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UK National Air Ambulance Service

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UK National Air Ambulance Service

Old 20th Jul 2018, 15:18
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Please don't get me wrong, I've been in this business since the 'fairly early days' (a while after Geoffers admittedly) and during the period of expansion throughout the regions, introduction of doctors (of various skill levels) and lots of 'reinventing of the wheel' I always said that the best outcome would be to develop an 'RNLI of the skies' providing common standards of training and equipment across the country; however, I always added that this would never happen because of the personal attachment felt by the fund raisers for THEIR air ambulance and separately because of the vested interests of the management teams (I'm generalising!).

I left full time HEMS just as pre-hospital doctors, armed with knowledge gained in Afghanistan etc. were being introduced to a lot of the regions and now that I'm again doing more HEMS, I see an incredibly well funded, equipped and trained team at most of the units I work with - on that basis it is difficult to see the current system as broken, even if some regions may need some assistance to move in the right direction.

Cheers

TeeS
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Old 20th Jul 2018, 17:23
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The potential cons outweigh the pros but only just. A service more like Germany or Austria would be best. France also is not charity funded and according to one senior clinician I’ve spoken to light years ahead of the U.K. in pre hospital care. Whilst NPAS as a national model has proven to be farcical and an abject failure closer cooperation at least and reduction of different types etc along with some actual better planning would make an immediate difference.

But where would the empire builders go then. The CEO’s on 6 figure salaries and bonuses. The charities who have raised so much of people’s hard earned they can’t spend it quickly enough to avoid losing their charitable status. The ever larger airframes no longer able to land in suburban confines that charities better served before. The wastage on, in one instance, an airframe offered gratis from the Middle East only to be paid for and still require massive extra spend to make it airworthy when others were available as a pair for 10-15% of the cost in the U.K. ex another charity. The charity travelling 6 on board so every clinician can get stats and boxes ticked to a scene then refusing to carry a casualty to hospital as they don’t have the fuel capacity. The charity with no affiliation to any actual ambulance service upgrading to a larger multi crew operation. The ambulance service who will task their own asset still on another hospital pad half an hour away as opposed to the aircraft over the ‘border’ 6 minutes away but not wearing the correct colour scheme or branding. I could go on but maybe BBC panorama might get interested if I did. Oh how they love to spend all the people’s money yet air ambulance pilots are the poorest paid in the U.K., and amongst EMS pilots in Europe the poorest also despite now requiring ever higher qualifications.

Some centralisation might actually drain the swamp.

Have lovely weekend everyone.
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Old 20th Jul 2018, 17:25
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Totally agree with SARWannabee and TeeS - some well motivated people but varying policies and protocols. That means some patients get restricted or suboptimal care - either from under treatment or over treatment - they cant all be correct

If the NHS 'ran' the medical aspects nationally we would see exactly the same as in NHS operating theatres or X Ray - some minor variations but national minimum standards, an accepted protocol for most situations etc etc. Clinicians could properly apply pressure for optimal care. Errors or negligence would be seen as such and, in some cases at least, drive improvement or change.

The current situation is rather like buying a new aircraft, tearing up the manufacturer's SOPs and writing your own........
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Old 20th Jul 2018, 20:15
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Radgirl - speak for kiwiland but not the UK. One has to separate the operation if we are to address your views successfully.
The aviation side of the operation is a bolt on accessory (a necessary one obviously) which would survivie whether it was a national or regional operation.
The financing side would however be decimated by government interference. As has been said before in this thread, government only looks at the bottom line. Efficiency doesn't exist in government dictionaries.
For your information - NPAS (the police national airforce conglomeration) is a laughing stock in the UK. It has been ridiculed by the HMCC report and those who work inside the set up know that what was and what is - are two different beasts. It is a symbol of how NOT to run a national airforce.
Independent charities for HEMS are a necessary evil. It's been adopted by the local populace who are very proud of what they have created (touchy feely). And they don't want it diluted by external foces. Nationally it is very inefficent but who cares? It works and it works so well - the government are steering well clear! Thank the Lord.
You could be alluding to the medical side of things and yes maybe there is room for optimisation.
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Old 20th Jul 2018, 23:36
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TC - I have been careful to describe the benefits as I see it of the medical side being part of the NHS. I stick with that view. I regret I do not agree it works so well....... patient care is compromised as I explained above. It is difficult to think of another example of so much money being spent with so little audit or scientific analysis.....

I have rather kept away from the aviation side, and I am well aware of the NPAS fiasco, but your question 'who cares' about inefficiencies is answered by those other medical charities competing for the public's money, and ultimately the patients they seek to help. There is considerable research showing finite charitable donations (and I refer to the UK, not NZ!!).

