strike. Rubbish would pile in the streets, attracting vermin and encouraging disease, just because of a dispute that served no purpose for the people paying for it.

There’s nothing wrong with standing up for your rights as an employee, of course not, but private company employees have rights too and they don’t need to punish the tax payer to enforce them.

Where is the evidence that private services in the health sector would lead to worse healthcare? When, in recent history, have we tried it en masse? Comparing the services provided in other countries, such as the USA, is simply not viable because we are not the same. Most of it exists by the back door anyway, so the whole argument is moot. Even seemingly stand-up Socialist-Green-Communist propagandists have profit in their blood so blow-by-blow evidence for one thing or the other is neutralising to me. It may be time to try something different.

I work in the public sector of course, so I am benefiting from the tax pound but I also generate new tax money. The services provided by the ambulance service, hospitals and other healthcare sources are exceptional but they are becoming less value for money because they are subject to abuse and the cuts necessitated by Government in these days of debt. There have already been heavy job losses in the NHS and there are more to come. Frontline staffing will suffer a blow for sure and whether or not it directly affects the quality of care provided will be down to a couple of things; the slowing-down or complete end of abuse of services by those who don’t even pay for them and the privatisation of aspects of the system that are just too big and expensive to run efficiently and cost-effectively.

We all want to be protected in our jobs; we all want to continue to sustain our families with income but what if there simply isn’t enough left to keep it going? What if our service-driven economy, coupled with the behaviour of the banks has led us to near-financial ruin?

Be safe (and hopefully employed).

Saturday, 2 April 2011

Vicious sweets

We’ve reached a new low in society when pathetic incidents like this provoke a response that triggers such expensive and embarrassing circumstances. The cops are not to blame here; they have no option but to follow up on reports like this. It’s the child and, more importantly, the parents who need a good talking to about getting real. Why on earth would the kid want to run to his parents about this?

And what notion do grown adults have of common-sense when they report incidents as innocuous as this to the police?

Are we now at a point where, if a child accidentally bumps into another child, the police will visit and begin a full-blown investigation? I think the Chief Constable needs to send a letter out to the community asking them to grow up.

There’s only one word to describe this – ridiculous. 

Image above created by Daneboe

More doc-bashing
This guy found out all about his medical condition after surfing the Web. He had no choice apparently because none of the medics he’d gone to seemed interested in exploring the possibilities. I’m not defending them to the hilt and this young man had every right to be concerned and discover for himself what was going on but, again, I’m sure we’re not getting the full story.

The average GP is busy. Let’s face it, they have hundreds of patients to deal with and a lot of nonsense to get through, just like we do in the ambulance service. Tests would have been carried out I’m sure. The docs probably found nothing untoward and that’s why he got ‘fobbed off’.

He was found to have POTS but it’s not all as clear-cut as the newspaper is trying to make out. In the same Wiki article you will find this statement: POTS can be difficult to diagnose. A routine physical examination and standard blood tests will not indicate POTS.

The guy was unlucky enough to have been seen and ‘fobbed off’ by doctors under a lot of pressure and no time to go tilt-table testing. Arguably, they could just have laid him down and then sat him up, testing his heart rate and blood pressure changes as they did so but this is not a very scientific way of diagnosing anything, so they probably did all the tests they were required to do and considered his condition to be anomalous.

Lots of things are going undiagnosed every day by doctors. Forgetting that they are human and very often unable to spend the quality time they could with each patient is a major mistake to make. There’s nothing wrong with a bit of research and suggestion to see if you can move things along for yourself but be wary of online ‘facts’. Even Wiki informs us all that it cannot guarantee the accuracy and validity of its articles without proper source references that can be checked.

The Sun has printed a perfectly good story for the purposes of shocking its readers into vilifying the medical profession, whilst promoting the virtues of online medical information. I’m not saying that was their intention but the average Sun reader probably won’t do any background research into this or even think twice about the possibility of other arguments. It’s just so much more fun (and a lot easier) to say ‘damned doctors – they don’t know what they’re doing!’ when you are not one yourself. I stopped slagging off astronauts long ago for the same reason.

 This really tickled me; the photograph just leapt out as soon as it loaded

I know, it's not very medical or society-related. But it's funny.

Be safe.