Dr Anthony Marsh is blunt when he tells you the patient is not doing as well as expected.
His diagnosis for the East of England Ambulance Service Trust, of which he has been chief executive for four weeks, is hopeful, but he makes it plain that six months has been lost through lack of action.
Dr Marsh has already turned around Essex and West Midlands Ambulance Services, having worked his way to the top since joining Essex Ambulance Service as a non-emergency ambulance man in 1987. On top of ambulance qualifications, he holds an MBA and MSc in strategic leadership and an honorary doctorate for work in emergency preparedness, so he backs front line experience with management qualifications
At the end of last year it was announced he would become EEAST’s chief executive alongside the same role in West Midlands.
He first became involved in EEAST in April 2013 when concerns expressed by MPs resulted in the NHS Trust Development Authority asking him to conduct a governance review. His report, published in June, was damning, speaking of good front line staff frustrated by a management that failed to listen or to implement change and seemed to exhibit a culture of helplessness, accepting things ‘were as they were’.
Last week Dr Marsh admitted: “In part, that’s still the problem, in spite of the non-executive directors, and some of the executive directors, leaving, insufficient progress has been made in the six months to Christmas.
“If they had accepted my report and done something about it in June, I wouldn’t be sitting here now.
“The people who have led the organisation I genuinely think did their best — they weren’t bad people — but I don’t think they were sufficiently clear about what the priorities are and they weren’t seeing them through.
“There have been too many items on the action plan — if everything is a priority, nothing is a priority. I would rather have fewer things to deliver and actually deliver them.
“If you accept certain things are important then it’s clear what you need to focus on.”
He believes his front line experience matters, though he accepts the service has changed since he started.
“The feedback I’m getting from staff is that they believe they have an ambulance chief in post who gets what what they do,” he said. “They haven’t been sufficiently supported in the past.
“We deal with 3,000 emergency calls a day. We don’t want to be tied down with overly bureaucratic systems that delay decision making and aren’t supporting staff.
“The staff are working in uncomfortable circumstances. At this moment I could have staff now going up a motorway embankment, it could be raining, it would be cold. Staff could be in a situation where they are threatened by people. We need to support them.
“We need sufficient numbers to do the job and when they are dealing with a challenging case we need to give them support.
“For example if a crew goes to a baby that’s seriously injured or ill, they’re trained to deal with it but we need to follow up with that crew afterwards to make sure they can cope.”
He said there was no question of forcing crews to have counselling but that a ‘range of services’ should be available to them.
Action has already been taken on numbers. They will no longer take on the lower qualified emergency care assistants, but announced last Friday they will are recruiting 400 student paramedics. He wants to have a paramedic on every emergency ambulance, which will take time.
“You can’t just recruit paramedics — they don’t just exist somewhere, you’ve got to train your own,” he said. “That takes three years.”
He wants to make sure he is making best use of staff by having fewer response cars and more emergency ambulances and to have a fleet of vehicles that are all under five years old, but, again that takes time. Emergency ambulances are built to order and even then there is the question of the manufacturers having the factory schedule slots to build them, so they are ordering 50 now knowing that it may be the end of the year before we see them all.
So how long did it take to turn round WMAS after he took over in 2006? “That depends on what aspect you look at,” he said. “Response time targets we achieved in the first year, financial balance in the first year, but other things take time.
“One of my aspirations was no vehicle on the fleet older than five years and paramedics in every vehicle and we’ve only recently achieved that.”
Response times have been a bugbear in the East. Though EEAST has usually met times across the region, there has been criticism of response times in rural areas.
Dr Marsh feels people are perhaps more flexible than the response time targets set by Government.
“People understand that if you live in a rural part of the country you are going to have wait longer for public services to reach you, but it’s about what’s acceptable,” he said. “If you live 15min from an urban area your perception is you’ll wait 15min, but if it’s two hours it wouldn’t be acceptable.
“Our responsibility is to provide the best service we can for the circumstances we operate in.”
He said the target of reaching 75 per cent of emergency calls in 8min was across the region, so the 25 per cent takes account of longer times in rural areas.
But he added: “You come back to what’s acceptable. It does seem to me that we need to provide a service that meets the needs of the patients rather than a tick-box response time.
“I’m trying to secure a level of flexibility round the 8min response target so we don’t have to tie up so many response cars and we can have more ambulances that will go to people.”