If you change the way you look at things, the things you look at, will change.

The things you look at will change

In case you wanted to send a card, the 17th August is Robert de Niro’s birthday.

It’s also the day, in 1962, East German Border Guards shot Peter Fechter in the pelvis, while trying to escape, over the Berlin Wall. 

He lay, in no-man’s-land, screaming for help. No one came. It took an hour for him to bleed to death.

On the 17th August, this year, it will be the day people will be laying in the NHS’ no-man’s-land. The gap between calling for an ambulance and none arriving. 

Over 100 people will die.

The 17th is the prediction, made by Marc Docherty, nurse director of the West Midlands Ambulance Service. 

He’s done the mathematical modelling and in an excellent exclusive, in the HSJ (well done Emily Townsend), tells us it’s the Titanic moment, the tipping point, the day the ambulance service will collapse. 

The HSJ reveals

‘…handover delays at the region’s hospitals were the worst ever recorded…

…rising numbers of people were waiting in the back of ambulances for 24 hours…

…serious incidents have quadrupled in the past year, largely due to severe delays.

Royal Stoke Hospital recorded the highest number of handover delays, over an hour, in April with 1,588, while Shrewsbury and Telford was not far behind with 1,263.

Docherty’s specific prediction is based on the knowledge that a third of resources will be lost to delays… meaning the ambulance service can’t respond.

What’s to do about it? Is there a solution or will the inevitability of gradualness squeeze the life out the ambulance service?

We’ve known about the problem, for long enough. 

In April, the Association of Ambulance Chief Executives called on NHSE to ‘accelerate their activities’ to find immediate solutions to delays’ after it emerged 40,000 people were put at risk while waiting in ambulances.

NHSE ‘highlighted’ their ‘investment’ of an additional £130m since September 2021 in 999 and 111 services to improve timeliness of response to patients in the community…

… fat lot of good that did.

Victoria Vallance, CQC’s director of secondary and specialist healthcare, said they are ‘continuing to support efforts by providers through its programme of system-wide urgent and emergency care service inspections.’

… fat lot of good that will do.

She added; We’ll continue to monitor services and use our regulatory powers where necessary.

… fat lot of use that is.

The ‘Shropshire and Staffordshire system’ highlighted various upgrades and investments to emergency departments, enhanced triage, and same-day emergency initiatives… to help reduce handover delays.

… fat lot of good that’s doing.

Meanwhile; WMAS raised its risk rating for handover delays in October, to the highest in its history. Docherty says it reflects the fact patients are dying every day… because of the delays.

Back to the question, ‘what to do?’ The answer is, back to basics and is not…

Improving call centres. It will simply mean people will be answered quicker, but wait just as long, for an ambulance. 

Having more ambulances will only create longer queues. More people will be stuck, just as long, in the back of them, waiting for handover.

Spending money on A&E, never a bad thing but it will still get choc-a-bloc with patients, because there is nowhere to move them on.

The wards are full because discharges are grinding to a halt. 

Back to basics, back to basic management; root-cause-analysis; 

We can’t get ‘em in coz we can’t get ‘em out.

… because social care is on its knees and can’t cope. Added to which numbers of District Nurses have dropped from 7,055 to 4,031, in the ten years to 2019.

Regulation won’t fix this. Poorly targeted spending won’t fix this. More ambulances will join the queues and more people will die in no-man’s-land.

We are losing the bigger picture. We need to zoom-out.

System leaders must step back from short-term and urgent problems take a helicopter view. 

Focus instead on the whole supply-chain. The log jam is up-stream. The solution is getting people home, turning on the living room lights, not more blue lights.

If you change the way you look at things, the things you look at, will change.

News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.