London Ambulance Service
The London Assembly Health Committee is currently looking at how Londoners could have more of say in the way that the London Ambulance Service works, what Londoners want from the Ambulance Service in the future and how it can be helped to perform better.
What are the main things you expect from London’s Ambulance Service? What do you think are the main challenges that the Service is facing today? And what do you think the London Ambulance Service could do about the number of alcohol related call outs?
Summary
The London Assembly Health Committee published their report ‘Supporting London’s ambulance service’, which makes recommendations on how best to support the London Ambulance Service. The committee listened to members of the public, representatives of the London Ambulance Service Patients Forum and Talk London.
The recommendations include:
- Develop an access to work programme to help unemployed Londoners get a job within the service.
- Share best practice to encourage workforce diversity and engage more with London’s diverse communities.
- Identify community safety needs and the resource needed to maintain a safe and secure environment.
- Identify gaps in existing provision for falls, mental health, maternity care and end of life care by developing a city-wide response.
108 Comments
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Speedy service, knowledgable, competent staff who are not under time pressure or suffering extreme fatigue, who are well paid and respected.
Couldn't have said it better.
Yep that sums it up pretty perfectly.
I agree with Laura as well. I haven't dealt with London ambulance services but I've seen first hand how they work in a couple of occassions in the Midlands. Another good aspect to add is to make sure they can differentiate between true medical emergencies and more minor cases (e.g. alcohol-related minor injuries) when they are on-site. At the same time also have enough time to put focus on the tasks at hand whatever the case.
I agree with this. Ambulance station closures have reduced effectiveness and leads to fewer ambulances having to travel greater distances and this puts a strain on staff and organisational resource. Well trained, well rested and well compensated staff will provide greater returns where the closures have taken place. Increasing strain on existing resources doesn't lead to efficiency.
Apologies. Replied to the wrong post last time
I totally agree with Laura Cade. Absolutely right.
very well said
Service reserved for cases where a rapid response and time to hospital is key to saving life. I'd like to see more air ambulances in use and more regional centres that take on cases responded to by air ambulance. More training for staff. Staff are well rested, well paid - ideally, no conflicts with other roles they have so they're not overtired and stressed.
I agree with this. Ambulance station closures have reduced effectiveness and leads to fewer ambulances having to travel greater distances and this puts a strain on staff and organisational resource. Well trained, well rested and well compensated staff will provide greater returns where the closures have taken place. Increasing strain on existing resources doesn't lead to efficiency
Why can't the London Ambulance Service and the London Fire Brigade be a combined emergency service.
It works well in other countries, just one control room answering emergency calls for fire and ambulance. One station to garage vehicles, all employed by one employer. It must reduce costs.
The NHS could still run the ambulances for routine journeys and the vehicles would be garaged at the hospitals.
At the moment there are too many chiefs and not enough Indians in both the Ambulance Service and the Fire Brigade
I tend to agree with this idea.
Fire crew receive first aid training and some have paramedic training, so another reason this combined emergency service idea sounds like a good one.
I like the idea, but at present we get a telephone triage service so that the right actions are taken, I recently had to call the 101 service and because I have had a stroke they tend to go down that road first, second and third, I knew it wasn't but had to work through that before I got the the go to a&e, after saying several times did I need an ambulance. :)
London's Ambulance Services are doing a great job and considering the size of London it is certainly not the easiest job.
However, I always wonder, and pretty much every Londoner I talk to, why the sirens are the most ear pearcing of all countries. Sirens are necessary and saving lives, I am not criticising the use of it, but I think it is a serious problem for pedestrians that live in the vincinity of areas like a hospital, where we get about 40 times a day the numbing volume on the hearing system.
Agree!!
Emergency vehicles need to be loud for good reason. On the street, I agree that they are ear-piercing. But if you are in an ambulance, on the way to save a life, and the driver in front of you doesn't hear the siren or get out of the way because they are sitting in a vehicle with the windows up and music blasting from the speakers (and not paying attention), you have delays which could be the difference between life and death. Sirens are meant to alarm, to get pedestrians to take action and get out of the way, and to alert people of their arrival.
I haven't noticed house prices going down in the vicinity of hospitals and ambulance stations - nor under aeroplane flight paths.
The ambulance service is clearly under a huge amount of pressure. I lived in Australia for a while. There, if you are in a higher earning bracket, you pay for annual ambulance insurance. This is either a separate insurance or within general health insurance package. This costs for a couple, roughly $100 per year. If you don’t have insurance and you call an ambulance you risk a bill of $1000. This is good as it helps further fund the ambulance service and also discourages people for calling out ambulances for non emergencies.
The Australian system is shameful.
The biggest problems facing the London Ambulace Service today is poor and badly managed roads in London, an excess of road works and road blocking construction works, rickshaw taxis and traffic congestion caused by all of the above and including an excess of cycle lanes, some of which are not even used.
Expectations include speed of response, ability to handoff to secondary urgent care that is able and ready to receive patients, well trained staff, and properly equipped to handle all manner of incidents - this includes up to date IT, communications as well as modern medical equipment.
