David Knight: Being honest about north-east ambulance delays playing a role in deaths could help ease crisis |
Rick Strang might sound like the former frontman of an 80s punk band, but he’s struggling to play a good tune on an old fiddle at the moment.
Punks liked to shock with their own brutal raw honesty – or perhaps utter delusion.
Mr Strang appears to be blessed by the former, and plenty of it.
Whereas punks might have imagined their surge into public consciousness as a matter of life and death, what Mr Strang does every day really is.
He’s a health troubleshooter hired to solve Aberdeen Royal Infirmary’s (ARI) crisis over horrific ambulance queues – carrying desperate patients they can’t offload for hours.
They waited a miserable 13 hours at worst to get in as ambulance stacking reached double figures; some died before a delayed ambulance turned up.
It can’t be proved conclusively that waiting kills people, of course; there are usually numerous medical complications to consider first.
Mr Strang spoke extensively to the P&J about his Herculean task in restoring humane ambulance waiting times at ARI, instead of this Dystopian horror show.
Something which transpired was that tragedies associated with collection or offloading delays were not recorded, or noted as possible contributory factors in deaths.
They should be – just for the record.
Doctors could argue for longer than the time it takes to get into ARI over whether ambulance delays cause deaths; ordinary people would say common sense tells them they do.
ARI ambulance delays should be recorded on death certificates
I think the presence of any ambulance delay at ARI running into hours should be recorded on death certificates as a possible contributory factor, even if it cannot be proven medically to be a specific cause of death.
After all, I’ve seen “old age” recorded as a main cause of death on certificates – ahead of medical conditions – so why not “waiting for ages”?
This crisis has eaten away at ARI for several years with no visible improvement, but sadly it happens elsewhere.
I remembered a hospital (in England) calling me to say my mother-in-law would be discharged after consultants completed their rounds at 10am.
A disabled widow in her late-80s, she was finally delivered by ambulance to her home at midnight -14 hours later; we never found out why.
Something else quite startling came out of Mr Strang’s interview with the P&J: his extraordinary honesty and transparency in sharing how dire things were over ambulances queuing outside accident and emergency.
We’re not used to this from our public servants; they usually buy up every last tin of varnish from B&Q to gloss it over.
Yet the hidden hand of bureaucratic obfuscation was not far away as detailed ambulance records about delays, which he hoped to supply to the P&J, were not forthcoming.
The official excuse was that the data was not “owned” by NHS Grampian, but by the Scottish Ambulance Service.
Utter nonsense, of course, and not in the public interest; a flimsy barrier which could be removed easily in the pursuit of genuine transparency.
Maybe Mr Strang is too honest for some inside the institution, but he’s a man on a mission with a short contract and deadline to meet.
In scoring ambulance and patient-delivery processing at ARI he mentioned “two out of 10” at one point.
No doubt he’ll tread on toes at the door to casualty, but he has to; drastic action is required by people at every level.
His score echoed scenes in the first episode of US medical drama The Pitt from HBO Max.
A hospital boss berates a senior medic over poor processing of emergency patients compared to other hospitals (there’s a similar disparity between Aberdeen and Dundee).
A waiting room is full to bursting like a Third World refugee camp, patients described as “boarders” because there are no beds – and routine waiting times of 11 hours.
‘Eyeballs on them in case they start dying’
A grim mantra was being repeated, “Eyeballs on them in case they start dying”.
The medics blamed budget constraints on hiring more staff – even in America’s private system.
For Mr Strang it’s more about finding extra on-site space to clear the backlog swiftly.
What a job he’s got; monolithic organisations such as the NHS often appear to be dying from a terminal case of inertia.
Factor in turf wars between management and rival departments – from elite surgeons to cleaners and support staff grinding away on shop-floor tasks (without whom surgeons would grind to a halt) – and a toxic barrier to change appears.
Mr Strang’s aim for one-hour ambulance turnarounds by September seems an impossible dream, but I genuinely wish him the best.
The last thing we want is for things to fade back to how they were – only for Mr Strang’s mission to crash on the rocks of despair and alienation.
Feelings of depression over failure, which a real former punk star – the late Steve Strange – sang about on Visage’s 80s hit Fade to Grey.
David Knight is the long-serving former deputy editor of The Press and Journal