New challenge for 999 boss

DR Chris Carney who helped turnaround the East Anglian Ambulance Trust, has just been announced as the new chief executive of the new six county East of England Ambulance Service NHS Trust.

DR Chris Carney who helped turnaround the East Anglian Ambulance Trust, has just been announced as the new chief executive of the new six county East of England Ambulance Service NHS Trust. It's a big challenge, he tells STACIA BRIGGS - geographically it's the biggest challenge in the country.

THE first time he ever travelled in an ambulance was at the age of 12 when he was suffering from peritonitis, and the last time was just a few weeks ago on the way to hospital for a back operation.

“The staff were very good,” said Dr Chris Carney, who will head the new East of England Ambulance Service NHS Trust which covers Norfolk, Suffolk, Cambridgeshire, Essex, Bedfordshire and Hertfordshire.

“They didn't even take the opportunity to ask me about a pay rise, or drive particularly quickly over all the big bumps in the road!”

Dr Carney, 54, is no stranger to rocky roads. He qualified in medicine at the Royal Free Hospital in London and then worked as a doctor in General Practice, Accident and Emergency Medicine and Pre-Hospital Care until the mid 1990s.

He was appointed operations and medical director of the then-failing Staffordshire Ambulance NHS Trust in 1994, chief executive of Bedfordshire and Hertfordshire Ambulance and Paramedic Service NHS Trust in 1997 and chief executive of the Hellesdon-based East Anglian Ambulance NHS Trust in 2000.

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When Dr Carney, who is one of the country's leading authorities in pre-hospital medicine, took over at East Anglia six years ago, the trust was failing to meet its response time targets, arriving at just 40 per cent of life-threatening calls within eight minutes.

A damaging public inquiry had highlighted serious flaws in the structure of the organisation, citing a lack of local management and poor staff morale as major problems within the trust.

Within a few years, the trust was reaching more than 75 per cent of life-threatening calls within eight minutes and had won national and international praise for innovations such as the country's first cycle paramedic, introducing community paramedics based at GP surgeries, emergency care practitioners and giving telephone advice to some callers who dial 999 with minor conditions.

“Most of the jobs I have done in ambulance services have been in situations where there's been a need to change and modernise. East Anglia was the largest of those challenges and it's been a major piece of work over the past six years moving it from the doldrums to being very successful indeed,” said Dr Carney.

“Everyone has worked incredibly hard to get the EAAT in the position it's in today. The chief executive is there to provide steering and leadership but I'm not actually out there on the frontline doing the job; the staff do that.

“Our staff made a decision after the inquiry when they were battered and bruised, that they would support quite major and substantial changes, and today their jobs have changed quite radically from what they were six years ago. They are responsible for the success of the EAAT.

“The management team can act as a stimulant, but it can't work until people are prepared to make the commitment to a new system, and that is what our staff have done.”

Now Dr Carney will head the newly created trust which covers around 7,500 square miles, the largest trust geographically in the country, and will serve around 6 million people.

“Professionally, it's incredibly challenging. This is the first time that England has had such large ambulance trusts and we have to ensure that things will run smoothly and continue to improve,” he said.

“We've known that this reorganisation was on the way and so it's good to get to the end of the process and start being able to look forward and plan how we are going to make this new trust work. Personally, I have got to get used to a trust which has large urban, as well as rural, areas.

“The challenge is to provide a cost-effective 999 service alongside our other patient care roles over a huge, huge area while retaining our very local feel. We have to be flexible and adaptable.”

Practical issues will involve working towards a time when all areas use the same technology, the same vehicles and can share the same resources in a bid to further improve efficiency and save money.

“It can be small things like buying the stationery for all three areas at the same time to save cash or it can be bigger things, like buying the same type of ambulance in bulk to get a better deal across the trust,” said Dr Carney.

“We have all got our own special areas of expertise which means we can share that experience and make the new trust the best it can be. Essex has gone through a quite major revamp after hitting the buffers about three years ago and is now a top performing trust.

