Well, first things first. I attend the LAS Trust Board meeting as the Chair of the LAS Patients Forum about every six weeks or so, although sometimes the meetings can be more frequent. The meetings are officially "public meetings" but invariably I am the only member of the public or service user of the London Ambulance Service present. The papers sent to me for the meeting beforehand are voluminous, taking most of Monday to get through, plus there are verbal reports on the day, so one has to be very much on the ball. I always put a number of questions and occasionally supply points of information also. The only other people sitting in the 'public' section at this meeting, and there are often none other than me, were some employees of the LAS, a UNISON official and a host of contractors who were working on the LAS's new Command Point contract.
Usually the two most important reports being presented are those of the Chief Executive and the Medical Director, and it is usally to those two reports that I put questions. The Chief Executive's report included a refeence to the scrutiny into the LAS currently being carried out by the London Assembly's Health & Public Service's committee, and a rep from the committee was present at the Board meeting. This included evidence being provided by the Patient Forum's Vice Chair, Malcolm Alexander, as I was away in France at the time. I have just seen the transcript of the session and it will be put up on the London Assembly website soon. On April 6th, the Chair and the Chief Exectuive of the LAS will also give evidence to the committee in public session at City Hall. I made the point at the meeting, as there have been moves to sideline the Patients Forum, that that the Chair of the Health & Public Service's Committee had attended the last Forum meeting and stated that he wanted the Forum to be "the eyes and ears of the London Assembly concerning the LAS."
I then put a question to the Chief Executive as to what would happen about "alternative care pathways" which are supposed to be in place after April 18th, when Category B calls (non-life threatening emergency calls) are being abolished. The theory is that these pathways are supposed be there for patients to use. I pointed out that a Forum member had recently had cardiac symptoms and had walked into the NHS Walk in Centre at Guy's Hospital seeking treatment. He was told by staff there that he should not have gone there but should have called a taxi to go to the A&E at St Thomas' Hospital. This is not how an "alternative care pathway" is supposed to operate. The CEO did not answer my question directly and later I went up to him and challenged him about this. His response was that of course the alternative care pathways would not be in place this April and that it would take about a year to have them in place - in the interim he believed that the LAS would have to be particularly careful about vulnerable patients. I am not altogether reassured by this.
We were also told that the Coroner's Report into the London bombings will be realeased on May 6th and there is certain to be a great deal there about the role of the LAS. The Patients Forum will be discussing this after May.
I put a question to the Medical Director, Dr Fiona Moore, about the disapperances of 'controlled drugs' from LAS stations, about which the Board has been informed on a regular basis over the last year or two. She stated that the LAS regarded it very seriously but to put it in context, the LAS dealt with 2000 controlled drug units every month and the investigations only covered 3 ampoules. She also informed the meeting that the Controlled Drugs Unit of the Met Police made regular unannounced visits to LAS stations.
I then asked her about the events of Saturday during the TUC march and how the LAS had been involved. The Director of Operations replied that 104 ambulance staff had been involved and that 80 people had been injured and the LAS had received a further 80 calls for assistance. Two ambulance staff had been injured, one treating an injured police officer. LAS staff had hoped to stand down by 9.30pm but were unable to because of the continuing need for their services.
The move towards Foundation Trust status is also proving very frustrating for the LAS as more and more questions are being asked by the Strategic Health Authority about details. Originally they had hoped to given the green light by the summer but now it looks as if there will have to be a Board to Board meeting on May 24th and depending on any issues arising from that, they will seek approval from the Secretary of State on September 1st. The Board was also presented with the final blueprint for the Foundation Trust status and I pointed out that the proposed timescales for the opening of nominations, i.e. two weeks, was totally unreasonable as it would not allow genuine patients and health activists enough notice if they were on holiday or if the post was not fully functioning. The Chair backed me with this and they agreed to extend the timescale.
The Board also approved the annual budget and at this point, the trade union representative from UNISON rose to speak.He said that it was a bad day for the LAS and a bad day for staff and patients. He pointed out that 130 frontline staff were being lost. He went on to state that more and more was being expected from the remaining staff. While pointing out that partnership between management and staff in the LAS was good, he warned that there were limits to that partnership and that it was not unconditional. I took this as an ominous sign of trouble ahead. The UNISON rep did recognise that the cuts were being driven by external forces, i.e. the government. The Chair of the Trust noted his comments and assured him that there was a year to manage the budget and that the concerns of the unions would be treated seriously. Having said that, the Board then unanimously voted the budget through.
There were, of course, many other major issues discussed, many of which I will cover in my report to the Patients Forum. But it demonstrates that it is important to have an active patients body and to have active engagement in the operation of the LAS. I will be reporting back on this at the public meeting of the Patients Forum at the LAS HQ in Waterloo Road on Monday April 12th from 5.30pm to 7.30pm where there will also be a presentation on 'The Red Blanket - Infection Control in the LAS'.
The rare appearance by the UNISON rep and the internal report on staff morale which showed an increase in many not wishing to go to work, all indicate an unsteady and dangerous time ahead for the LAS and the seeking of foundation trust status could easily be affected by all of this. It is vitally necessary that London's third emergency service continues to have active public and patient engagement in its affairs.
For anyone interested LAS Trust Board papers are all available here
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