Misplaced Pages

#661338

50-458: The London Ambulance Service NHS Trust ( LAS ) is an NHS trust responsible for operating ambulances and answering and responding to urgent and emergency medical situations within the London region of England . The service responds to 999 phone calls across the region, and 111 phone calls from certain parts, providing triage and advice to enable an appropriate level of response. It is one of

100-645: A statutory instrument . NHS trusts are not trusts in the legal sense but are in effect public sector corporations . Each trust is headed by a board consisting of executive and non-executive directors , and is chaired by a non-executive director. There were about 2,200 non-executives across 470 organisations in the NHS in England in 2015. Non-executive directors are recruited by open advertisement. All trusts ( foundation trusts and those which have yet to reach foundation trust status) are regulated by NHS England and

150-552: A different role within the service, or leave. A fire in the basement of its Waterloo base in October 2010 caused the LAS to relocate the EOC to the back-up control room in east London due to an interruption to the building's power supply. The service took the step of urging the public to find other means of transport to hospital for anyone with non-life-threatening injuries. In 2013, the LAS

200-649: A duty to act on signals of poor performance on quality and safety data, and yet many of the papers presented to them have been found to be lacking good data visualisations. The High Court of Justice decided in December 2019 that NHS trusts were not charities for the purposes of the Local Government Finance Act 1988 , so they have to pay business rates at the full rate. A study by the University of Exeter in 2020 found that in 70 out of

250-530: A more tailored treatment package to specific and significant groups of patients in the community including: Volunteers make up a small but significant proportion of front line ambulance staff that respond to emergency calls in London. Voluntary responders vary in skill level, but their principal purpose remains the same. That is to attend medical emergencies as quickly as possible to improve the patient's chance of survival, saving lives which may have been lost without

300-797: A national basis, deal with NHS-wide issues. An example is NHS Blood and Transplant . Local Government Act 1929 The Local Government Act 1929 ( 19 & 20 Geo. 5 . c. 17) was an act of the Parliament of the United Kingdom that made changes to the Poor Law and local government in England and Wales . The act abolished the system of poor law unions in England and Wales and their boards of guardians, transferring their powers to local authorities. It also gave county councils increased powers over highways, and made provisions for

350-729: A number of London hospitals and PCTs to take patients to and from their pre-arranged hospital or clinic appointments, the PTS responds to ad hoc journey requests and provides specialist transfer facilities. Cycle responders, who operate in areas such as the City of London , the West End , Stratford , Kingston Town Centre as well as Heathrow Airport , use custom built Rockhopper mountain bikes manufactured by Specialized Bicycle Components . In 2017, 140 new Mercedes Sprinter ambulances were introduced and 60 new Volkswagen Tiguan to be incorporated into

400-632: A part of the LAS, London's Air Ambulance Charity is deployed by the LAS from its base at the Royal London Hospital in Whitechapel using either its ground RRVs or its helicopter. As well as accidents and emergencies, the LAS operates a 195-vehicle patient transport service (PTS). Previously a centrally funded service, this element of the LAS is now subject to an open market and is required to tender for work from primary care trusts (PCTs) and other NHS bodies. As well as being contracted by

450-443: A population of just a few hundred and did not have the resources to deliver modern local government services. Similarly, there were a number of rural districts created in 1894 that had small and irregular areas. There were also a few areas where parishes in one county were administered by a rural district council in another. Section 46 of the act provided for a review of districts in each administrative county in England and Wales, with

500-647: A report by the Care Quality Commission (CQC) in November 2015, which rated it "inadequate" overall and raised "significant concerns" about its performance. 54 inspectors visited 16 ambulance stations and emergency operation centres in June. Criticisms focussed on: On 23 May 2018, LAS was taken out of special measures by the CQC, being rated good overall and outstanding in patient care. The report noted that

550-513: A requirement for ambulances to be available for anyone who needed them. The present-day London Ambulance Service was formed in 1965 by the amalgamation of nine existing services in the new county of Greater London , and in 1974, after a reorganisation of the NHS, the LAS was transferred from the control of local government to the South West Thames Regional Health Authority . On 1 April 1996, the LAS left

SECTION 10

#1732765145662

600-564: A safe level. The future of private ambulances within the LAS is unclear. In March 2014, operational difficulties were reported at Hillingdon Hospital because the private ambulances did not appear on the A&;E hospital alert system. In November 2021 the trust announced that it would be directly employing the 500 staff in "make ready" teams who are responsible for cleaning and restocking ambulances before they are taken out. They have been employed by Mitie for some years. In its last inspection of

