Private ambulances increasingly used to respond to 999 calls

Ambulance services are increasingly calling in private firms to respond to 999 calls in the latest sign that NHS care providers are struggling to cope with the sharply rising number of patients who need urgent medical attention.

The London ambulance service (LAS) has had the biggest increase among England’s 10 regional ambulance trusts. The amount it spent on private ambulance providers soared from £700,000 in 2011 to £10.1m last year, a thirteen-fold increase.

Cost of private ambulances

Many other NHS ambulance services are also spending more of their budgets on private firms because of their growing reliance on them to meet demand.

For example, the amount paid out by South East Coast ambulance service (Secamb), which covers Kent, Sussex and Surrey, rose from £5.8m in 2012 to £11.6m last year, though it spent even more than that, £14.5m, in 2014.

Similarly, Yorkshire ambulance service paid private services £1.85m in 2014-15 to respond to 10,862 incidents. Last year that jumped to to £7m for attending 38,821 incidents.

The number of calls for assistance in London to which private ambulances have responded rose from 5,024 in 2011 to 59,749 last year. The figure includes both 999 calls and non-urgent journeys to hospital or other medical appointments.

Number of private ambulance responses

The trend has sparked serious concern about the NHS’s chronic shortage of paramedics, which has coincided with big annual rises in emergency calls to all 10 ambulance services in England.

“Ambulance services are not something that should be flung out to the private sector,” said Tim Farron, the Liberal Democrats leader, who obtained the figures for London under a freedom of information request.

“We should not be offering this out to the lowest bidder. It’s not what people want or expect, and the NHS needs more paramedics.”

He said increasing demand was forcing NHS services to draft in private operators to ensure calls were answered on time. “Without the private providers we would currently not have enough resources to get to all the patients who need an ambulance.”

East Midlands ambulance service’s spending on private firms has also risen, up 15% from £4.47m in 2013-14 to £5.15m in 2015-16.

North West ambulance service used to pay only St John Ambulance and the British Red Cross to supplement its own services. But in 2014-15 it began using private providers for the first time, spending £998,741 on seven firms during that year, including QAS Ambulance (£244,365) and Trust Medical (£206,744).

Paul Woodrow, the director of operations at LAS, said: “We have seen a 45% increase in the number of life-threatening incidents in the last five years, responding to 504,685 category A incidents in 2015-16 compared with 347,659 in 2010-11. To continue providing a safe service to Londoners, we use three carefully selected providers in a similar way to hospitals employing agency nurses.”

Crews employed by all three providers “are appropriately trained at either paramedic or emergency medical technician level and carry the same equipment as our crews”, he said.

However, some NHS paramedics claim that private ambulance personnel are not always as well trained as them.

One Secamb paramedic said: “We as crews think they are not as well trained as us and we regularly have to travel with them and the patient to hospital because they cannot cope.

“They are good people but don’t have the same level of training as Secamb staff. This is not good for the patient as their skill set is well below ours. Often they call up asking for para backup, meaning they can’t manage that patient.”

LAS spending on private firms increased almost seven-fold inside one year, from £700,000 in 2011 to £4.8m in 2012, and then more than doubled inside the next 12 months to just under £10m in 2013. It fell slightly in 2014 to £9.2m but then rose to £12.2m in 2015, before falling to £10.1m last year.

Paul Evans, the director of the NHS Support Federation, a research group, said: “Ambulance services sit at the epicentre of the crisis in health and social care services and it’s not surprising they are struggling to cope with demand, but even so this is a shocking escalation in privatisation.

“Resorting to private providers is not the answer if we want to secure safe and effective emergency services. The evidence shows that they use fewer paramedics than NHS crews, which impacts upon patient safety as they will inevitably be sent to treat patients that they are not qualified for and leads to more situations where more experienced staff have to be sent to take over.”