Interestingly New Zealand went from a system not dissimilar to the UK to the current system where all providers are under an umbrella which includes the Ministry of Health, but there is a consultation under way to further integrate the service for a variety of reasons including uniform cover and standardised integrated medical care. The proposal includes increasing government spending, increasing audit and achieving clinical standards with clinical governance. Whilst we need to be very careful extrapolating from country to country, New Zealand in many respects of this argument is a scaled down UK with a very similar health system. We would do well to watch developments there and be willing to learn. A little more science and audit in HEMS is sorely needed.
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Old 21st Jul 2018, 07:22
  #46 (permalink)  
 
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Originally Posted by Radgirl View Post
TC - I have been careful to describe the benefits as I see it of the medical side being part of the NHS. I stick with that view. I regret I do not agree it works so well....... patient care is compromised as I explained above. It is difficult to think of another example of so much money being spent with so little audit or scientific analysis.....
I'm not sure which HEMS unit you have experience of, and I don't wish for you to say, but I must say that bears no resemblance to the UK HEMS units I fly, which are numerous. They are constantly auditing, publishing research, undertaking moulage, hosting frequent public governance days, meeting other organisations to learn from each other, following up with patients, and looking for any feasibly way to optimise the patient care. Clearly from your experience this is not the case in some areas, but are you sure they aren't the exception?

There is a great sense of camaraderie at HEMS units and charities, and this I believe in part is due to the small teams, and personalisation with people all they way up the chain. You understand the identity of those you are working with and they understand your requirements and are receptive to change.

I just don't see any good coming from nationalisation of charities or operations. As soon as they lose their independent identity in their given region the public too will become disassociated, and see the aircraft as an NHS asset which should be therefore paid for by government. The only obvious benefit? Cost savings, but cost isn't really the issue here. All UK air ambulances combined run for far less money annually than the annual deficit for Kings College Hospital alone, and they have no problem funding themselves.

As stated before, the NHS medical protocols across the various ambulance trusts aren't even standard. In many cases the doctor led services in the UK are way ahead in thinking than their associated ambulance trusts, and being held back by the bureaucracy of them, when in other areas of the UK they are afforded much more autonomy. If you're to apply a standard across the board, I'd say it would be to further remove the doctor lead services from NHS ambulance trust protocols, and set a new standard for the advanced practitioners which is most appropriate to PHEM so they can deliver the advanced care they wish to and practice for.
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Old 21st Jul 2018, 12:55
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Thanks SARWannabee. I dont want to hog this thread as there is a risk of repetition, but in medicine audit and research means properly set up studies with ethical committee approval, peer reviewed and published in the medical literature. Please PM me with examples if you can find any. Case reviews and discussions are not research. Lists of injuries and logs of times are not medical research.

You make my argument well in your last paragraph - by acknowledging the wide range of medical care across the country, you are in effect saying some are better than others. An integrated trauma system that the medical profession recommended in 1989 !!! would see HEMS as one link in the trauma chain. This would reduce autonomy (which is variability by another name) and allow better research, identifying weaknesses and improving standards as happens continually in the hospital setting

I think this is a theoretical argument. The NHS has such massive problems which the politicians seem unable to understand. Their answer is to simply pour in more money which wont work. They are about to ban whole areas of medicine (knee arthroscopy, spinal blocks etc) so there isnt a snowballs's chance of them volunteering to take on additional services from the charitable sector.
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Old 31st Oct 2018, 19:01
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Cash boost for Air Ambulances announced in Autumn Budget | Latest Norfolk and Suffolk Business News - Eastern Daily Press

The UK government is to provide 10 million pounds of funding to UK air ambulance charities, announced in this week's budget. Is a UK national air ambulance agency becoming any closer?
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Old 31st Oct 2018, 23:25
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Question Freedom

One wonders sitting in a dark place North of the Border thinking, do you think that might include us in amongst it this time or leave us out , Everything considered from afar that it is a another disaster waiting to follow NPAS ,and as we all no that we are stand alone with that .
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Old 1st Nov 2018, 09:01
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Originally Posted by Radgirl View Post
Thanks SARWannabee. I dont want to hog this thread as there is a risk of repetition, but in medicine audit and research means properly set up studies with ethical committee approval, peer reviewed and published in the medical literature. Please PM me with examples if you can find any. Case reviews and discussions are not research. Lists of injuries and logs of times are not medical research..
I only just saw this reply - one consultant and university professor, working with one of the many HEMS services has posted 73 pieces of relevant research in the last 10 years or so surrounding pre-hospital medicine survivability rates, the use of pre-hospital blood and other interventions, which have been published in medical journals and peer reviewed. There are many more however they aren’t typically published by the charity themselves as they aren’t the charities work, they are the doctors research, however they are the product of a close relationship between the two if you look at how many of the linked research articles are HEMS related after a long fruitful relationship spanning a decade or more and rely on data generated through close cooperation https://www.google.co.uk/amp/s/www.r...hard_Lyon5/amp
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Old 1st Nov 2018, 18:51
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Please don't even think of it, at least not until you've looked at the total and unmitigated disaster that NPAS became. Oh, the concept was a great idea!
Take 27 Different forces operating some 33 aircraft, move them around a bit in order to give better cover, standardise the training, bring maintenance into one supplier thus gaining on economies of scale etc. Standardise aircraft types, and Insurance cover. Bring in direct employment of a pool of Pilots on a National contract. Establish National Policies etc. Regionalise control rooms, and operate on a Regional basis. The main objective being to maximise efficiency etc. -- Simple? No --Not One bit of it!

