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TRANSCRIPT - PANORAMA "CASUALTIES"
17 JANUARY 2000


DAVID ROSE
When this teenage girl collapsed by the poolside, paramedics were called to her aid.

MALCOLM TURNBULL
There wasn't any urgency. There wasn't any contact between the paramedics.

DAVID ROSE
Her parents thought she'd be in safe hands, but the paramedics were out of their depth. When this woman was attacked, this paramedic did nothing.

PATRICK DELANEY
Negligence. How can we ever live with that?

DAVID ROSE
Just how good are Britain's paramedics?

[Scenes from Casualty]

DAVID ROSE
In real life as on the TV drama Casualty, Paramedics are the shock troops of the health service. Eleven years ago we were promised a paramedic on every ambulance. But the reality doesn't always match Casualty's ideal.

JON NICHOL
At the very least paramedics don't improve your chances of survival in serious trauma.

DAVID ROSE
Some of those who've seen them in action are losing their confidence.

NICOLE BERESFORD
I'd be really, really worried if I had to call out a paramedic. I really would

ROGER THAYNE
CHIEF EXECUTIVE STAFF AMBULANCE TRUST
Anybody suggesting doing it differently is seen as an immense threat.

BARRY JOHNS
SENIOR VICE-PRESIDENT AMBULANCE SERVICE ASSOC.
I think it's been one huge success story, the development of the ambulance service in this country.


DAVID ROSE
Away from the world of TV drama, that trust is sometimes misplaced. Tonight Panorama reveals that shortcomings in the ambulance service and its paramedics' lack of training are costing thousands of lives each year. At the same time, huge regional differences between the treatments paramedics give mean your chances of surviving a heart attack or a car crash may well depend on where you live.

MRS JANICE TURNBULL
The girls were very close, they did lots of things together. Although there was a ten year age difference, Katy loved to go off shopping with Hailey and she loved having Hailey friends around.


DAVID ROSE
Hailey Turnbull and her baby sister Kate lived in Durham. At fifteen, Hailey seemed fit and healthy. But her life was about to hang on the skills of two paramedics.

JANICE TURNBULL
Anything to do with the water she loved it. She actually started swimming lessons at a very early age. She was very confident in the water.

DAVID ROSE
On 2nd March, 1995, Hailey went to a life-saving class. But she was about to face her own emergency - for real. Her parents lived just minutes away. They were phoned by the baths and told Hailey had collapsed. They rushed to be with her. Mrs Turnbull was stopped from going to her daughter, but her husband was let through. He found himself confronted by a horrifying sight. Hailey was on the poolside, unconscious, being given mouth-to-mouth resuscitation by the lifesaving instructor. There were also two paramedics who weren't treating Hailey at all but carrying in equipment.

MR MALCOLM TURNBULL
I hadn't been there very long when I didn't feel things were right. The only person at the time treating Hailey was the poolside trainer. I think the first reaction Janice was to come out and say to you, Hailey's dying in there and they're not doing anything about it. There wasn't any urgency, there wasn't any contact between the paramedics. It appeared they were just carrying equipment.


DAVID ROSE
Their own official report reveals the paramedics thought Hailey was having an asthma attack - although her parents had told them she had no history of asthma. In fact, she had suffered a cardiac arrest - quite why, we still don't know. Every second counted. She needed immediate electric shocks from a defibrillator. Her life was ebbing away. It took eight minutes for the paramedics to arrive. Another eight minutes went by before they used their monitor and saw her heart had stopped.

MR TURNBULL
Hailey was starting to go blue, her lips were going blue, and I said to one of the ambulance people, she needs oxygen, she needs air, she's not breathing.

DAVID ROSE
First they wasted time trying to pass a tube into her lungs to give her oxygen. They'd carried two defibrillators to the poolside - but now they decided it would be too dangerous to use them, because of the water.

MR TURNBULL
I had the impression that we'd phoned 999, that the paramedics were there, they were the cavalry, they were the people who would come and save Hailey's life. I expected them to take over. But the longer time went on, that just didn't happen.