Late last year Coperforma, a private transport firm, had to hand back the £63.5m contract it had held only since April for taking patients in Sussex to non-urgent hospital appointments after a series of blunders. Some of those involved cancer patients, and led MPs and others to describe its service as “a shambles”.

Evans said: “That shows that there are serious flaws in outsourcing theses vital services.”

Christina McAnea, the head of health at the Unison union, said: “Strained NHS finances have led to staffing shortages where shifts aren’t covered and ambulance services have no option but to call on private companies to fill the gaps.

“But the millions of pounds used hiring private ambulances would be better spent filling vacancies and holding on to those highly skilled staff who are leaving in droves.

“Ministers must accept that by continually slashing budgets they are forcing ambulance services into short-term solutions for urgent long-term problems. This helps no one.”

Private ambulances increasingly used to respond to 999 calls

The increasingly polarised debate on abortion imperils women | Sonia Sodha

Imagine the outcry. A charity offering a common medical procedure – 70,000 a year, more than in the NHS itself – is found guilty of terribly poor standards of care. You’d expect some calls for the chief executive’s head; others claiming this represents the creeping privatisation of the NHS; and serious questions asked about how NHS commissioners were unaware of the issues.

This did, in fact, happen last year. The charity was Marie Stopes International and the procedure was abortion. The Care Quality Commission found serious problems. Staff responsible for getting consent from pregnant girls under 16 were not trained in recognising signs of child sexual abuse. Doctors left clinics before all patients had been discharged, leaving them with nurses untrained to deal with emergency situations. And inspectors observed a case where doctors failed to ensure a visibly distressed woman with a learning disability understood the procedure she was about to undergo when seeking consent.

The CQC’s report was rightly couched in the neutral, objective tones of a regulator. But for believers not just in a woman’s right to choose but her right to safe healthcare, it was an upsetting read. Marie Stopes voluntarily suspended some of its services straightaway as a result. (They’re now up and running again, having satisfied the CQC they have addressed their concerns.)

But its initial media response left much to be desired. A spokesperson characterised the problems as ones of governance and protocol and said they did not endanger the safety of women. Its chief executive declared its intention to regain full assurance from the CQC within a few days, hardly the sign of an organisation on top of serious failings. Yet with one or two exceptions , this was met by women’s rights campaigners with overwhelming silence. No pro-choice voices expressed outrage or demanding accountability for these failings in women’s care.

I have friends who found it an easy decision, others agonising. The debate feels dominated by two extremes

Our abortion debate in the UK is – thankfully – nowhere near as fraught in tone and tenor as in the US. But the broader reaction to the Marie Stopes case reveals how little room it has for nuance. In saying nothing, the pro-choice lobby left the way clear for the religious right to brazenly assert that our abortion law isn’t fit for purpose. They’d have done that anyway, but it’s a sad indictment that most commentary on this case came from a few blogs on religious websites.

The case raises issues that have gone unaddressed. The CQC gives hospitals and GP surgeries, unlike abortion clinics, a clear rating that tells patients whether they are outstanding or inadequate. Surely women have the right to know this about the clinic where they are getting an abortion? The good news is that the government has signalled that this may be about to change.

It also raises lack of parity in regulation of physical and mental health services. The debate about abortion counselling has become dreadfully polarised: anti-abortion campaigners such as Nadine Dorries argue that a charity providing abortion services cannot offer truly independent counselling because they are open to accusations they’ll use that counselling to pressurise women into using their services.

I don’t believe for a minute that charities such as Marie Stopes would set out to offer biased counselling: it would be a betrayal of its charitable mission. But like all forms of counselling and psychotherapy, abortion counselling isn’t subject to independent regulation. Anti-abortion organisations such as Life can offer independent counselling with no regulation at all. And given the issues uncovered by the CQC at Marie Stopes, it’s fair enough to ask questions about the quality of its counselling service. Because it’s unregulated, we just don’t know.