650-424: A total of 4,957 staff. The Medical Directorate provides advanced paramedic practitioners in critical care who are specially trained to deal with critically ill patients, and who can provide interventions outside the normal scope of practice of a paramedic like mechanical ventilation and sedation. Advanced paramedic practitioners in urgent care support the LAS aim to reduce conveyance rates by managing more patients in

700-464: A view to forming more effective areas for administrative purposes. The process involved the putting forward of a scheme by the county council to which objections or representations could be made before an order was made by the Minister of Health . All county councils were required to finalise schemes by 1 April 1932, although the period could be extended at the minister's discretion. The final submission

750-522: Is hoped that by this measure there will be an improved response to the most urgent calls. It has also implemented a system of "intelligent conveyancing" where ambulances avoiding hospitals that are known to be under pressure. This has reduced the average waiting time for handover from ambulance to hospital staff by 180   seconds, though the average journey time has increased by 27   seconds. In December 2014, it asked other ambulance services for help after its busiest ever week with 11,008 call outs for

800-590: Is part of the National Health Service , receiving direct government funding for its role. The LAS responded to over 2.1   million 999 calls for assistance, and over 1.2   million incidents in the year ended March 2020. Incidents rose by 20,000 in 2015/16, putting more pressure on the service. All 999 calls from the public are answered at one of the two Emergency Operations Centres (EOC) in Waterloo or Newham who then dispatch and allocate

850-415: The Care Quality Commission . Board members are, from November 2014, subject to a fit and proper person test . All trust boards are required to have an audit committee consisting only of non-executive directors, on which the chair may not sit. This committee is entrusted not only with the supervision of financial audit , but of systems of corporate governance within the trust. Hospital board members have

900-643: The River Thames to Deptford, where they could be quarantined on hospital ships, departing from three special wharves at Rotherhithe , Blackwall and Fulham . At Deptford, in order to transfer patients between the hospitals at Joyce Green and Long Reach near Gravesend , a horse-drawn ambulance tramway was constructed in 1897 and extended in 1904. In 1902, the MAB introduced a steam driven ambulance and in 1904, their first motor ambulance. The last horse-drawn ambulances were used on 14 September 1912. Although

950-521: The 213 trusts all the board members were white. Overall BAME representation at board level was 8.9%. Medical directors of BAME ethnicity accounted for 19.4%, about the same as the overall percentage of BAME doctors. In September 2015 Jeremy Hunt was reported as saying "I think we do have too many trusts as independent organisations" in a context where mergers between trusts and the establishment of chains of hospitals were being discussed. Subsequently Simon Stevens made it clear that he did not expect

1000-824: The 999 emergency service, LAS operates 111 urgent care services covering north east and south east London. In the year to March 2020, the service answered and triaged 2.08   million 999 calls, 1.22   million 111 calls, and attended 1.18   million incidents. The 999 and 111 call centres and control rooms employ a total of 1,655 staff. The Ambulance Services directorate provides front-line crews formed of paramedics, emergency medical technicians and emergency ambulance crew, and non-emergency transport services. The department also provides incident response officers who are operational commanders, and provide 24/7 operational management. Clinical team managers also provide operational command resilience but primarily provide 24/7 clinical management and leadership. Ambulance operations employs

1050-532: The British Red Cross, as demonstrated in the 7 July 2005 London bombings. LAS also utilises the GoodSAM app to alert off duty trained medical persons to a nearby cardiac arrest and the location of nearby automated external defibrillators . The LAS operates around 450 emergency ambulances. In addition it can deploy around 100 fast response units in various cars, motorcycles, or bicycles. Although not

SECTION 20

#1732765145662

1100-433: The LAS has a Trust Board consisting of 13 members. The board includes; a non-executive chairman, five of the service's executive directors (including the chief executive), and seven non-executive directors. The chief executive and chief ambulance officer have responsibility for oversight of seven directorates: Operations are directed from two control rooms: one in central London and one in east London , both of which have

1150-763: The MAB Ambulance Section were the first public body to employ women drivers, due to the number of men who had volunteered for military service. By July 1916, the London County Council Ambulance Corps was staffed entirely by women. By 1930, the MAB was the largest user of civil ambulance services in the world, however the Local Government Act 1929 meant that work of the MAB was taken over by the London County Council, which also took charge of

1200-542: The MAB was legally supposed to be transporting only infectious patients, it increasingly also carried accident victims and emergency medical cases. The Metropolitan Ambulances Act 1909 empowered the London County Council to establish an emergency ambulance service, but this was not established until February 1915 and was under the control of the chief of the London Fire Brigade . Also in 1915,