The challenges include the congested secondary care system and the delays this causes, the use of ambulances by repeat callers without life threatening conditions, and traffic in London and available equipment.
Reduce the number of "top level" management and make sure the ones who are there are suitably qualified.
Improve pay and conditions for front line staff and give them the proper equipment to do the job they have trained for.
Make the roads better so ambulances can travel at a reasonable speed without risking damage to the vehicles and give them some kind of "priority button" so they change traffic lights in their favour.
Make better use of first responders
I believe that there were some changes to the service. It seems that they will cut the amount of ambulances to transport and help people and increase the number of medical first response medics. Still, that is being done and I don't know how it is going to affect the need for people to be transported to hospitals.
My suggestion is that there is the need to increase the number of ambulances, qualified personnel, and of course of the first response medics.
Immigration.
Agreed.
I think they should do a study on the effective volume of their sirens, as they're way too loud and almost certainly cause hearing damage to pedestrians. They should also be prohibited from using their sirens after 11.30pm the same as cars. If you live on a main road it's basically constant sirens and very annoying.
Main roads in huge cities are noisy. Move house? Get some double glazing?
AlisonPrice - I have double glazing and I shouldn't be forced to move house. I don't think it's unreasonable to expect ambulances to stop using their sirens after 11.30pm when there's no traffic and people are trying to sleep. Their lights are enough to forewarn their approach at night.
My last two trips to A&E (one of which I was taken in an ambulance, the other I was at Paddington Station so they were able to wheel me in a wheelchair to St Mary's) I was vomitting severely so couldn't get a taxi but didn't require a full ambulance. I think this is probably true of a lot of people that they need to get to A&E & a taxi wouldn't take them/they don't have a car but don't need an ambulance.
If the government/London could provide something to transport all these people, effectively just a taxi that has wipeable seats etc, multiple sick buckets etc etc, then perhaps this would take a big strain off ambulances that can be used for life threatening situations? And of course saves a huge cost too.
Similarly more mental health nurses/staff provided, as well as care for the elderly to pick them up when they've fallen etc so that ambulances are used purely for life threatening cases.
Economically it makes no sense to have cut costs to all these services as it then ends up costing more sending an ambulance there.
From my experience the staff require more training in urgent care, and the ability to speak to on call GP at night more quickly (had to wait two hours for a call back by which point I was losing consciousness).
Ultimately there is clearly a huge issue with funds and the distribution of this needs to be reconsidered somehow, and an understanding that investing elsewhere reduces the strain on ambulances.
Disagree with the suggestion below re: paying, as this goes totally against the whole concept of the NHS and risks in life threatening cases people can't pay for an ambulance. However I do think there needs to be a big ad campaign to help people understand how much it costs for an ambulance to come out and how they should only be used in a true emergency.
The number of ambulance stations needs to be increased to cut response times. Scrap targets. It puts the driver under pressure, increases the risk of accidents and injury to him/herself and occupants. If I need to call one I dont want them having an accident on the way.
I would also like to chip in on the ear splitting volume of the sirens. Why do they need to be audible from miles away in London.
I live near a main road that seems to average over twenty siren runs per day. Of course not all ambulances, and to be fair their drivers do keep switching them off if little traffic.
When I am actually walking as a pedestrian my hearing aid goes bananas when one goes past and I have to cover my ears.
As others have said I understand the need for emrgency vehicle sirens and lights, but query their volume.
If more people stopped abusing the LAS by calling 999 for no serious reason, perhaps the LAS wouldn't be overworked and underfunded!!! Then when there is a genuine emergency wait times will be significantly reduced and more lives saved, which in turns frees up space in A&E when it is chocker block with 60% of cases that do NOT need to be there!
Are you claiming that 60% of 999 calls are unnecessary? If yes, that's nonsense. It sounds like something an accountant dreamed up to justify making spending cuts.
apart from that, i want a speedy service, compitant unit operators, polite, and i also wish at least one unit operator were trained in more procedures, that the unit carried more drugs so perhaps more could be treated in situ and not require transfer to hospital too!
No abulance services should be contracted out to failing corporations like G4S (remember the olympics security fiasco?) as they are here in Wandsworth.
Primary care needs improvement to reduce excessive demand. On the day our council reduced the number of home care visits for the elderly emergency calls shot up as elderly folk with mobility or memory issues attempted to get into baths, prepare meals, change bed linen etc. without the assistance they needed.
More work is needed on public education around appropriate use of abulance services. Public education has transformed the drink driving culture from ''one for the road?" to " do you want another or are you driving?" Surely we can acheive similar to combat inappropriate emergency calls.
And of course fair pay, better working conditions, and union support for everyone working in the service to ensure the high standards and efficiency we all expect.
G4S? No wonder we're f-ed.
Is there London BHS ambulance service? I thought it had been privatised. Hence the cuts and consequent huge pressures on them. Bring it back under public ownership and fund it properly
Exactly, Corky. We don't want the ambulances going the same way as the trains, with the culprits getting a knighthood.
