Was ambulance review based on wrong stats?

This data was initially collated and given to Lightfoot by the senior management team of GARS. The staff of the GARS attended a presentation of the review findings by Lightfoot. Large elements of the presentation could be found within the content of the review that is accessible to the public on the GARS website. However, the following facts were presented to the staff, but not written in the review.

Lightfoot stated that, on average, over the two-year review period, the GARS responded to 1.5 emergencies between the working hours of 1800 and 0800. They also stated that paramedics made a total of 19 drug interventions per month.

The Lightfoot review made recommendations on ambulance cover and use of level-four clinicians (paramedics) based on these figures. The figures are now being used as a basis upon which future working patterns will be determined.

Unsurprisingly, Lightfoot has deduced from this that GARS can reduce ambulance cover over evenings and night-time and questioned whether paramedics were necessary in Guernsey, given that they effectively do so little and cannot maintain their skills. Upon learning of these figures from Lightfoot in the presentation, the staff became extremely alarmed, as there was no question that they were hugely incorrect. It would appear that certain paramedics had exceeded the overall 19 drug interventions on their own. Quite an impressive feat, considering they were one of eight full-time paramedics.

A review of three months following the review was permitted (i.e. June 2013-August 2013) and the results were vastly different to those upon which Lightfoot made recommendations. Over that three-month period, it was revealed that, on average, GARS responded to 6.09 emergencies between the hours of 1800 and 0800 as opposed to 1.5. Paramedic drug interventions averaged 49 per month over those three months as opposed to 19. Total drug interventions (i.e. paramedic and EMT) over those three months averaged 65.3 and the monthly average paramedic interventions required was 57.3. When requests were made by the staff to review the 24 months used in the review, they were refused.

It is unknown why the initial data was wrong. This will inevitably result in insufficient ambulance cover at night-time, putting the people of Guernsey at great risk. It is also likely to result in insufficient paramedic availability to the critically ill and a movement towards much lesser-skilled volunteers being utilised on ambulances.

Among other things, this reduced manpower will significantly contribute to the £1m. cost savings recommended by the review – a saving that is necessary in order to maintain the costly senior management team. The costly senior management is also part funded from rescue donations, as they take money from the rescue fund to pay the management services they assign to it.

Given the cost of the review, it is concerning that many recommendations were based on wrong information and are therefore of little worth. The GARS is a small organisation and until recent scrutiny has managed to exist out of the watchful eye and controlling hand of the HSSD. This freedom will continue as long as the States loan is kept to a minimum. The data used in the review would have been a sure way to help achieve this.

Name and address withheld.

Editor's footnote: St John Ambulance and HSSD were invited to comment and responded as follows:

A spokesman for HSSD responds: 'The Health and Social Services Department does not consider it appropriate to comment on allegations in a public forum. The department will initially discuss the letter with St John and will then decide if the statements made in the letter should be investigated. We encourage the author to contact HSSD's acting chief officer directly with supporting evidence which may help this process.'

Jon Beausire, St John Ambulance & Rescue Service, responds: 'Thank you for the opportunity to respond to your reader's letter. The St John Ambulance & Rescue Service (SJARS) has in place procedures to address allegations made against individuals or the organisation. I would urge the reader who wrote this letter to contact the service so that the matter can be investigated in an appropriate manner.

We would, however, like to take this opportunity to make the following comment about the Ambulance Service Review.

The reviewers (Lightfoot), who were commissioned by HSSD, were provided with all of the SJARS clinical, operational, financial and other performance data. They interviewed a total of 62 people, including 25 ambulance employees, union representatives and managers from the service. The reviewers had the ability to cross-reference all patient report records with copies that are handed over to the A&E department. A full account of the review approach by Lightfoot is contained in the published report.

A summary of the review analysis was presented to all employees in September 2013, following which more up-to-date data was also analysed. It was agreed that only the most up-to-date data would be used. Eight months have now passed since the end of the review and during that time, over half of the recommendations have been progressed with the support of both HSSD and a cross-section of employees from SJARS.

The analysis of data is constantly under review as demand on the ambulance service varies and we are committed to working with the most up-to-date data.

We have made many changes already to enable St John to continue to deliver a quality emergency ambulance service but we also acknowledge there are still areas for improvement.

To this end, regular monitoring meetings are being held between SJARS and HSSD. We also continue to work with other health providers as we progress towards a sustainable emergency ambulance service for our island community.'