What transformed our ambulance service?

THIS week marks ten years since the Evening Star's Ambulance Watch campaign was launched.Today the picture is very different from the 1990s when public faith in the service was at its lowest ebb - our region's ambulance service is one of the best in the country.

By Paul Geater

THIS week marks ten years since the Evening Star's Ambulance Watch campaign was launched.

Today the picture is very different from the 1990s when public faith in the service was at its lowest ebb - our region's ambulance service is one of the best in the country.

Health reporter SARAH GILLETT investigates how the transformation happened.

WHEN the Evening Star began its Ambulance Watch in 1996, the service was at an all time low.

Ten years on things have turned round dramatically, with the Healthcare Commission announcing just yesterday that The East Anglian Ambulance NHS Trust - now superseded by the East of England Ambulance Service - was rated as “good” on quality of services and “fair” on use of resources.

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But it has not been achieved without a lot of hard work.

Someone who knows all about that is Andrew Egerton-Smith, who was chairman of the East Anglian Ambulance NHS Trust from 1997 until earlier this year.

He said: “At the time of my appointment in 1997, the trust, which had been formed in 1994 from a merger of three country trusts, was not in a good state.

“The problems arose primarily as a result of inadequate planning prior to the merger, and conflicting cultures post-merger leading to erosion in standards.”

With a growing financial deficit and failing response times to contend with, Mr Egerton-Smith was thrown in at the deep end. He recalled: “Press comment was regularly unfavourable, often for good reason as the radio system frequently caused resources to be deployed to the wrong place and there was regularly no radio coverage in areas across the patch, which both caused failures to meet public expectation.”

Undaunted by the challenge he set about reinforcing a sound management structure which would enable the trust to get back on the road to recovery and give staff and patients the service they deserved.

“After a few months in post I was amazed by the loyalty and continued hard work of all frontline staff in all sections of the trust.

“This gave me the confidence to realise that changes to the structure and managerial side of the trust would bear fruit as the goodwill of staff was of a very high order,” he said.

In the proceeding years a dramatic transformation of the trust began to take shape.

As technology and medicine progressed, patients began to see a return to an ambulance service they could trust and rely on.

Matthew Ware, spokesman for the service, said: “The main changes which the public will have noticed will be the way in which the ambulance service responds.

“Ten years ago, if you dialled 999 then an ambulance would have arrived on the scene no matter what, whereas now there is a lot more work that goes on to try to make sure the most appropriate response is given.

“You are just as likely to see a single person arrive on scene in a rapid response vehicle or it may be that, in less serious cases, advice is given over the phone and the person is directed to a more appropriate service for them.”

This changing way of working has been necessary because of the massive increase in calls the service receives.

In 1995/96 there were 79,046 calls to 999, in 2005/6 there were 179,959.

Mr Ware said: “There is no way there were 100,000 more people suffering this year than there were a decade ago but it reflects a complete change in the way people view the service and health care in general.

“People have much higher expectations and they are more prepared to call an ambulance for minor things, that's why we really have to divert some of our resources in to looking at ways of managing some of those calls.”

Despite the new pressures, the service now manages to hit government targets, and average response times are much faster than a decade ago.

The government states that 75 per cent of all life threatening calls should be reached within eight minutes, and 95pc within 19 minutes - targets which ambulances in East Anglia continue to meet.

Last year saw the ambulance service struggle to hit the target of reaching 95pc of all non-life threatening calls within 19 minutes but, on average, response times have fallen to just over eight minutes for all types of call.

But despite the impressive figures, the service is not perfect and there is still plenty of room for improvement. At times of peak demand resources are still overstretched and nowhere was this more poignantly highlighted than in the case of Ipswich man David Halley-Frame, a young asthmatic who died after waiting more than half an hour for an ambulance to reach him in Ipswich town centre in August last year.

The service was also shaken up by a dramatic merger earlier this year, which critics feared could lead to similar problems to those witnessed following the 1994 re-structuring.

The supersized East of England Ambulance Trust, covering the whole of Norfolk, Suffolk, Cambridgeshire, Essex, Bedfordshire and Hertfordshire, launched on July 1 but for patients and front-line staff there has, as yet, been little change.

Mr Ware said: “I don't think patients will really see any changes.