“Equally, Bedfordshire and Hertfordshire have turned around their performance in the past six or so years. We are all going in the same direction, but up until now we have been travelling in different styles and in different ways. Now we have to move together and learn together.

“The great thing is that if one of the trusts we are merging with has a fantastic idea, we can steal it! Similarly they can benefit from the schemes and innovations from East Anglia.”

In the short term, the new executive team will find offices in the middle of their new “patch” while the structure of the new trust is decided. Although management will have to get used to a whole new set of locations, frontline staff will remain in their own area (unless they wish to transfer within the trust).

“If an ambulance crew is in Cromer in the morning, they won't find themselves on the M25 in the afternoon. Local knowledge is key to us,” said Dr Carney.

“But if we do have a major incident in our area, we suddenly have three times the resources to call on that we used to have. Overnight we become better equipped for large-scale problems, such as train crashes.”

Redundancies are inevitable - nationally around two thirds of ambulance chief executives have lost their jobs - but frontline crews and control room staff will not be affected.

“Sadly, we will have to lose some senior members of staff in management positions. This is part of the NHS commitment to pull money out of administration and organisational issues and put it into patient care,” said Dr Carney.

“This will obviously be very painful, because we are going to lose some good people. But there will be no impact whatsoever on around 95 per cent of our staff and no impact on frontline staff - paramedics, technicians, call takers, Patient Transport Services and so forth.

“Most people won't even notice the changes which will be going on. As far as everyone living in the six counties is concerned, it will be ambulance business as usual.”

Anthony Marsh and Will Hancock, chief executives at Essex and Bedfordshire and Hertfordshire ambulance trusts respectively, have been selected to lead services in the West Midlands and Thames Valley area. EAAT chairman, Andrew Egerton-Smith, will also not be part of the new trust (“he deserves immense credit for his stewardship of the EAAT during my time here and before” said Dr Carney).

There are no plans to close any of the current headquarter offices for each of the three trusts which will merge on July 1 to become the East of England Ambulance Service NHS Trust.

“As far as I am concerned, Hellesdon's future as one of the trust's bases is secure. We have a state-of-the-art control centre which, as far as I am concerned, is a model for the rest of the country,” said Dr Carney.

“Hellesdon (near Norwich) is working excellently, and I see no reason whatsoever why that should change. Ambulance services from England and Europe visit Hellesdon to see an example of a top-notch centre. The last thing we want to do is close it.

“We are going to be dealing with at least 500,000 calls a year, and that figure always rises by around seven to ten per cent a year. We need all the call centres we've got - in fact in many cases we will need to expand them.”

He added: “I have greatly enjoyed my time at the EAAT, although there have been times when I've wished I could have had a few more hours sleep!”

Dr Carney, will remain on the First Responder list in his new role, meaning he can be called on to attend an incident ahead of an ambulance if he is closer to the call.

“The buzz for me is that I can see that we're now providing a better service for patients and a wider range of services. The new trust is going to be a challenge, but it's one I'm really looking forward to.”

N What do you think Dr Carney should do first to help our health service? Write to Your Letters, The Evening Star, 30 Lower Brook Street, Ipswich, IP4 1AN or email

From July 1 there will be 12 NHS ambulance trusts in England, with mergers of many of the existing 29 trusts.

The government hopes that by creating fewer, larger ambulance trusts, there will be less bureaucracy, more money to invest in frontline services and better care for patients.

The mergers will not involve a reduction in ambulance vehicles or frontline staff.

The strategic review of ambulance services in England was conducted by Peter Bradley, national ambulance advisor and chief executive of London Ambulance Service.

Changes to ambulance trust boundaries have been announced alongside a major reorganisation of NHS Primary Care Trusts in England.

The East of England Ambulance Service NHS Trust will cover a population of 6.2 million, cover 7,500 square miles, deal with around 544,000 calls per year and attend almost 460,000 incidents every year.