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Ambulance experience

You’ll have seen stuff on the news recently (if you’re in the UK) about how the ambulance service, and indeed A&E medical services generally, are struggling to cope, missing targets and so on. Part of this also relates to how the NHS contracts GP services.

The debate about ambulance services (which are regionalised) is covered on the BBC website in relation to individual regions but in general they struggle with performance targets, often can’t recruit staff, experience budget trimming and so on. A&E is covered here on the BBC website; the ongoing debates about how local GP services are provided is also bound up with the introduction of the new ‘111’ service to replace the NHS Direct phone lines and so on.

But here’s a snapshot.

Someone who’s staying with us was in serious pain overnight – their head, face, neck. Paracetamol couldn’t shift it. They were literally screaming in pain. It could have been a bunch of things – an abcess, an infection, a migraine. They couldn’t tell us because they were in so much pain they could barely speak. Sob and scream, yes. Give answers to questions, no. But their face and neck were swollen and they were sweating, though there didn’t seem to be a temperature.

Had this happened 20 years ago I’d have phoned my doctor’s surgery (which is also their doctor’s surgery); spoken to a locum and arranged a home visit. The outcome would have been prescription painkillers.

This morning, with my friend having been in serious pain for about 5 hours at that point, I called the surgery – which is open on Saturday mornings but only for prebooked patients. The phone was answered by computer. No appointment is possible today but here’s an alternative number. The number turned out to be the county’s out-of-hours service. I spoke to a doctor there and explained the situation – and their response was to pass the call on to the ambulance service.

Give them credit: an ambulance was here in less than 10 minutes. The painkillers they carry are morphine-based, and used for treating serious injuries such as broken limbs. Not suitable in this case. Having decided the pain, face and neck swellings weren’t the result of a major infection, brain bleed or the like and were, if I can put it this way, painful but not an actual medical emergency, the only options they could offer were a trip to A&E, which doesn’t seem sensible because the problem isn’t a traumatic injury or anything requiring intensive treatment; leave me to arrange transport to an ‘urgent care centre’ (they used to be called walk-in centres); or just dose him up on the strongest over-the-counter painkillers we could lay our hands on, and book a doctor’s appointment on Monday. Since he didn’t want to be moved and there seemed no immediate reason to move him, he opted for the latter and I went with that.

So basically the difference 20 years makes is that I couldn’t get a doctor to see him on a Saturday and probably prescribe some good painkillers, which would have been the most effective option; but I could get a fully-equipped ambulance and crew for about an hour of their time, which didn’t seem to either me or the crew the best use of their resources and expertise or indeed the best use of the resources they could access – the local A&E department. And the outcome was a halfway solution that may keep the problem in check until Monday when he can get to the doctor’s surgery.

It’s no wonder that A&E is choked up with people who have minor ailments, because getting a doctor to make a home visit at the weekend and on short notice doesn’t seem to exist as an option any more. The ‘urgent care’ centres are, I used to think, a good solution to dealing with non-emergency cases that nonetheless need medical attention. But not in cases like this, because the ambulance couldn’t take him there to be looked at and having a screaming person in a taxi for a 12-mile journey isn’t going to be a sensible move. It’s no wonder ambulance crews are cynical about the amount of their time taken up on calls of this nature – and it wasn’t me that called the ambulance, remember, but the out of hours telephone service. And it’s no wonder A&E departments are stressed if they’re getting a large proportion of cases like this.

If that’s the way the medical service has gone, it clearly means more demand for ambulances and paramedics – because the doctors you can access out of hours are miles away on the end of a phone, rather than being locums answering calls rerouted from the local GP’s surgery and who are actually close enough to make a quick visit. And it would be helpful if the paramedics had the training and at least limited powers to issue prescriptions if they’re the key people dealing with stuff that in medical terms is relatively minor even if it’s painful, debilitating and scary for the person experiencing it. On the whole, this looks like a case where the quest for efficiency and budget control means that expensive resources – ambulances and potentially A&E departments – have ended up being overused and inappropriately used.

And the ‘crunch’ problem, or at least one of them, relates to cases that do need medical attention, where the solution is probably quick and simple, but also where the most effective treatments are only available on prescription.

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