“The only thing it really affects is the management side of things. We can buy things like drugs and equipment a lot more cheaply, because we are a larger organisation, but patient care really shouldn't be affected.”

Dr Chris Carney, chief executive said: “The healthcare Commssion's report is testament to the skills and dedication of the staff and management of the old East Anglian service covering Cambridgeshire, Norfolk and Suffolk.

“The task now is to ensure that these successes are continued and built upon under the auspices of the new East of England service, which includes Bedfordshire, Essex and Hertfordshire.

“Some big challenges lie ahead as we integrate the work and practices of three services into one, with changes to how we record response times from April 2008 also a significant factor.”

WEBLINK: www.eastanglianambulance.com

n Response posts - mini ambulance stations in strategic locations (e.g the Novotel in Ipswich)

n Study of historical call data to pinpoint when and where the calls are most likely to come from. This is used to judge how many ambulance resources to have at any given time and location

n Satellite navigation on all ambulance vehicles, as well as satellite tracking and digital mapping to enable control to pinpoint where all vehicles are at any one time

n Community Paramedics - based at GP surgeries in rural communities to respond to 999 calls and assist in primary care to try to reduce the need for ambulance call outs.

n Emergency Care Practitioners - paramedics or nurses with additional skills, both responding to 999 calls and working in the GP out of hours arena

n Rapid Response Vehicles - single manned vehicles which get potentially life-saving aid to patients quickly before an ambulance arrives

n Community First Responders - volunteers trained by the ambulance service, mostly in rural areas, to get assistance quickly to cardiac arrest patients and others

n Air ambulance - partly funded by charitable donations, the ambulance service provides paramedics for the service

n Thrombolysis - clot-busting heart drugs administered pre-hospital. These were only previously given in hospital and often outside the critical first hour of treatment

n Tail-lift ambulances - designed to significantly reduce back injuries caused to crews from lifting patients in and out of vehicles

n Make-ready depots - purpose built units producing a supply of cleaned and stocked ambulances for use by crews

n Nurse telephone advice in control - some minor calls transferred to nurses or paramedics in control to avoid sending an ambulance unnecessarily

n New £1.2m state-of-the-art control room in Hellesdon, Norwich - opened in 2005.

The headlines we used to write, to expose the failing East Anglia's ambulance service in the late 1990s, could not be more different to what we see today.

Back in October 1996, the East Anglian Ambulance NHS Trust as it was then known, was failing to reach patients in time. The Evening Star demanded improvements for Suffolk's 650,000 people, and launched what became an award-winning Ambulance Watch campaign.

One of our most shocking stories revealed that it took the ambulance service two-and-a-half hours to reach a pensioner with a broken hip.

Then 86-year-old pneumonia sufferer Vera Norton had to wait an incredible six hours, for an ambulance to get to her home in Alderton.

At the time, the Patients Charter stated that ambulance should get to an emergency within 14 minutes in an urban area, and 19 minutes in a rural area. But instead we were studying the timings month after month, only to be left angry and disappointed yet again.

We were revealing stories like how the ambulance control room at Norwich sent an ambulance from Saxmundham to an emergency at Ipswich market - and these sorts of disasters left you praying you would never need to depend on the service in an emergency.

We also exposed flaws in policy and procurement. A fleet of new American-style ambulances, bought after managers had enjoyed a transatlantic trip to source them, had to be taken off the road, the trust lost its contract to provide non-emergency cover in Suffolk, and the radio system suffered dangerous blackspots.

At the same time, I was meeting dedicated ambulance crews who were working their hearts out, but were being sent to the wrong village, and alerted to incidents too slowly. Their morale had spiralled in to despair.

In 1998 we called on then health secretary Frank Dobson to intervene, gave him our evidence, and in March 1999 the day of reckoning dawned.

His damning report in to the ambulance trust's failings was revealed at a public enquiry. He pulled no punches, condemning ambulance chiefs for a catalogue of 'unforgivable and unacceptable' failings which left Suffolk, Norfolk and Cambridgeshire without a reliable service. He agreed the root of the problems went back to when three county services merged in to one trust.

The inquiry marked a turning point in the ambulance service, from which innovation and imagination emerged as the way forward.

New management spearheaded ideas, including community responders and paramedics on bikes, and today, thank goodness, the ambulance service is run very differently to those dark days we'd all love to forget.

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