There is a culture of silence within the NHS which ensures that the general public don’t get to find out about disastrous policies and dangerous practices until the staff feel there’s no alternative.

I’m sure the general public would know just how bad things are but for the power of the blatant gagging clause and financial threats inherent within NHS contracts. NHS employees are not allowed to discuss company matters, even when they leave. Pure and simple.

As a consequence, when things get unbearable, you’ll only hear about anonymous letters sent to the department of health and local MP’s and press. Despite whistle blowing policies that are supposed to protect people who are concerned and want to protect patients, staff and the trusts they work for, no one, no matter how well meaning, will put their name to their exposure of bad practice in the NHS.

It is widely accepted amongst my colleagues that our employer has a long memory. If an employee exposes poor management or dangerous practice within the trust, they may well be protected by official whistle blowing policies and therefore untouchable at the time. However, they know from experience that area and regional managers within the company will have marked their card as a trouble maker. The end of their career is practically a certainty, because it is human nature to make mistakes, no matter how hard we try, but those who tow the line have theirs overlooked more often than not.

We have seen time served, experienced and excellent paramedics dropped like hot stones as soon as they have given the management half an excuse. The persecution is covert yet obvious to all who watch it. And though bitter and angry when one of us takes a hit from people supposedly in our corner, most simply accept it. The unions traded away their teeth. The heart and soul of the workforce has squeezed out of it by snakes in the grass. Anonymous letters are all we have left to say our piece.

So here is an example of something that will affect you, either directly or indirectly, at some point in your life.

The trust earns bonuses from government based on meeting performance targets. Like many government organisations these targets are supposed to ensure that certain standards are met. And like many organisations, the NHS cooks the books to ensure it meets these targets.

Take these two examples.

In order to earn bonuses, the response time to serious and life threatening category A calls is 8 minutes from the point when 999 is dialled. Putting aside the officially recognised fact that only 10% of these calls turn out to be serious or life threatening and that the risk posed to the public, let alone the inconvenience caused by ambulances blue lighting to scene, it is virtually impossible to make these deadlines in a large vehicle in rural areas.

Little does the public know that, despite being billed by the trusts as the way to save lives by arriving within this 8 minute deadline, the fast response cars being purchased and fielded all over the country may actually pose a threat to patient health.

JRCALC guidelines, the emergency medical bible, states quite clearly that despite the broadening range of care that clinicians can provide on scene, sometimes timely and rapid removal to a hospital is the only thing that can save some patients. After all, we can hardly perform complex surgery in ditches. The guidelines make it clear that rapid transport to definitive care is paramount. If your patient is bleeding internally, for example, any delay can kill them.

But what people don’t realise is that when a medic arrives on scene, the clock stops. There is no financial incentive for the trust to rush further help to the scene. The medic on scene is not able to take the patient to hospital. And since the medic was probably sent to ‘take a look’ before calling for an ambulance crew, the ambulance may well take much longer to arrive. The risk is that patients could bleed to death in the street who might have survived had they been transported by an ambulance that had been dispatched to the scene to begin with.

The problem is that such deaths will go undetected and so their occurrence will not lead to better practice. In audit terms, if we arrive in 8 minutes and the patient dies, it is considered a successful job. If we arrive in 10 and the patient lives, it’s a failure.

I’d like to be able to say that the figures will out, but they don’t measure outcomes, only response times. Government standards could well kill you or a loved one.

To add insult to injury, if you do make it to hospital the crew will be held up by the hospital that is also beholden to arbitrary time limits set by people who don’t know any better.

A&E staff will not accept non-urgent cases from crews until they are practically able to begin treating the patient. This is due to the waiting time limit of four hours set on A&E departments. The clock doesn’t start until we hand over our patient and book them in. So, to further stretch ambulance resources, crews can wait up to an hour or more for hospitals to accept their patient. The patient has waited 5 hours to be treated by staff, but the four hour standard has been met.

Understandable or not, everyone is cooking the books.