DAVID ROSE
They moved Hailey to the foyer. There was no water there but they still didn't shock her heart. It wasn't until they reached the ambulance that they used a defibrillator - at least 24 minutes after the 999 call. It didn't work. Doctors finally restarted her heart in hospital. But it was too late. Deprived for so long of oxygen, her brain had been fatally damaged. As a later inquiry confirmed, the paramedics had first misdiagnosed her; then failed to give her the treatment she needed.


MRS TURNBULL
If they'd assessed the, the situation immediately and moved Hayley to the ambulance, hopefully that would have happened much, much quicker and, you know, consultants have told us that, that would have given Hayley a much, much improved chance of survival. And it was probably on the Sunday that they withdrew the sedation and said that she was actually brain dead at that point.

DAVID ROSE
Malcolm Turnbull cannot but dwell on the mistakes that were made, and wonder whether his daughter might have lived.

MR TURNBULL
There isn't a day goes by than I think of Hayley and I think 'what if..'. What if I'd put her in the car and taken her to hospital? What if the paramedics had been better trained, better qualified? Would Hayley still have been here? And that's a question I continue to ask myself.

DAVID ROSE
Hailey's death was investigated by the Health Service Ombudsman, who was highly critical. But the paramedics kept their jobs. The local ambulance service said it had learned valuable lessons and changed its clinical practice.

DAVID ROSE
If the paramedics who treated Hailey Turnbull had been better trained, perhaps they might have realised what was wrong with her more quickly, and so saved her life. Here in Bristol, where the BBC series Casualty is filmed, I asked people what they knew about paramedics, and how much training they thought they received.

QUESTION: What do you know about paramedics?

WOMAN
I've seen them on Casualty, they're highly trained, they have motorbikes and ambulances, and, God forbid, if I have an accident, they'll save my life.

QUESTION: How much training do you imagine paramedics actually get in real life?

WOMAN
Hopefully, an extra two years?

MAN:
I would imagine it's similar to doctors: several years' training to actually do it.

YOUNG WOMAN:
A couple of years? Nearly as much.. not as much as like a doctor, but about as much as like a nurse or something.

OLD MAN:
Three years at least.


DAVID ROSE
The reality is rather surprising. After a year on the road as a technician - basically a driver qualified in first aid - the trainee paramedic gets just six weeks in the classroom, followed by a few week's experience in hospital.


QUESTION: What's your reaction?

WOMAN:
I'd be shocked. And if I ever do have a road accident, I hope there's someone more trained than a paramedic. I'm surprised.

MAN:
Yes, I would have thought it was a lot more than that, considering what they have to do out and about. They haven't got any other back up of the hospital staff or anything like that when they're out there, they're on their own aren't they.

YOUNG MAN:
Gosh! They're so important. That's incredible.

DAVID ROSE
Professor Jon Nicholl heads one of the country's leading medical research teams, the author of several reports on ambulance care. Some of his findings make worrying reading.

PROFESSOR JON NICHOLL
MEDICAL CARE RESEARCH UNIT, SHEFFIELD UNIVERSITY
I think the public probably think that paramedics are better trained than nurses. Whereas the opposite is true. Most paramedics only get four to eight weeks of theoretical training, followed by a similar period of practical training, followed by a year on the road when they're working as paramedics but they are trainees still. Nurses. on the other hand. usually do a three year course which is a mixture of practical and classroom training. But it does go on for three years, so this is really quite a different degree of training.

DAVID ROSE
Is there anybody else in the health service who has to make a life or death decision about what to do with a patient who's only got four weeks training in the classroom?

PROFESSOR JON NICHOLL
Well nowhere else in the health service I think would that happen.

DAVID ROSE
And the consequence of the fact that it does happen must be that some people die who otherwise might live.

PROFESSOR JON NICHOLL
Yes, I'm sure that that is a consequence, the only thing is that we know that it is surprisingly rare.