1250-453: The ability to take over control entirely if required. Special events in London are co-ordinated from the service's event control room, also located in east London. During mass casualty incidents, the command structure works on three (or four) levels: gold, silver and bronze. This system was used effectively in response to the 7 July 2005 London bombings . The LAS employs a number of operational staff in different departments In addition to

1300-649: The additional resources being available to the ambulance service. Importantly, the deployment of any voluntary responder will not replace the automatic allocation of a regular front line ambulance. There are two principal roles for volunteers within the London Ambulance Service. These roles include: LAS volunteers are supported by London Ambulance Service Voluntary Responder Group, providing logistical and financial assistance to keep volunteers operational. LAS can also call upon auxiliary aid from external voluntary organisations such as St John Ambulance and

1350-413: The ambulance control room. Staff were also hampered in their use of mobile phones as the mobile phone networks were temporarily brought down during the day. In July 2009, the new radio system recommended after the bombings was rolled out. NHS trust NHS trusts were established under the National Health Service and Community Care Act 1990 and were set up in five waves. Each one was established by

1400-502: The appropriate resources. To assist, the service's command and control system is linked electronically with the equivalent system for London's Metropolitan Police . This means that police updates regarding specific jobs will be updated directly on the computer-aided dispatch (CAD) log, to be viewed by the EOC, and the resources allocated to the job. In 1818, a parliamentary select committee had recommended that provision be made for carrying infectious patients in London "which would prevent

1450-415: The busiest ambulance services in the world, and the busiest in the United Kingdom, providing care to more than 8.6   million people, who live and work in London. The service is currently under the leadership of chief executive Daniel Elkeles and chair Andrew Trotter. The service employs around 5,300 staff. It is one of ten ambulance services trusts in England providing emergency medical services, and

1500-472: The charge of rural district councils , as well as retaining control of roads classified by the Ministry of Transport . Urban district councils continued to be in charge of unclassified roads in their areas. The 1929 act sought to solve a problem that had arisen in the existing scheme of local government, with administrative counties divided into many small urban and rural districts. Some urban districts had

1550-405: The community and the hospital trusts are generally planning to follow these initiatives. Foundation trust status may be applied for by the above categories of NHS trust. Successive governments have announced that all NHS trusts should become foundation trusts, and deadlines have been set for this transformation, which have repeatedly been missed. Several special health authorities , organised on

London Ambulance Service - Misplaced Pages Continue

1600-813: The control of the South West Thames Regional Health Authority and became an NHS trust . In late 2017, LAS adopted the Ambulance Response Programme, which altered the targets for response times to 999 calls to reflect patient outcomes by removing hidden waiting times after a successful trial by the Yorkshire Ambulance Service , West Midlands Ambulance Service and South Western Ambulance Service . Will be attended by single responders and ambulance crews Response time measured with arrival of transporting vehicle As an NHS Trust,

1650-564: The conveyance of persons suffering from any infectious disorder". The first became operational at The South Eastern Fever Hospital, Deptford , in October 1883. In all, six hospitals operated horse-drawn "land ambulances", putting almost the whole of London within 3 miles (4.8 km) of one of them. Each ambulance station included accommodation for a married superintendent and around 20 drivers, horse keepers and attendants, nurses, laundry staff and domestic cleaners. A fleet of four paddle steamer "river ambulances" transported smallpox patients along

1700-433: The existing structure. The effects of the review orders made in the period 1932–1938 on the county districts was as follows: The act did not allow for the abolition of municipal boroughs , so a number of small boroughs continued in existence. This power was later incorporated in the Local Government Act 1958 . At the same time as reorganising rural districts, many parishes within them were also amalgamated. It

1750-409: The fast response unit fleet. The LAS plays a significant role whenever an incident causes mass casualties in London. Examples include: Due to an increase in demand, the LAS has used private ambulance companies, and some charities, to provide additional everyday operational cover. This is largely to ensure set response targets are met and so that the level of resources available to the service stays at

1800-472: The home environment without the need for a hospital admission. The 999 Operations department provides the staff to work in the EOCs, such as call-takers and dispatchers. The department also contains the clinical hub which is staffed by clinical advisors undertaking hear and treat, and clinical team navigators providing clinical support to frontline crews, other EOC staff and maintain oversight of clinical safety at

1850-649: The modern fleet of 107 MAB motor ambulances, together with 46 ambulances which were run by local poor law unions . Taken with the 21 ambulances already operated by the LCC, this provided a comprehensive service for all kinds of illness and accident, which was under the direction of the Medical Officer of Health for the County of London . The LCC also took control of the River Ambulance Service, but it

