Don't wait to prioritise ambulance service
Essential public services paid for out of the public purse - that is, our taxes - tend to be taken for granted as a right. As a result, they are open to abuse. That is a quirk of human nature we have to live with. A prime example is frivolous use of our ambulance service that wastes hard-pressed resources. Officials have to strike a careful balance in trying to curb it so as to ensure the service is not compromised. But few would quibble with their decision that ambulances will take emergency patients only to the nearest public hospital from the end of next month. Officers will refuse requests to take patients to private hospitals without documentary evidence of specific medical need.
The ambulancemen's union says this will lead to better use of emergency resources, and that even some private hospitals have been abusing the service to transfer patients between one another. Happily, according to Fire Services Department officials, the private hospitals association accepts the decision.
About 4 per cent of ambulance calls involve requests to be taken to specific private hospitals, or about 1,900 out of 517,000 calls in the first nine months this year. That pales by comparison with the 22 per cent and upwards of calls each year that are not emergencies. Officials have told lawmakers the more frivolous examples are for mosquito bites and constipation, and that some people just want a free ride to hospital. This wastes a life-saving public resource. Suggestions that penalties or charges be imposed in such cases as a deterrent are understandable, but fire chiefs have rightly chosen the more constructive course of public education.
The ultimate goal is to prioritise calls to the emergency 999 number and match them to tiered response times. Meanwhile, the government's latest plan for improving our ambulance service aims at a target response time of 12 minutes in no less than 92.5 per cent of cases - no mean feat when you take into account traffic congestion as well as breakdowns and staff shortages that can sometimes occur.
Unfortunately, we face a wait until 2014 for a final decision on a prioritised dispatch system to ensure that ambulances are sent to the most urgent cases first. Calls will be categorised on the basis of answers to dispatch operators' questions as life-threatening, serious or non-acute, with response targets of nine, 12 and 20 minutes respectively. At present, operators need only record addresses and contacts to direct ambulance crews to the location, although they may seek more details of a patients' condition. The government has said the delay in introducing the new system is to address public concerns. Staff unions and patients' rights groups fear it could lower the level of service, since not every patient or caller could be precise about a patient's condition over the telephone. With little room for error, mistakes would be inevitable, but no more so than in an undiscriminating system. There is a need for a more sophisticated approach to make the best use of resources.
The government's caution about 'rushing' prioritisation is understandable, given the fears about changing a system that has generally served us well. But it is not clear how that translates into a delay of some years. Safeguards could be put in place to minimise the risk of inaccurate prioritising, such as treating a call as an emergency if there is any doubt. That is how other developed economies have dealt with it. Hopefully, talk of a trial priority system in selected districts before 2014 will be translated into action. Then the public could be educated to accept best practice sooner rather than later.