DAVID ROSE
The Ambulance Service Association, which represents the service nationally, insists there's no real problem. But it accepts there's room for improvement.


BARRY JOHNS
SENIOR VICE PRESIDENT AMBULANCE SERVICE ASSOC.
Paramedic training today is very robust and provides an infinite improvement in care over the last decade. What we are saying is that there is growing evidence to suggest that the role of the paramedic can be further enhanced.

DAVID ROSE
So you do accept the evidence that things aren't quite as good as they might be?

BARRY JOHNS
I say there is limited evidence to suggest that we can improve things, and that's natural.

DAVID ROSE
Another doctor who has researched the state of pre-hospital medicine is Charles Deakin. He is also disturbed by what he's found, and is convinced that paramedics need more training.


DR CHARLES DEAKIN
CONSULTANT ANAESTHETIST
SOUTHAMPTON GENERAL HOSPITAL
Generally it's been assumed that the standard of care that's being delivered in the pre-hospital environment has been adequate and that casualties are delivered to the hospital with everything possible having been done for them. Over the last ten years though there has been quite a lot of research that has brought this into question. I think in terms of what we're asking them to deal with and the severity of injuries then a significantly longer training,
certainly more than the six to eight weeks that they have already, would be appropriate for paramedics who are being asked to deal with seriously injured patients on the road side. It would certainly improve their diagnostic skills and the skills in terms of treatment that they offer.

DAVID ROSE
In this exercise at the national fire brigade training centre, a paramedic with many years experience directs the other emergency services. In reality, things don't always go so smoothly. The first thing a paramedic has to do is ensure the patient can breathe properly, that their airway is clear - vital to prevent brain damage. Research suggests that paramedics aren't as good at this fundamental part of their job as they should be. More than half of those taken to hospital with serious injuries arrive with some airway obstruction.

DR CHARLES DEAKIN
These results have been quite surprising really, everyone has assumed that airway management has been optimal on the roadside.
People are now beginning to look at whether the airway skills that paramedics are taught are adequate.

DAVID ROSE
Sometimes, the only way to help both heart attack and accident victims breathe is to put a plastic tube down their windpipe. Anaesthetists also do this in hospital when they give a general anaesthetic. It's called intubation.

DR CHARLES DEAKIN
This is the view you see as you look into the back of the mouth to insert the tube into the trachea, the windpipe, and then you can see the soft pink tissue beneath that which is the epiglottis which covers the windpipe, and then underneath that are the vocal cords and it's that structure through which we try and pass the endotracheal tube. Unfortunately, with trauma patients, often the view is not as good as this.

DAVID ROSE
So it's actually more difficult because of the angle of the head, often, to intubate by the roadside than it is in hospital?

DR CHARLES DEAKIN
Doing it on the roadside is a lot more difficult.

DAVID ROSE
Anaesthetists aren't allowed to intubate patients until they've done it at least a hundred times under supervision. Paramedics, on the other hand, will go out on the road after just twenty practice attempts.


BARRY JOHNS
You ask who can deliver an intubation in an upturned car at night, then it's the paramedic who can and it's the anaesthetist who can't. The training really does show that the paramedics are capable of doing that, and they perform the intubations day in and day out very successfully.

DAVID ROSE
But what you're telling me is that paramedics are just better at intubating patients than anaesthetists.

BARRY JOHNS
In the pre hospital setting.


DR CHARLES DEAKIN
That's an interesting view. I would be surprised that if someone who had done twenty intubations, whether they were an anaesthetist or a paramedic, was better than someone who was doing it every day of their life.

DAVID ROSE
An NHS study in 1998 found that more than a third of intubations attempted by paramedics failed. Yet in Britain, only doctors, not paramedics, are trained to intubate a group of patients who often need it most - people with head injuries who aren't completely unconscious. Trying to insert a tube will make them choke and vomit; yet without intubation, they will suffer brain damage.


