The Wales Audit Office’s Fflur Jones took auditing to another level by joining a Welsh ambulance crew for a recent night shift. In her blog Fflur shares both the things she learned from a night with the crew and also some observations of what others can learn from this most important of services.
On Friday, 29 July 2016 I was kindly given permission to accompany a paramedic crew while they worked a typical weekend nightshift. It was an experience that had a greater effect on me than I initially expected and is one that will stay with me for a long time.
This observation was part of our review on emergency ambulance services commissioning, looking at the commissioning arrangements introduced in 2014 which brought all seven health boards together to commission ambulance services in a collaborative way.
The Welsh Ambulance Service Trust provides the service for the people of Wales under the direction received from the commissioners. As part of this review I was keen to get a sense of how delivering emergency ambulance services looks ‘on the ground’ and whether decisions made by the commissioners under the new arrangements are yet having an impact on the service the public receive on the frontline.
I arrived at the ambulance base and was assigned to observe a team of two paramedics for the night. The crews work on rotating 12 hour shifts and the crew I was with informed me that I could stay for as little or as long as I’d like. I’d soon come to regret not preparing for the evening with a power nap or an energy bar! Thankfully the friendly and welcoming attitude of the crew and the team at the ambulance base soon put me at ease and by 6pm we were ready to go and received the first call of the night.
As the night wore on I came to realise how the up-beat and positive attitudes of the crew are contrasted by the situations they face each day. The calls I observed the crew responding to throughout the night were varied but exposed a number of common illnesses and issues the crew are regularly faced with. The calls ranged from the routine to the extreme: from a caller that did not require any urgent treatment who had contacted the service for the third time that night to a patient suffering life-changing injuries as a result of a road traffic collision. I’m assured that the life of a paramedic is never dull.
The challenges faced by crews are numerous and varied and were far greater than I had previously appreciated. These range from attempting to manage public behaviours and expectations, pure logistical issues of getting to patients who are in precarious situations or who simply don’t answer the door once the crew has arrived, managing tensions over issues of ownership of the patient by, and capacity within hospitals, to being subjected to ongoing scrutiny of performance against targets by the media and the public. I also witnessed a crew member being physically and verbally assaulted, which I’m told is another regular occurrence.
Crews manage each and every one of these challenges with an unwavering focus on the patient and on the need to help people who can’t (or won’t) help themselves. “It’s the best job in the world” one of the crew tells me, and this is a strongly held belief of paramedics up and down the country.
While the extent of the dedication, compassion and kindness shown by the ambulance crew was the most profound learning point to me of the night, the experience taught me much more. I learnt a lot about the continuing battle to educate and inform the public about where to go and who to contact when they’re unwell, which makes campaigns such as NHS Wales ChooseWell so important. Calling an ambulance is not always the right choice and other alternatives, such as pharmacies and out of hours services can get patients seen quicker and allow ambulances to respond to the cases where they’re most needed. It also taught me that the need for the public sector to work together to provide better services and to provide services for unmet needs and to fill service gaps is greater than ever.
However, what I am assured of following my experience is that those who come into contact with patients each day will ensure that the patient will always remain the biggest and most important focus and driver for and during change.
Keep an eye out for the full commissioning report on the Welsh Ambulance Service Trust which will follow this Autumn.
About the author
Fflur Jones is a Performance Project Officer at the Wales Audit Office. She joined the health team earlier this year after previously working in the local government team and is currently working on a number of varied reviews relating to health within health boards and trusts across Wales.