About 40 million people in the UK are living with illegal air pollution levels, according to analysis commissioned by the Labour party.
Earlier this month the Guardian reported thousands of children across England and Wales are exposed to illegal levels of air pollution from diesel traffic, putting the health of young children at risk in the long term.
Under pressure to lower pollution levels and improve the quality of the country’s air, the government is facing criticism for a last-minute bid to delay the publication of its clean-air plan, which the high court had said must be produced by 24 April.
After a call-out asking readers for their experiences of air pollution, some of them tell us how they’re tackling the issue.
‘Despite being let down by our council we are determined to fight on’
A march attended by Aire Valley Against Incineration (AVAI) supporters.
We currently have quite high levels of air pollution in the areas around Bradford and Leeds. Our council has given the go-ahead for a private company to build an incinerator in the bottom of the Aire Valley – near homes, schools and a sports facility. The incinerator is not for household waste, but for industrial waste that will be shipped in from all over the country by 70 HGVs a day. One of the roads that these lorries will use is Hard Ings Road, Keighley, which is already on the Greenpeace energy desk’s map as being over the legal pollution limits.
We are campaigning hard to stop the building of this incinerator. We are also very concerned about the location – at the bottom of a valley that experiences regular temperature inversions which will make it very difficult for the pollution to disperse. We have nearly 6,000 members on our Facebook group, more than 8,500 signatures on the online petition and more than 2,100 objections have been made on the council’s planning portal. A recent march that we organised was attended by over 600 local people. Despite the fact that our council has let us down, we are determined to fight on!
Rachel Shimbles, 47, from Keighley
‘I’d encourage people to seriously consider leaving London. My quality of life shot up when I did’
As an ex-Londoner, I know how bad air pollution can be in the capital. Kendal air is much cleaner – but we still have places where legal levels of pollution are being routinely breached. I campaign with 20’s Plenty for Kendal as a way to encourage people to walk and cycle more in our compact little town – to make Kendal less congested, safer, cleaner, quieter and even more attractive as a place to live and to visit.
I’d encourage anyone to seriously consider leaving our capital. My quality of life shot up when I moved up here – and clean air was definitely a part of that. But – and it’s a big but – no one should be under the illusion that everything is rosy outside our big cities. It isn’t.
Paul Holdsworth, 57, from Kendal
‘I have lobbied local politicians, Defra and my MP’
We live in a densely populated urban environment and have been badly affected by the smoke and particulate pollution from a neighbour’s wood burner coming into our home for months at a time. As a result and after investigating the associated pollution issues we have become acutely aware of the significant health risks and damage regularly breathing this pollution causes, its effect on our quality of life and the long-term health risk. However, after we complained to our local authority we have found our hands have been tied behind our backs with the council failing to act.
I am active on Twitter, have lobbied local politicians, Defra, our MP, and contacted Gary Fuller (the senior lecturer in air quality measurement at King’s College, London). Having grown up during the implementation of the Clean Air Act, we mistakenly believed it had put an end to the blight of air pollution. A new Clean Air Act for the 21st century is needed to impose proper balanced controls. Pollution is a choice, breathing is not.
cleanairforall2, 55, from London
‘I switch off air fresheners when I can’
Cecilia taking part in a vintage bike parade. Photograph: Rita Platts
I set up a campaign called Gasp in 1980 (Group Against Smoking in Public). We achieved most of our goals but my intolerance to other forms of air pollution has caused me to run one-woman campaigns against other unwanted forms of air pollution. More recently I have campaigned against so-called “air fresheners” which pump out noxious fumes in an effort to cover everyday smells. They make me heady and nauseous. I often go into local shops and switch them off if I can find them hidden. I now won’t go to a hotel or get in a taxi that uses plug in air fresheners. I wish there was a national campaign to stop the sale and use of these things. I’m also a lifelong cyclist and have campaigned over many years on the benefits of cycling including the positive impact of cycling on air pollution.
Cecilia Farren, 67, from Bristol
‘We’re in the process of moving away to get away from the traffic’
The road on which we live has very high levels of traffic. It is a poor area, with many families renting their accommodation. My wife’s asthma has definitely worsened and the noise from the road is constant, as the traffic includes many HGVs and buses. Recently, the road was closed for a month to replace the mini-roundabout at one end with a traffic-light system.