DR CHARLES DEAKIN
The only patients, in terms of trauma, that they can intubate successfully really are those with what we call a Glasgow Coma Scale of 3, that's patients who are completely unresponsive and patients who are completely unresponsive from trauma have a very, very poor outcome, probably less than 2 or 3 percent survive. The only trauma patients that paramedics can intubate are generally those that are dead.

DAVID ROSE
The only way to intubate semiconscious patients is to give them anaesthetics and muscle relaxing drugs to dampen their gag reflex. In America, where most paramedics are trained for two years, they can give these drugs. Giving their British counterparts these skills might have dramatic results.

DR CHARLES DEAKIN
If you can intubate patients on the roadside with a head injury then you make a big difference in terms of whether they survive or not. You're probably looking at somewhere in the region of 600 to 1,000 patients who could have survived.

DAVID ROSE
If a paramedic fails to diagnose an injured patient correctly, the consequences can be fatal.

PATRICK DELANEY
My mother was very good with children and if somebody was ill she'd go round and see them.

DAVID ROSE
Janet Delaney was a healthy woman of 58. She lived in Derby with her daughter, Kelly, not far from her son Patrick and his family. On 9th July last year she popped out to collect her wages from the local pub where she worked.

KELLY
I was speaking to my mum about different things, and she seemed okay, she seemed fine. She seemed happy. And then I went upstairs to have a bath because I had arranged to go out that night with a friend.

DAVID ROSE
While Mrs Delaney went out, a few streets away, Nicole Beresford was getting her children ready for bed. She knew Mrs Delaney by sight.

NICOLE BERESFORD
I came downstairs and I noticed there was a bit of commotion in the street, so I went outside to have a look because I thought somebody had knocked my cat over, and then realised it was Mrs Delaney lying in the road and she looked like she'd fallen backwards, or someone had dragged her backwards. To begin with we all felt that she'd been mugged or she'd been attacked or some such sort because she always carries a black bag with her and she'd got no black bag with her, and the contents of perhaps what would have been in her bag were all sort of thrown all around her body.

DAVID ROSE
Nicole noticed what looked like blood on the back of Mrs Delaney's head. She appeared to be unconscious, and began to vomit. A passing driver dialled 999. First on the scene was a paramedic in a rapid response car, Brenda Blood. The Ambulance Service thought highly of her, and had chosen her to appear in this TV documentary about the job of a paramedic.

NICOLE BERESFORD
She saw Mrs Delaney and her response was "Oh she's drunk, she's not a very nice person, I know her and she's drunk" and we were all quite shocked because she hadn't made any examination. All she kept repeating was "No, she's drunk" and then the paramedic put some surgical gloves on and got onto the floor and slapped Mrs Delaney across the face a couple of times to ask her to get up.

DAVID ROSE
Mrs Delaney lay in the street for half an hour until an ambulance arrived. Brenda Blood told them to go away. In fact, Mrs Delaney was sober: she'd drunk only a pint of lager hours earlier. But the paramedic called the police and asked them to deal with her.
How long in all was the paramedic in the road with Mrs Delaney before she was finally taken away?

NICOLE BERESFORD
It was well over an hour before the police arrived and took her, well over an hour.

DAVID ROSE
And in that hour did, at any stage, the paramedic examine Mrs Delaney?

NICOLE BERESFORD
No, not once. The only time the paramedic went near Mrs Delaney was to remove her teeth and slap her face and that was it.

DAVID ROSE
Brenda Blood told the police that Mrs Delaney was drunk, and they took her home. Her daughter was there to meet her.

KELLY DELANEY
My mum got out the police car and she seemed really confused, she didn't know where she was, she was disorientated. She seemed really strange. And the policeman said that she'd had a few too many.

DAVID ROSE
Assuming she needed to sleep it off, Kelly left her mother on the sofa and went out. Mrs Delaney had arranged to meet a friend that evening. When she failed to turn up, he went to her house and let himself in. He saw at once she was in a critical condition, and called another ambulance - which did take her to hospital.

DAVID ROSE
Did you see her in hospital?

PATRICK DELANEY
I got there two minutes after she'd died.

