The troubleshooter

There is a new feeling sweeping the corridors of ambulance headquarters just outside York - one that's been conspicuously absent for too long. Pride in a job well done. No one who has needed to call on their services has ever doubted the dedication or commitment of the paramedics and ambulance crews who, day in and day out, go about their business of saving lives.

But at times over the past few years, they must have felt doing their jobs was an uphill battle.

Morale hit rock bottom a few years ago with a Channel 4 Despatches documentary and a subsequent damning official report in which former chief executive Mike King was accused of bullying and intimidation.

Then there was the merger of the North Yorkshire service with neighbouring ambulance services to create the giant Tees, East and North Yorkshire Ambulance Service (TENYAS) - a monster covering a huge 4,500 square miles.

That, inevitably, caused further disruption. By the beginning of this year, the service was failing. New government targets insisted that paramedics should be reaching three-quarters of all 999 calls rated most urgent - those in which a life was felt to be at risk - within eight minutes. In the area covered by TENYAS, just 55 per cent of those calls were being reached in that time.

Statistics are never exciting. However, to the person lying critically injured after a road accident, a paramedic delayed by just a couple of minutes could signify the difference between life and death.

In June, chief executive David Craig quit by mutual consent - an acknowledgement he had failed in the important job of getting ambulance crews to the scene of an accident quickly.

A new man was drafted in to do the job and given the role of troubleshooter. And troubleshoot he did.

Trevor Molton kept his job as chief executive of the West Yorkshire Ambulance Service - one of the country's best performing - but over the past three months he has also been responsible for an astonishing turnaround in the fortunes of the Tees, East and North Yorkshire service.

When he first walked through the doors three months ago, the 46-year-old manager, who lives in York, gave staff 100 days to turn things around and hit their performance targets. Remarkably, they achieved it.

Figures announced yesterday revealed that the ambulance service is hitting its eight-minute response targets for more than 76 per cent of calls - beating the Government's 75 per cent target and putting it among the UK's top-performing services.

How has this happened?

Partly its a change of management style that's got the best out of staff. Mr Molton won't be drawn into direct criticism of his predecessors, saying only: "We have had people with a very different management style than the one I think is necessary for an area like this and an organisation like this."

But the talk over the photocopier at ambulance headquarters is about how he has fired everybody up, and brought a new mood of purpose and optimism.

"He's a breath of fresh air," said one insider. "He's got this drive about him. He's a real motivator and he seems to listen to what people say."

He himself insists it wasn't difficult to turn things round. "The staff here are so good," he says. "They are so committed to providing a quality of service. It is really down to the fact that so many people have responded."

Morale may be important. There is more to turning around an ailing ambulance service than making people feel good about themselves, however. It is in the changes to the way the service operates that the real breakthroughs have been made.

Traditionally, Mr Molton says, ambulance call centres reacted to 999 calls, despatching ambulances as and when a call came in. There was no attempt to predict where an ambulance was likely to be needed.

That's all changed. By analysing what emergency calls come in, when and from where, it's possible, he says, to make broad predictions about where ambulances are most likely to be needed at any time of day.

"You can then literally ramp up cover for that particular area at certain times of day. You can have crews standing by in more appropriate places.

"So now you will quite often, for example, see a rapid response car sitting in Clifton Green or Acomb Green at a certain time. They are responding to past patterns of demand."

Other methods used to turn around performance have involved recruiting extra staff - sometimes it has been as simple as a few extra cleaners, so that paramedics at a station don't have to waste their time on cleaning - and updating the 'mapping' software on board ambulances.

New satellite navigation equipment helps emergency crews reach their destinations quickly and easily - even when they don't know an area - by means of computer-controlled electronic maps on the dashboard, which show the best route to take and tell the driver when to turn.

"It is proving a real asset in helping shave vital seconds off our response times," says Mike Crosby, the ambulance service's fleet manager.

Despite the improvements in morale and in the ambulance service's performance, Mr Molton is the first to admit much remains to be done.

While the service is now hitting its response times, in remote rural areas the picture is not so rosy. In the Dales, only about 70 per cent of top-priority emergency calls are being reached within the eight minutes.

More ambulances and paramedics will help, Mr Molton says - he reckons the service is about £1 million short of being able to afford all the staff and equipment it needs to be really effective. But by itself, even that won't be enough.

He's keen for his ambulance service to work together with the pool of health workers already operating in rural communities - doctors, nurses, health visitors - to provide the sort of emergency care people need. By using a 'joined-up' approach, he says, the ambulance's 999 control room could alert health workers in remote areas who could conceivably reach the scene of an emergency far quicker than an ambulance.

He's already talking with the North Yorkshire Emergency Doctors Service about that. And he'd also like to see a partnership with NHS Direct, the service where members of the public can dial a helpline and speak directly with a qualified nurse. If some of those nurses could be used to assess the urgency of a call, he says, this could help paramedics prioritise and deliver help more quickly to those in greatest need.

It all sounds too sensible to be possible. No doubt creaking NHS bureaucracy will get in the way somewhere. For now, we should be grateful simply that ambulance staff are at last being able to deliver the kind of service they have always wanted to.

But seeing what's been achieved in the past 100 days, don't bet just yet against a few more tricks being pulled out of the hat.

Updated: 10:45 Tuesday, October 02, 2001