This nuance risks getting lost altogether. Many pro-choice campaigners argue that the media overdramatise abortion as more psychologically difficult for the average women than it really is. It does, but there’s no one size fits all. I have friends who found it an easy decision, others agonising. The debate feels dominated by two extremes: the belief that abortion is the worst thing that can ever happen to a woman and the idea that every woman saunters out of her appointment whistling.

A woman’s right to choose is the product of a hard-won fight. In that context, I can understand how demanding a better regulatory regime for substandard providers or introducing tougher counselling standards might feel like ceding ground. But what if our morally fraught debate means we neglect the equally important question about whether women are getting the quality of care they deserve?

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The increasingly polarised debate on abortion imperils women | Sonia Sodha

Youthful Australians increasingly jobless, unmarried and residing at residence

Youthful Australians are much better educated than in the past but far more most likely to be unemployed, unmarried and residing at residence with their parents, a snapshot of demographic trends has discovered.

Much more young men and women are joining the dole queue, with the youth unemployment charge growing from 8.eight% in 2008 to 13.3% in 2014, according to the biennial welfare report card from the Australian Institute of Well being and Welfare (AIHW).

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The kind of function youthful people are engaging in has also modified, with one particular in two getting in informal operate in 2013, compared with just above 1 in 3 (35%) in 1994. For the initial time, the youth component-time employment price in 2013 exceeded the youth total-time employment charge, at 44% and 43% respectively.

The federal government has proposed a 4-week freeze on jobseekers below the age of 25 accessing welfare payments, as a way of receiving more younger people into work.

Critics say it does not address the underlying triggers of unemployment, and is “punitive”, and unlikely to pass the Senate due to a lack of assistance from crossbenchers.

The statistics partly reflect the trend for younger folks to keep in education longer, with three out of 10 youthful individuals combining perform and schooling. 4 out of 5 Australians aged between 15 and 24 are totally engaged in schooling, education or employment.

Indigenous Australians and these residing in rural and remote communities, younger people with disabilities, and younger folks who do not have English language capabilities are considerably much less likely than broader society to be in schooling, employment and instruction.

Regardless of that, government welfare paying has been growing far more gradually than financial growth, at 2.six% and two.9% respectively.

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The biggest proportion of welfare expenditure, at $ 93.1bn, went to the aged pension and disability and carer payments. That compares with $ 7.5bn spent on unemployment benefits, and $ 36bn on welfare companies.

The greater youth unemployment rate means dad and mom have to wait longer ahead of becoming empty nesters. In 1997, 50% of youngsters aged 18–24 lived with their mothers and fathers. By 2012–13, this had improved to 60%.

Australians are also marrying and obtaining youngsters later. The quantity of ladies who received married in between the ages of twenty and 24 fell from 34 per one,000 individuals in 2003 to 25 per one,000 people in 2013. Males are marrying even later on in lifestyle, with the variety of twenty-24-yr-olds marrying dropping from 19 per 1,000 to 15 over the identical 10-yr time period.

The common age of 1st-time mothers in Australia has risen from 25.four in 1971 to thirty.eight in 2013. In the exact same 12 months, the average age of a very first-time father was 33.

Female workplace participation has gone up too, with three out of four females amongst 25-34 in paid operate by 2014.

Although the huge bulk – 68% – very own their own home with or with no a mortgage, the quantity of folks renting has risen drastically from 18% in 1994, to 25%. The amount of older Australians who very own their houses outright has fell from 78% in 2002 to 71% a decade later on.

The percentage of Indigenous Australians who own their houses rose from 22% in 1994 to 30% in 2013.

Domestic violence continues to be the main driver of homelessness in Australia, with the huge bulk of people in search of homelessness companies currently being girls and youngsters.

Household violence is much worse for Indigenous ladies – they are 34 times more likely to be admitted to hospital due to domestic violence than the wider public.

Youthful Australians increasingly jobless, unmarried and residing at residence