DAVID ROSE
Mrs Delaney died from a fractured skull. Two men have been charged with her murder. The Ambulance Service refused to comment to Panorama, saying the case is sub judice. A few weeks after Mrs Delaney's death, ambulance officials agreed to talk to her family, only to cancel the meeting an hour before it was due to start. Brenda Blood, the paramedic, has been suspended, pending a disciplinary hearing.

PATRICK DELANEY
She's gone through that attack, and then the people that have come to save her treat her and call her a drunk. Slander and negligence - how can we ever live with that?

DAVID ROSE
A recent study by Professor Nicholl assessed whether being treated by paramedics improved patients' chances of surviving serious injury. The conclusions were surprising.


PROFESSOR NICHOLL
The findings in that report were that there was a higher mortality amongst patients treated, patients with serious injuries treated by paramedics, than similar patients managed by non-paramedics.

DAVID ROSE
He assembled a panel of experts, who looked at 179 cases where paramedics treated people who had died from injuries. They tried to assess whether these deaths were avoidable.

PROFESSOR NICHOLL
They thought that seventeen of these patients, who were attended by paramedics, could possibly.. their lives possibly could have been saved. But when they looked in detail and thought about everything that had been done, they finally concluded that eight of them had probably avoidable deaths.

DAVID ROSE
So one in ten might possibly have lived; almost one in twenty probably could have done. Professor Nicholl says similar numbers die avoidably in hospital too. But the Ambulance Service Association seems unperturbed.

BARRY JOHNS
Trauma cases themselves represent less than 10% of the demand that is placed upon emergency ambulance services. The incidences are tragic, they are certainly regrettable, but it important that we learn from them. But then to suggest that those few isolated incidents undermine the quality of the training delivered in this country, I think is perhaps an insult to the service.

DAVID ROSE
Across the UK there are 36 ambulance services. Each has its own treatment instructions laid down by committees of doctors known as clinical protocols. We've carried out a survey of some of these protocols, and found wide discrepancies. This is No Man's Heath, where four counties and three ambulance services meet - East Midlands, Staffordshire and Warwickshire. If you find yourself here, dying from heart failure and someone dials 999, you'd better hope the ambulance comes from Warwickshire. Their paramedics, and theirs alone, can give you a shot of a life-saving heart drug, frusemide, and also the best drug available for relieving your pain, diamorphine. On the other hand, if you were lying in a smashed up car with a punctured lung, your best hope would be an ambulance from Staffordshire, where all paramedics learn a life-saving technique to keep you breathing, needle decompression. And East Midlands? Well, most of their paramedics couldn't give you any of these treatments. But then again, the chances of the ambulance coming from East Midlands are fairly small. There response times are much slower. Some of the biggest differences between services concern drugs. One example is Warwickshire.

WARWICKSHIRE PARAMEDIC
OK, these are some of the drugs that we carry that other ambulance services don't, we've got Frusemide for relief of patients suffering from left ventricular failure.

DAVID ROSE
Now what's that?

It's a drug, it helps remove some of the fluids when people have... they've got bubbling on the lungs and it basically it gets the whole system on the move again.

DAVID ROSE
I mean is that really a life saving drug?

WARWICKSHIRE PARAMEDIC
It can be a life saving drug, yes, certainly. When people go a long way down the road they're almost drowning by the time we get there.

DAVID ROSE
Last year Warwickshire paramedics gave Frusemide to 140 patients. Yet our survey reveals only five ambulance trusts give this drug across the country. When Derbyshire, Leicestershire and Nottinghamshire merged to form East Midlands last April, one of them, Nottinghamshire, had been using the drug. But after the merger, it wasn't extended to the other areas, while in Nottinghamshire it was actually restricted.
Here's a drug, you use it in part of your service area, not in the rest of it. It seems absolutely baffling.

MIKE HANDY
CHIEF EXECUTIVE, EAST MIDLANDS AMBULANCE SERVICE
But at the end of the day I have to be responsible and accountable for what happens out on the road, and I'm accountable for the drugs and the authorisation at the end of the day.