The month was bliss for the residents, but once the road reopened the traffic worsened with a corresponding effect on the quality of air. We are now in the process of moving away to a location that is quiet, but one that we are not sure we can afford. Right now, we feel like the gamble is worth it to get away from this road.
Tens of thousands of children at more than 800 schools, nurseries and colleges in London are being exposed to illegal levels of air pollution that risk causing lifelong health problems, the Guardian can disclose.
A study identifies 802 educational institutions where pupils as young as three are being exposed to levels of nitrogen dioxide that breach EU legal limits and which the government accepts are harmful to health.
The research, commissioned by the mayor of London, Sadiq Khan, suggests thousands more children and young people are at risk from toxic air than previously thought.
Khan said the results were devastating and warned that it was the capital’s poorest children who were bearing the brunt of the air pollution crisis.
“It is an outrage that more than 800 schools, nurseries and other educational institutions are in areas breaching legal air pollution limits,” he said.
“This is an environmental challenge, a public health challenge but also – and no one talks about this – it is fundamentally an issue of social justice. If you are a poor Londoner you are more likely to suffer from illegal air.”
Khan called for the government to introduce a clean air act and for a diesel scrappage scheme to take polluting cars off the road quickly.
Sadiq Khan: ‘We are evaluating the success of other cities … Nothing is off the table.’ Photograph: Dinendra Haria/Rex/Shutterstock
The results show nearly double the number of schools than previously thought are affected by illegal levels of toxic air. A report that was kept secret by former mayor Boris Johnson revealed last year 433 primaries were exposed to dangerous levels of air pollution.
The new data shows 802 out of 3261 nurseries, primary and secondary schools and higher education colleges, are within 150 metres of nitrogen dioxide pollution levels that exceed the EU legal limit of 40µg/m3 (40 micrograms per cubic metre of air).
A third of state nursery schools in the capital (27), nearly 20% of primaries (360) and 18% of secondary schools (79) are in areas where toxic levels of nitrogen dioxide threaten children’s health. Of the further education colleges in the capital, 43% (30) were in areas of illegally toxic levels of NO2.
Nurseries map
Traffic is a major contributor to air pollution and there is growing concern about emissions from diesel vehicles, which contribute through the production of particulate matter and nitrogen oxides (NOx).
Dr Francis Gilchrist, consultant respiratory paediatrician at Royal Stoke University hospital, said it was known that children were particularly sensitive to air pollution and that lung damage had lifelong consequences.
“If something is not done about air pollution these issues are going to get worse and worse. There is definitely concern that air pollution is affecting children’s lungs – in particular it exacerbates respiratory illness, like asthma, and it predisposes children who are healthy to having repeated chest infections,” he said.
“If you damage your lungs in childhood you are likely to see these effects right through into adulthood, so there is a lifelong impact.”
Khan hopes the introduction of what he says is the world’s first ultra-low emission zone will cut toxic NO2 emissions from diesel vehicles by 50%. He plans to extend the zone to the north and south circular roads in the capital and has brought its introduction forward a year to 2019.
Last week he announced that drivers ofolder, more polluting cars will have to pay a £10 charge to drive in central London from October.
But other cities – including Paris, Athens and Madrid – have announced more dramatic measures, introducing car-free days and bans on diesel cars from city boundaries.
Khan said he had not ruled anything out. “We are evaluating the success of other cities. We are looking at their plans and nothing is off the table. But at the moment we think our plans are the most effective.”
London is not alone in the UK in facing an air pollution crisis. Khan and the leaders of four other cities badly affected by poor air quality – Leeds, Birmingham, Derby and Nottingham – had written to the government calling on them to do more to tackle the problem across the UK.
“It must be the case that air quality in other cities is having a similar impact and that it is worse in the most deprived parts of those cities. It must impact on schools in the same way, but they do not have the information that is now available in London. The government must take action,” he said.
The new research on schools, nurseries and colleges was based on modelling of data from 2013 carried out by experts from the environmental research group at King’s College London and Aether, the environmental data analysts.