The London Ambulance is an emergency service, therefore I would hope that the service is fast, staffed by experts in providing emergency, life saving care. However, more often then not you hear stories of Ambulances taking over 10 minutes to arrive or being used as a transportation service rather than an emergency care service.
Over 10 minutes? I've heard of people waiting 13, 16, even 35 hours! Many people die waiting.
Mini Holland and other "traffic calming" measures that are creating gridlock and making major routes impossible to pass down. Meanwhile it takes 5 miles to do a half mile journey when rat runs and other minor routes have been blocked off. So everything is slowed down to a standstill. How much extra time it is taking for emergency vehicles to reach their destinations under these conditions?
Mini-Holland is also turning the pavements into cycle paths. Ofo/Oleo doesn't help. Nor does Deliveroo, Uber or Uber Eats. We don't want our streets swamped with door-to-door McDonalds.
Funding to run an efficient Ambulance service which responds to all emergency calls and deals with the most serious cases in priority. Enough funding for the Mental Health services to ensure that those with mental health issues who make unneccesary calls to the Service clogging up the system so that the real emergencies are delayed, don't run the system into the ground. Powers for action to be taken against time wasters without diagnosed mental health issues who just think this is fun and can't be bothered to find out the right information but just call 999! I am immensely proud of my paramedic Goddaughter who works all the hours sent for very little salary. She trained hard with a degree and is a credit to the NHS - but she is not paid a living wage. Cut out some of the hospital managers who duplicate jobs (see Enfield/Barnet Royal Free Trust) who still manage teams which lose notes, duplicate or miss appointments and get some efficient staff doing these jobs - not 'jobs for the boys' or family members!!! These are costing the NHS a fortune in financial terms and goodwill in reputation!
I used to work in the NHS. If there are too few back-office staff or they are temps with no training, there is no time to chase "lost" notes.
Some Royal Free staff work so many hours there ought to be two people doing the same job.
In the last couple of years when I have had to phone an ambulance, I have received an excellent service, especially the Paramedics who are so professional and arrived super quickly.
However I have heard stories of people waiting a long time for ambulances which I think shows how overstretched they are. I think more should be recruited and trained. I think they should be paid well and improve working conditions.
I think anyone who assaults an NHS worker and especially front line workers should be punished.
What Londoners want from the Ambulance Service?
1) To get to us fast. This is a huge problem in south London where traffic is terrible.
2) Smart paramedics who can make the RIGHT decision FAST and know more than 'first aid'. They should be almost the clever as an A & E doctor. Standards need to be raised and so does pay.
3) Ambulances should carry better life saving equipment and the staff should know how to use it.
My understanding was that ambulance crew know a lot more than First Aid, and many of them are paramedics. Also that ambulances carry a great deal of life saving equipment. Do you know otherwise? Please enlighten us on the reasons for your comments 2) and 3)
Hi everyone. Thanks for sharing your views.
We asked the London Assembly Health Committee for more information on the training for ambulance staff. They told us that ambulance staff have different levels of training. If we are talking about paramedics, they generally have a degree in paramedic sciences. The London Ambulance Service also has different options e.g. this for emergency ambulance crew.
The London Ambulance Service is also developing an ‘advanced paramedic role’.
What sorts of incident would you call an ambulance for? When would you dial 999 rather than heading to A&E yourself or seeking care elsewhere?
Talk London
Yes, the Mayor needs to do more to reduce traffic congestion.
Also, it would be nice if the ambulance crew turned their engines off while pulled over.
Outstanding emergency service providing quality, informed first point of contact treatment and care in a reassuring, professional manner. Their primary role is patient care in vulnerable situations and providing expert medical intervention at the first location and on the way to A & E. A consistent success.
In the era of modern audio and visual contact, rationalisation is required on the handover process from ambulance staff to A & E staff to avoid or minimise the absurd situation of ambulance staff sitting in A & E departments waiting to provide an oral report on their contact with the patient.
Second, an emergency ambulance service will always be required and joining up with other blue light services is not new but isn't progressing at sufficient speed in the UK. This joining up should also included an integrated approach to health with social care and stop patients being ferried by LAS to A & E depts when the real issue is social care and requiring more sustainable solutions than can be provided by A & E.
LAS should have powers to divert patients or require other professionals to intervene when A & E dept is not the optimum solution. Appreciate demarcation issues and additional training costs but the saving to A & Es, upskilling of LAS, and integrated health and social care would bring both substantial benefits to the patient and substantial savings to the NHS.
Social care should be funded, but people also need the time off work to look after their own families. The benefit system should give people more time to care as well.
The main things I would expect are for calls to be answered quickly, for advice on the phone to be useful, for ambulance crews to arrive quickly (where necessary and where possible!) and for staff to be well trained and friendly but also happy in their jobs so that they don't gain lots of experience and then leave the service because they're exhausted or frustrated.
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