DAVID ROSE
But you can give that authorisation in Nottinghamshire. You're saying you can't in Derbyshire or Leicester. It makes no sense.

MIKE HANDY
I can't give that authorisation.

DAVID ROSE
Well your committee and your and...

MIKE HANDY
The authorisation comes from the medical committee that I've been talking about.

DAVID ROSE
But where's the logic? They've authorised it for use in Nottinghamshire. It doesn't take a lot of training to train paramedics to use this drug, perhaps a day at best. It's not in use in Derbyshire or Leicestershire. Where's the logic?

MIKE HANDY
I'm sorry. That's.. I'm not going any further with that.

DAVID ROSE
Treatments available for trauma patients are just as uneven. Here on Casualty, paramedics save a patient with a punctured lung by relieving the pressure in his chest, a procedure known as needle decompression. In reality, only half the 36 ambulance services can do it.

DR CHARLES DEAKIN
If I was trapped in a car crash with a collapsed lung, then I wouldn't want it to be in a county where the paramedics weren't trained in that procedure. It's a life-saving procedure and if it wasn't performed then the outcome may well be death.

DAVID ROSE
The Ambulance Service Association says it exists to promote best practice of the kind seen on Casualty. It doesn't always succeed.

BARRY JOHNS
Currently it's variable and I think it's that variability that has been a strength, but also that strength has got to make sure that everybody has advantage to best practice.

DAVID ROSE
And at the moment they don't.

BARRY JOHNS
No, some services don't use certain skills, use certain drugs.

DAVID ROSE
Use best practice.

BARRY JOHNS
They don't use best practice at the moment.

DAVID ROSE
This isn't the only area where the ASA is failing to improve national standards. This is Roger Thayne, chief executive of the Staffordshire service. Thayne's carried out radical reforms. By focusing on times and places of peak demand, he's cut response times and saved money which he's invested in extra training. It's made him unpopular.

ROGER THAYNE
CHIEF EXECUTIVE, STAFFORDSHIRE AMBULANCE SERVICE
I've felt like the public enemy No 1 of the ASA at times.

DAVID ROSE
The government has set a target for all ambulance services. By March next year, they must get to 75 per cent of emergencies within eight minutes. So far, only Staffordshire has met this target. None of the others come close. In Staffordshire, Thayne and his other managers don't just drive their desks: they drive ambulances when necessary. Others don't seem ready for this change.

ROGER THAYNE
I think a lot of them are very reluctant to change and are in a time warp of "Well we've always done it this way and we haven't seen it done any differently" and anybody suggesting doing it differently is seen as an immense threat.

DAVID ROSE
Instead of waiting in stations far from where emergencies occur, Staffordshire crews use 'forward posts,' rooms for crews to wait in rented on housing estates or petrol stations where and when they're likely to be most needed. The resulting faster response has saved hundreds of lives, especially of patients in cardiac arrest.


STAFFS PARAMEDIC
Well I think it's best if you've got a bit of chest pain to go and get it checked out properly, especially if you have had a heart attack in the last four weeks. It's always best to get it looked at.

DAVID ROSE
In 1992 Staffordshire's cardiac arrest survival rate was no more than the national average - 2% of patients were resuscitated and taken alive to hospital. Now that figure is 11%.

STAFFS PARAMEDIC
Just going to lift you up on to the ambulance now darling. Ready?

Okay.

DAVID ROSE
If the ambulance service in the whole of England managed to achieve that level of improvement, how many lives might be saved a year?

ROGER THAYNE
Approximately 7,000 more people would arrive with a chance of survival at hospital.

DAVID ROSE
Of those 7,000 - people who are now dying - up to a half could expect to walk out of hospital within a week. Thayne's figures are backed by the academics.


PROFESSOR JON NICHOLL
Staffordshire are, are top of the table, they're the sort of the Manchester United, but we're still hopeful that if the ambulance services can move there, which Staffordshire have already achieved, then over the whole country, as you say, several thousand lives will be saved, and that really will be some achievement.