The modelling is more precise than the government’s measurements, which the high court has condemned as overoptimistic.
School NO2 table
Judges told ministers last November they must cut the illegal levels of NO2 in dozens of towns and cities in the shortest possible time after ruling their plans to improve air quality were so poor they were unlawful.
The government has until April to come up with proposals to bring before the court.
The study adds to the pressure on ministers to tackle air pollution amid growing evidence of a toxic air crisis in parts of the UK. London breached its annual air pollution limits just five days into 2017.
Last month Khan issued the first “very high” air pollution alert with warnings displayed at bus stops, train stations and road signs across the capital.
This year Khan gave £250,000 to fund 50 air quality audits at the worst affected primary schools. The money will allow schools to work with local councils to introduce measures to protect pupils from toxic air and could include banning the most polluting cars at drop-off and pick-up time, clean air routes for walking to school, green barriers and moving entrances away from busy roads.
Air pollution causes up to 50,000 early deaths – 9,000 of these in the capital – and costs the country £27.5bn each year, according to a government estimate. MPs have called it a public health emergency.
Khan is calling for ministers to introduce a comprehensive diesel scrappage scheme to compensate drivers who bought diesel cars after being told they were more environmentally friendly than petrol vehicles. He also wants the government to introduce a clean air act “fit for the 21st century”.
“Today people scratch their heads that 30 or 40 years ago we knew smoking was bad for your health but no action was taken,” he said. “I don’t want a situation now where in 20 or 30 years’ time our children or grandchildren say knew about air quality but no action was taken.
“I want London to be the envy of the world in relation to air quality, to be the greenest city in the world.”
‘Some days it makes me consider leaving London’
The playground at Tachbrook nursery school in Pimlico, west London, has lots to keep a three-year-old happy at breaktime.
But, like other schools highlighted in the report, it is very close to a busy main road. HGVs, cars, taxis and buses plough up and down the Embankment nearby, and so the school is subject to NO2 pollution levels above EU legal limits.
Headteacher Elizabeth Hillyard said she had signed a petition along with other headteachers in the capital urging more to be done about toxic air.
“Air pollution has bad effects on health and it needs to be addressed and all the heads in Westminster have signed the petition,” she said.
Like other schools, Tachbrook does what it can to protect children, including having a fence around the playground. Kate Lyons, a parent collecting her three-year-old son, said the issue was a concern.
“We are generally concerned about the air in this area,” Lyons said. “You can feel it and taste it. My little boy loves playing in the playground at school, and it does worry me.
“We live nearby and sleep with our windows closed because of the pollution. We used to live in Edinburgh and you can feel the difference living here in London and some days it is something that makes me consider leaving.”
A London clinic for women who have undergone FGM is being forced to close after the local council withdrew funding from March 2017.
The Acton African Well Woman Centre was awarded the Guardian sponsored Diversity and equality award in 2011 and houses experts in the field of female genital mutilation (FGM) who are able to help women who have have been through the trauma of the procedure.
The facts you should know about female genital mutilation
It also offers women de-infibulation – a reversal of of the most extreme form of FGM. Type III is the removal of the entire genitalia, leaving a hole small enough for urine and menstrual blood to pass through.
“Ealing council’s priority is to raise awareness of FGM and the support available to a wider audience,” a spokesman told the Guardian.
“We will continue to commission FGM awareness work in the borough to reach more people such as schools and community groups and signpost women to clinical support,” he added.
The clinic was notified of the council’s decision late last year, but the closure was confirmed following the rejection of a last-ditch appeal to Ealing Clinical Commissioning Group for alternative funding.
Staff have told the Guardian closing the clinic will destroy a strong community of women who bring, “sisters, cousins and friends” to the service.
“I don’t think anyone is questioning the value and expertise of the service,” a worker said, but I wonder if it was white middle class women who were vocal and out there would they close down the service?
“These are vulnerable women and they don’t have many places to go. It’s devastating that this clinic can’t survive after 10 years demonstrating that it is a goal standard.”
Since opening in 2007, the Acton clinic has seen more than 1,000 women in its fortnightly open hours and staff have performed upwards of 500 de-infibulations.
A number of healthcare professionals have been trained by the clinic, including GPs at a community-based service in Bristol, which is modelled on the Acton service.
