Signing off with sirens

Monday
On Monday I visited the Greenwich commissioners. It was really valuable to have an understanding as to how the commissioners work, their relationships with service providers and how they gain an understanding as to how services are running. Even though both the service providers and commissioners have similar focuses toward providing an excellent service it is important for service providers to be accountable and for budgeting to be monitored externally.

I think having a positive working relationship with commissioners can be really valuable for service providers as both parties need to have a strong position within the relationship in order to negotiate successfully. Additionally if both parties trust each other and are reassured they both have the same ultimate goal then a more positive working relationship focussing on service improvement can be established.

I was surprised by how involved commissioners were in care deliver. In terms of conducting their own research on service improvement and patient experiences which I think is really useful within their role and also for service providers who can use these insights.

Tuesday
On Tuesday I had an opportunity to reflect on my orientation experience as it came to an end. I have found this whole experience very valuable in terms of gaining an understanding of the NHS, how it works, its current circumstances and pressures. I also valued hearing insights from staff from a variety of professions at different levels about service delivery and development. I now have a better understanding of the specific services Oxleas run and how they function within communities. I think I would have taken a very different perspective and approach to my work had I not completed this time on orientation. Having a mutual understanding of the service everyone is working together to deliver, improve and sustain is key and it is important not to lose sight of.

Saturday
On Saturday I spent the day in the London Ambulance Service with two paramedics. It was a really exciting day and I began to realise the huge variety of calls the ambulance receives all the time. Often paramedics deal with non-emergency situations by transporting people home or to hospital because they wouldn't be able to make the journey themselves. But then they must also be ready to deal with emergency, life-threatening situations at all times - when they must take control, think quickly and calm patients and their families.

There is a big incentive at the moment to ensure all patients go to the appropriate place for them when feeling unwell - whether that be hospital, a drop-in clinic or to stay at home and take some advice. While paramedics can suggest patients go to the location they believe the patient is most suited to it is ultimately the patient's decision as they know how they are feeling and what would comfort them best. Attending A&E can be expensive, have long waiting times and can be inconvenient, but despite this many people still want to attend because they believe this is where they will receive the best care. It is important to ensure patients have a good understanding of the different services available and what they offer so that they can make an informed choice about what is right for them.

The ambulance system is very regimented in terms of shift hours, toilet breaks, going to the petrol station, lunch breaks as well as recording the time spent in hospitals, time spent with each patient, the time it took to arrive etc. All of these things must be recorded to ensure efficient working. Ambulance workers work long, intensive shifts and it is important they take regular short breaks to make sure they remain alert therefore after completing the service with each patient they have 15 minutes break which could be used to have lunch, complete forms, clean the truck, relax or discuss the case and how they worked together. I could see how valuable this time out was to catch up with any back-logs and be fully prepared for the next case. We were busy all day from one patient to the next and the only breaks the paramedics had were these ones.

Paramedics must also be very adaptable in terms of their hours. They must arrive prior to the start of their shift to ensure the truck has all the equipment they need and to prepare and plan for the day ahead. Throughout the day they may get a call and begin the journey but this may change at any point until they actually reach the patient if a higher priority call comes up or another ambulance nearer to the scene becomes available. Additionally if they get a call as their shift is ending they must attend to it which could mean they actually finish a lot later than planned.

Despite some of the stresses of the job it is highly exciting and rewarding and the care, compassion and enthusiasm paramedics show and sustain was very admirable.

Finally, thank you to everyone who has hosted me over the past month, everyone has been very generous with their time and very patient when answering all my questions! The experiences I have had have been invaluable.