The only aim of NPAS as established, was to save money right from the start. No interest in increasing efficiency and effectiveness. But immediately close 50% of the bases, - plus a similar reduction in aircraft. Effectiveness was lost immediately because you had maximised the distances that aircraft had to fly. Instead of increasing the effectiveness of control they they opted for control on a National basis instead of a more efficient Regional Control system. This resulted in confusion and a downturn in morale. But critically they chose to Ignore the whole concept of reducing crime and an increasing the arrests of Criminals!

Oh yes NPAS was not a roaring success! Indeed it became a laughing stock!

So to those who propose the concept of a National Air Ambulance service I say , look at the tragedy of NPAS, learn from it and do not enter into the idea, unless your intention is to genuinely improve the availability of the service and not to just save money! I suppose If nothing else they at least you will have a a good model of how NOT to do it!

TF

Last edited by tigerfish; 2nd Nov 2018 at 02:18. Reason: clarification
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Old 2nd Nov 2018, 15:16
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Originally Posted by Nige321 View Post
Errr.... Why?
Yeah, good question.

As shown by the date this tread started, this has been bouncing around for a while. These ideas were proposed at a RUSI event in April 2012 and there was much rolling of eyes and shaking of heads. It was clear that there were too many egos in the room and not enough space left for common sense. And it's not about "the UK" and never will be. I can also tell you with certainty that these ideas are not for the benefit of either the casualties or the aircrew.
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Old 2nd Nov 2018, 20:53
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I don't really why the main argument against the idea is to use NPAS' example. This is a government organisation and will as mentioned only look at reducing cost, and usually do very poorly. Why not take the example of the RNLI, which are not government funded, like the AAs, and work nationwide, even internationally. Their supporters tend have strong ties to their local station as well. You will probably maintain the same income but a reduced overhead through lower maintenance, training and asset costs could possibly be used to improve cover of the service.
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Old 2nd Nov 2018, 22:14
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I'm sort of with Boessie on this, I agree that there is a tangible difference between a Government initiative which in the modern world is almost always motivated by reducing costs and that of an initiative driven by an independent organisation towards it's own ends, (whatever they may be).

The tragedy is that some of the independent organisations in this instance (AA's) are (in my opinion) motivated by aggrandisement, Sadly I feel that there is a real danger that this additional Government funding will inevitably be channelled towards wresting power away from existing stakeholders, eg:- Ambulance Services who provide clinical Governance having that responsibility removed and replaced by AA funded initiatives, an unecessary move that adds to the bill but delivers nothing more.

Don't get me wrong I applaud the work of all AA's, but I absolutely despair at the level of empire building that exists within their executive ranks and I am genuinely fearful that these additional funds will not result in more lives saved, but will simply serve to fund ego's and extend empires.
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Old 4th Nov 2018, 14:29
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Reducing costs overall can be the same as better organised and better resourced. Government departments, whether health or law enforcement, do not want to be dealing with dozens of little empires around the country that cause them to run entire departments to deal with them. A government with a spine and common sense might say 'If you want to operate AA in the UK then you will do X, Y and Z and operate according to P, Q and R." You might then end up with something more useful and which provides the giving public with more value.
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Old 5th Nov 2018, 00:21
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Ah! You mean like the Govt did with NPAS in respect of Police Aviation? Totally banjaxed it? Yes that's obviously a great idea!

TF
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Old 9th Nov 2018, 01:31
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I think there was far less reason to unify police aviation.
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Old 28th Jul 2022, 13:04
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Link to thirdsector.co.uk article:25 July 2022 by Russell Hargrave

25 July 2022 by Russell Hargrave



The Charity Commission has frozen the bank account of a charity that provides support to air ambulances amid financial concerns.

The regulator said it had opened a statutory inquiry into the Air Ambulance Foundation UK after the trustees failed to answer financial questions sent to the board.

The commission said the inquiry would examine whether trustees can account for how the charity spent its money and whether that spending supported its charitable objectives.

Charity Commission records show the charity filed its accounts late in each of the previous two financial years, by 94 days and 57 days respectively.

The accounts for the year ending April 2021 show that the Air Ambulance Foundation UK raised £480,000 over the previous two years, including three “very substantial” legacy gifts.

In the same period it made donations worth just £4,000, although the 2020/21 accounts say that it is considering “the possibility of the joint purchase of an air ambulance for one of the air ambulance services”.

The Air Ambulance Foundation UK did not respond to a request for comment.
I'm sure it's all absolutely fine, and there's nothing wrong, nothing to see here... yeah, right.
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Old 28th Jul 2022, 16:01
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Just take a look at how many pennies in the pound donated to the "The" Air Ambulance Service actually makes it to the helicopters. Now that's a bigger scandal. This bunch of crooks are merely dabbling in conparison
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Old 29th Jul 2022, 06:27
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Just take a look at how many pennies in the pound donated to the "The" Air Ambulance Service actually makes it to the helicopters. Now that's a bigger scandal. This bunch of crooks are merely dabbling in conparison
yes when the CEOs of the charities are paid far more than the people actually saving lives...how does that work?
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