The clinic does not refuse women from outside Ealing borough, which means any woman from across the UK can walk in. Women have come from as far as Northern Ireland seeking help.
Psychotherapist, survivor, and campaigner Leyla Hussein has referred women to the clinic. “What commissioners need to understand is that there’s a taboo,” she said. “[Women] aren’t going to go to the clinic in their area and we shouldn’t put barriers around them when they need to have access. I’m shocked and disappointed that the commissioners didn’t take that into account.
“A majority of women are cut by women. The idea of these of women trusting other women is a big deal. That they trust them is brave of these women to do that. Now that they have become confident and trusting, it’s going to be taken away from them.”
A petition to save the service has gathered over 11,000 signatures.
The NHS has been accused of letting down patients in pain by shutting London’s last community-based A&E-style service for people needing emergency dental treatment.
NHS England’s closure of the “urgent dental service” in Kentish Town will leave the capital’s 8.7 million residents with only two busy hospitals to go to with teeth problems. Dentists have warned that it will force more patients to seek help at overcrowded GP surgeries and A&E units. The disappearance is the latest loss of walk-in services across England for people with emergencies such as a broken tooth or abscess.
NHS England said the service would shut on 31 March, even though 5,451 people used it last year and patients come from all over London to get treatment. People should in future call the NHS111 helpline or seek an appointment with their regular dentist, they said.
“Access to emergency dental care is increasingly a postcode lottery. Inadequate provision is simply piling more pressure on GPs and A&Es that are not equipped to provide dental treatment”, said Henrik Overgaard-Nielsen of the British Dental Association.
“It’s absurd that NHS111 operators are asking patients to do ring-rounds [of dental surgeries looking for a free slot at short notice],” he said.
The association is urging the NHS to tackle the growing shortage of emergency dental services by arranging for high-street dentists to always have a certain number of emergency appointments available.
“It is irresponsible to shut a fantastic service that provides emergency dental care to patients without providing an alternative. Where do they think these patients are going to go?” said Dr Francesca Silman, a doctor whose practice is near the closing walk-in centre. “It is not acceptable to leave people in pain and in need of treatment, and this will only worsen the pressures already on GPs and A&E who can offer very little help to those that attend.”
Andrew Dismore, a Labour member of the London Assembly, has voiced concern about the service going, NHS England’s lack of public consultation, and the fact that it has been taken “against the wishes” of Whittington Health, the NHS trust that staffs it.
The dental association recently estimated that 135,000 dental patients a year end up attending A&E because they cannot easily gain access to care for a sudden problem. A further 600,000 seek treatment from a GP, adding to the pressure on family doctor services, it believes.
Guy’s limits emergency dental treatment to 55 patients a day. Photograph: Frank Baron for the Guardian
From April, Londoners needing urgent dental care will have only two options: specialist clinics at King’s College Hospital and Guy’s Hospital, both in south London, though the Guy’s service limits treatment to 55 patients a day and those needing care must be there as early as 7.30am to secure an appointment. The Royal London Hospital in east London recently shut its clinic.
An NHS England spokeswoman said: “We recently reviewed the service and found that there is sufficient capacity for patients who need urgent dental care at existing dental practices and so the closure of the service would not negatively impact patients in the area.
“There are more than 1,250 high-street dentists across London where patients can access dental care when they need it. Londoners in need of urgent dental care should call NHS111, who can then signpost them to the most appropriate service for their treatment.”
The largest NHS trust in England has been hit by a cyber-attack that could affect thousands of files across at least four London hospitals.
Barts health trust, which runs five hospitals in east London – the Royal London, St Bartholomew’s, Whipps Cross, Mile End and Newham – has sent a message to staff urging them not to open email attachments from unknown senders.
It was reported that the trust had been targeted with ransomware, which is normally delivered via emails that trick the recipient into opening attachments and releasing malware on to their system, in a technique known as phishing.
The trust has not confirmed those reports or said how much of its system has been affected by the attack or whether patient data has been compromised.
A spokeswoman said: “We are urgently investigating this matter and have taken a number of drives offline as a precautionary measure.
“We have tried and tested contingency plans in place and are making every effort to ensure that patient care will not be affected.”