STAFFS PARAMEDIC
Have you've taken some tablets? How many?

DAVID ROSE
Thayne has managed to impress the Department of Health, which has now commissioned Professor Nichol to conduct a study of how Staffordshire achieves its results, and how they may be more widely applied. The ASA is less impressed.

BARRY JOHNS
What aspect of best practice happens in Staffordshire that is not happening in whole or in part in any other service? Could you like to identify which ones?

DAVID ROSE
He's met the 2001 response target for the last 4 years. No other ambulance service has yet done so.

BARRY JOHNS
He's reported that, yes.

DAVID ROSE
His figures have been audited independently haven't they.

BARRY JOHNS
By certain people, yes.

DAVID ROSE
Well they've been independently audited, you can't. say they've been fiddled, surely?

BARRY JOHNS
Yes, well what I am saying.. no, there are good practices there.

ROGER THAYNE
No president of the ASA has ever visited.

DAVID ROSE
Now you're the Vice President of the ASA, have you been to Staffordshire and had a look at what they're up to?

BARRY JOHNS
I'm certainly aware.. fully aware of what..

DAVID ROSE
Have you been there?

BARRY JOHNS
No, I certainly haven't.

DAVID ROSE
They're just up the road aren't they, about 30 miles from here.

BARRY JOHNS
Very much so.

ROGER THAYNE
I think that they consider me very egoistic, dogmatic, dangerous, provocative.

DAVID ROSE
If I said to you that others in the ASA have described Roger Thayne as something of a maverick, and if I made the comment he seems to be slightly isolated in the ASA, do you think that would be fair?

BARRY JOHNS
That could well be a view that's held by a number of colleagues. It's a view of the individuals within the association, not the association's view itself.

DAVID ROSE
When paramedics make mistakes, bereaved families - like that of Maurice Webster, a pensioner from Leicester - feel they're much less accountable than other health professionals.

LYNNE HARPER
He only lived and worked to take his children on holiday, and then his grandchildren came along and he just lived for them.

DAVID ROSE
Mr Webster's love of life and energy concealed the fact that by the autumn of 1998, he'd had three heart attacks. He'd been told to go to hospital immediately if he experienced any symptoms suggesting a recurrence. His daughter, Lynne Harper, was with him on the evening of 28 October. She was soon worried about his health. He had pains in his chest and arms, shortness of breath and was covered in a cold sweat. An angina pill made no difference. A trained first-aider, she feared the worst, and called an ambulance. It arrived within ten minutes.

DAVID ROSE
So when the ambulance arrived at his door, how did you feel as you saw the crew arrive?

LYNNE HARPER
Relieved, that I'd got my Dad in safe hands.

DAVID ROSE
Two ambulance men, a technician and paramedic Ian Wiltshire, went in. They failed to assess or treat Mr Webster.

LYNNE HARPER
First of all, one of the paramedics sat straight down into the armchair, without speaking and sat back slumped in the armchair watching the television, and there he stayed. Sat there tapping his cheek, wiggling his feet.

DAVID ROSE
For almost 40 minutes, paramedic Wiltshire did nothing. Meanwhile, Mr Webster's condition was deteriorating. Lynne's daughter, Jayne Milankovic arrived. Eventually, Jayne says, as if spurred by boredom, the paramedic examined Mr Webster.

JAYNE MILANKOVIC
When they did finally put the equipment on him, blood pressure, ECG, they started to give each other alarming looks. He stopped watching TV - the one in the chair. He looked at his colleague. His colleague looked back. They still didn't speak. They still didn't say a word to each other, and within seconds, he'd stood up. "Right we'll get you to hospital. Straight to hospital."

DAVID ROSE
His family never saw him alive again. Mr Webster died soon after reaching hospital. His family feel his death was avoidable.


JAYNE MILANKOVIC
We could have got him in the car ourselves. Got him to hospital far more quicker than they had. We could have actually walked to a bus stop, got him on a bus, and got him the treatment quicker.

