The Welsh Ambulance Service (WAST) is aiming to be ‘a more open, communicative organisation, which tells its story better through our employees, our patients, the media and to politicians’
This week my Blog responds to the open request from Estelle Hitchon for dialogue.
Show the public that their efforts count
The public has responded well over the years to the public campaigns that encourage us to recognise, and act on, the first signs of heart attacks and stroke. Both of these illnesses are sensitive to any delay in both our own response, and that of public services, meaning the difference between life and death or long term disability. The public is doing their bit in taking on the messages both in symptom recognition but also in first responder services.
Unfortunately the focus of politicians and media has been on the performance of ambulances in achieving, what are in reality, arbitrarily set ambulance response times. The partnership between the public and the NHS in times of emergency is a true example of ‘co-production’, but do we know the outcome? It is about time we knew for sure whether the combined efforts of the NHS and the public are having a real impact on both survivability and reduced disability in these times of emergency.
Stop blaming the public for what is not their fault
The NHS is a complex system, and not necessarily designed to be logical or sensible for the public. Yet there is an insistence on blaming the public when they get it wrong. People who ring 999 for ‘trivial’ reasons are regularly, and publicly, humiliated . The public are exhorted not to go to A&E unless absolutely necessary. Yet the NHS has no real understanding of how many people are attempting, and failing, to gain access to other services. Call centres have systems that tell them how many calls were abandoned by the caller before they got through. The NHS largely has no such system. This type of information is needed across primary care to truly understand why people access the system where they do. GPs need incentives to look at the demand on their services for urgent care, and the capacity to meet it.
The NHS needs to understand that people use services in the way they have been designed to be used, and that this often includes aspect of poor design. It follows that the system needs to be re-designed, with the public, for it to be used in a different way. In the meantime we need not to blame, but see people where they pitch up.
Make the advice to visit a pharmacist practical
A big part of the Choose Well campaign advises people to seek advice from their pharmacist. Don’t get me wrong – I am a big fan of the pharmacist as a source of advice. But, its not easy to get is it? A few examples. My nearest pharmacy is on a main road, with no parking, and no private space for speaking to the pharmacist. Not the easiest place to get to when I’m feeling a bit rough. My family, in a rural village, until recently would need to travel seven miles for the advice of a pharmacist, when there is a GP practice in the village. Theirs was a practice that dispensed its own medicines, so no pharmacist advice there either. Thankfully this has been resolved as GP practice and dispensary were separated, and a new pharmacy opened. New pharmacies can be viable in rural areas and this needs testing in Wales.
There is some re-design required here too – pharmacists could be part of practice based advice systems over the phone – modern technology means that a multi-disciplinary team don’t necessarily need to be in the same place to dispense advice.
And when a pharmacy and a practice share a building, why is it in many cases that we need to go outside into the weather to get from one to the other? More needs to be done to get GP practices in the same building as pharmacists, and using the same door.
What are the radically different ways of doing things?
On a recent trip to France, an ambulance was called to a relative in trouble with chest pain. We were an hour from the nearest large hospital. The local fire service were straight on scene – they were the paramedics, and ran the ambulance. They also provided the life-guard service for the local pool as it happened. A local GP also arrived as part of the initial response team. This was a highly rural area, with a community using its resources to maximum effect.
Lets value our ambulance service
Like many people I feel I know the ambulance service well – I worked with them as colleagues at all levels, and been in the back of one once! We see their reassuring presence on bicycles, motorbikes, in fast looking cars, traditional looking vehicles and helicopters. We need to support them unwaveringly. As with all public services, politicians and the media seem to want to destroy our faith and trust in this service. So please lets not allow this to happen. There are a few flaws, but where would we be without them.