1900-483: The most seriously ill and injured. Demand is up 15% on the same time last year. Help has only been requested previously in respect of events like the Olympics or the 2005 bombings. The service has more than 400 vacancies and has had problems recruiting people. It is failing to reach its response targets. In 2014/15, the trust recruited 175 paramedics from Australia. The trust was placed into special measures following

1950-698: The operational level. The Resilience and Special Operations department employs paramedics in the Hazardous Area Response Team (HART), who are specially equipped to deal with casualties at height, in water, or urban search and rescue. There are two HART teams, one each covering the east and west of London. A Tactical Response Unit contains paramedics specially trained to respond to complex incidents, such as those involving firearms or acid attacks. Helicopter emergency medical service (HEMS) paramedics working for London's Air Ambulance Charity also fall under this department. Front-line roles in

2000-497: The remaining NHS trusts to become foundation trusts, saying "We are frankly kidding ourselves if we think the non-FTs are going to pass the kinds of criteria that have been set by Monitor ." There are several types of NHS trusts: Over time the distinction between different types has eroded, and both hospital and mental health trusts have taken on responsibility for various community services. Sustainability and transformation plans all propose to move services out of hospitals into

2050-443: The restructuring of urban and rural districts as more efficient local government areas. Under the act all boards of guardians for poor law unions were abolished, with responsibility for public assistance transferred to public assistance committees of county councils and county boroughs . The local authorities took over infirmaries and fever hospitals, while the workhouses became public assistance institutions. Later legislation

London Ambulance Service - Misplaced Pages Continue

2100-481: The service in September 2019, the Care Quality Commission (CQC) gave the following ratings on a scale of outstanding (the service is performing exceptionally well), good (the service is performing well and meeting our expectations), requires improvement (the service is not performing as well as it should) and inadequate (the service is performing badly): In 2000, the LAS faced funding difficulties and an increase in

2150-473: The trust include: London's Air Ambulance Charity work alongside and is dispatched by LAS, who also provides paramedics to the charity, to work alongside doctors who are sourced from national and international hospitals. LAS published its strategy for 2018/19 – 2022/23 in April 2018. It focused heavily on in introduction of what it describes as "pioneer services". These are services which are focused on delivering

2200-435: The trust needed to focus on ensuring safe staffing levels of the control room, diversity amongst staff and improvements in management of mental health. Concerns were raised in internal LAS documents over the performance of radios and communication equipment used in the emergency operations after the 7/7 attacks . Again, the sheer volume of emergency calls received made radio communications difficult and put pressure on staff in

2250-557: The use of coaches or sedan chairs" but nothing was done. In 1866, a Hospital Carriage Fund provided six carriages to hospitals in the metropolitan area, for the use of patients with smallpox or other infectious diseases, provided that they pay for the hire of the horses. The first permanent ambulance service in London was established by the Metropolitan Asylums Board (MAB) in 1879, when a new Poor Law Act empowered them "to provide and maintain carriages suitable for

2300-410: The volume of 999 calls , and it was criticised for poor performance in its response times. The service was sued for negligence in the case of Kent v Griffiths . The chief executive at the time, Michael Honey, left his post after talks with other members of LAS management. In 2010, the service lost its funding for the emergency care practitioner (ECP) role and existing ECPs were told they must change to

2350-542: Was by Cheshire County Council on 1 July 1935. The first orders under the act were made in 1932, and in November 1936 Robert Hudson , Parliamentary Secretary to the Minister of Health, was able to report that the process was nearly completed. The last order, affecting districts in the West Riding of Yorkshire , came into effect on 1 April 1938. In the counties of Radnorshire and Rutland no changes were made to

2400-642: Was disbanded in 1932. During World War II, the London Auxiliary Ambulance Service was operated by over 10,000 auxiliaries, mainly women, from all walks of life. They ran services from 139 Auxiliary Stations across London. A plaque at one of the last to close, Station 39 in Weymouth Mews, near Portland Place , commemorates their wartime service. In 1948, the National Health Service Act 1946 made it

2450-489: Was named by the Care Quality Commission as one of 26 healthcare providers in England failing to operate with sufficient staff. In September 2014, the trust announced that it would reduce the number of category C calls (the least serious) which receive an ambulance response by 15%. These calls will be triaged by a call handler and either referred to NHS 111 or given telephone advice by a paramedic. In 2014 only 64% of category A patients were reached within eight minutes and it

2500-513: Was to remove these functions from the control of councils to other public bodies: the National Assistance Board and the National Health Service . The Metropolitan Asylums Board was also abolished, and the London County Council became responsible for its institutions. County councils gained increased powers as the ultimate highway authority for all roads in the county. They acquired direct responsibility for all roads in

#661338