DAVID ROSE
And if you had, he might still be alive?

JAYNE MILANKOVIC
He may well be.

DAVID ROSE
Not long after the funeral they were sent an anonymous letter from a group of ambulance staff which confirmed their suspicions.

JAYNE MILANKOVIC
We received a fax from our solicitor, on Ambulance headed notepaper, stating their disgust at the crew that night. How they felt that this crew was letting the Ambulance Service down.

DAVID ROSE
Lynne and Jayne made a complaint, asking questions about the paramedic's failure to treat Mr Webster. There was a disciplinary hearing but the family weren't told its outcome. They knew that the paramedic had kept his job.


MIKE HANDY
I can't tell you what disciplinary action was taken against the crew. I have a responsibility of confidentiality as far as the crew is concerned, as I have a responsibility for confidentiality as far as patients are concerned. Disciplinary action has been taken against that paramedic, and
that paramedic has been subject to considerable retraining.

JAYNE MILANKOVIC
Drinking while on duty. Stealing from your employer. They're all dismissible offences, but there's no clarification on what they can do or not do to the public for fear of losing their job. It just seems that they can get away with so much.

DAVID ROSE
That, however, is set to change. Last year, Parliament agreed to make paramedics a state registered profession, like nurses. Under the new register, they could be struck off for professional misconduct. But this is at least eighteen months from coming into force. The new register will be run by a board under the Council for Professions Supplementary to Medicine. Its registrar says that for six months the Department of Health did nothing to set the
register up, failing even to agree the names for the board. At the end of last year they began to act.

DAVID ROSE
What do you think suddenly made events start to move again?

MIKE HALL
REGISTRAR CPSM
I believe it could well have been this programme being made.

DAVID ROSE
They would have felt embarrassed if there hadn't been the names after such long delay knowing that we were about to broadcast to Panorama.

MIKE HALL
I don't know, but certainly the name of this programme was mentioned when contact was made between the NHSE and ourselves.

DAVID ROSE
And in what context, what did they say?

MIKE HALL
Asking when the board was to be formed, and were told why the board could not be formed, because we'd not got approval of the two names we needed for council from the paramedics.

DAVID ROSE
So, the DoH contacted you and said, Panorama's coming out with a programme about paramedics, why is there no board, and you had to point out that they had to make the next move?

MIKE HALL
That is correct.

DAVID ROSE
The new board will have other powers, for example, it could insist on better training. For bereaved families like the Turnbulls whose younger daughter Katie now attends the lifesaving class like Hailey did, the need seems clear.

MALCOLM TURNBULL
I think we have to look very closely at what we're asking paramedics to do. We're asking them to take over from doctors. We're asking them to make decisions that doctors make. Yet we only give them six weeks training.

JANICE TURNBULL
I think its very unfair to put that much pressure on paramedics.

DAVID ROSE
The ASA also accepts there's a need for reform. As an interim step, it wants to introduce a slightly longer training syllabus of the kind already used here in Staffordshire. And looking further ahead it wants to create a new grade of superparamedic with degrees. The problem is, unlike doctors or nurses, whose training is funded centrally, ambulance services have to pay for training their staff. No one knows where the extra money for these improvements may come from.


BARRY JOHNS
If that's the objectives of the ambulance service in the United Kingdom, then we need to ensure that we set up the financial framework in which to ensure that training takes place.

DAVID ROSE
So what you're saying is you have an emerging concept for improving ambulance training but you don't know who is going to pay for it.

BARRY JOHNS
Quite right. There's a lot of questions still to be asked.

DAVID ROSE
Meanwhile, lives that might be saved are being lost.

MR TURNBULL
What we could do is make sure Hailey didn't die in vain, that we can learn from her death, that we can get a better ambulance service and maybe someone else won't have to go through what we've had to go through.

_____________________________

You can comment on the issues raised in tonight's programme by visiting our website at
bbc.co.uk/panorama.

ENDS

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