According to the Health Service Journal, the trust’s filing system between departments has been turned off while the investigation takes place.
Staff at the Royal Free London foundation trust were also warned to beware of attacks on Friday, the Guardian has learned.
“We have been informed of a major cyber-attack on NHS organisations. Please exercise extreme caution when opening any email attachments from unknown source or that don’t seem relevant to you. We will be carrying out security scans on all computers within the trust so please leave them switched on until further notice,” wrote the trust’s IT director, Tosh Mondal.
A spokesman said the email was in reaction to the Barts attack and that the Royal Free London, as well as Barnet and Chase Farm hospitals, had not been affected.
In October the Northern Lincolnshire and Goole foundation trust was hit by an attack in which malware was used to encrypt files and demand a ransom in order to restore access. The trust did not pay the ransom but was forced to cancel patient appointments as its systems were shut down to remove the virus.
John Bambenek, a threat intelligence manager at the firm Fidelis Cybersecurity, said: “The trouble is that local authorities and governments aren’t very prepared and they have extremely valuable information that simply can’t be lost, so they’re a tempting target for cybercriminals.
“Cyber defence is essential, but it’s no longer enough; organisations of all sizes need to invest in detecting threats as well. Only then will cyber criminals be caught early enough to expel them from the network before serious damage is done.”
London has breached its annual air pollution limits just five days into 2017, a “shameful reminder of the severity of London’s air pollution”, according to campaigners.
By law, hourly levels of toxic nitrogen dioxide must not be more than 200 micrograms per cubic metre more than 18 times in a whole year, but late on Thursday this limit was broken on Brixton Road in Lambeth.
Many other sites across the capital will go on to break the annual limit and Putney High Street exceeded the hourly limit over 1,100 times in 2016. Oxford Street, Kings Road in Chelsea and the Strand are other known pollution hotspots.
NO2 pollution, which is produced largely by diesel vehicles, causes 9,500 early deaths every year in London. Most air quality zones across the country break legal limits and the crisis was called a “public health emergency” by MPs in April. This week scientists said that one in 10 cases of Alzheimer’s in people living near busy roads could be linked to air pollution.
The new mayor of London, Sadiq Khan, has pledged new measures and to double funding to £875m over five years to tackle the problem. But the UK government’s plans have twice been ruled illegal in the past two years and it has been sent back to the drawing board to develop a third strategy.
Alan Andrews, a lawyer at ClientEarth – the group that successfully sued the government – said: “This is another shameful reminder of the severity of London’s air pollution and shows why the mayor has rightly made tackling it a top priority. It is absolutely essential that he now delivers on his promises and that the national government back him to the hilt.”
Andrews, who lives in Brixton, said Khan had promised an expanded ultra-low emission zone in 2019, which limits polluting vehicles, and to deploy the cleanest buses on the most polluted roads.
NO2 pollution in London How UK citites compare on nitrogen dioxide exceedance
“While these are vital steps in the right direction, we can’t wait another three years for action,” he said. “We need immediate action to cut pollution in the short-term and protect Londoners’ health during these pollution spikes.” In December, Khan issued air pollution alerts at bus stops, tube stations and roadsides due to high levels.
A spokesman for the mayor said: “The Brixton Road [breach] underscores why urgent action is needed to improve air quality across London.” He said Khan would shortly be announcing 10 new low emission bus zones, including one for Brixton Road.
“But this is not enough,” said the spokesman. “The government needs to match the Mayor’s commitment to improving air quality as quickly as possible.”
In December, Paris, Madrid, Athens and Mexico City pledged to ban polluting diesel cars from their centres by 2025 and a number of cities outside the UK have already taken action such as banning cars on specific days or making public transport free.
The government must produce a new national plan by April and ClientEarth said this must include clean air zones in many areas to stop the dirtiest diesel cars entering pollution hotspots. ClientEarth also said the “peverse” financial incentives that encourage people to buy diesel cars rather than cleaner ones must be ended.
Both a national network of clean air zones and tax changes were proposed within government as part of its last plan, but were rejected by the Treasury.
This week new data also revealed that modern diesel cars produce 10 times more NO2 pollution than heavy trucks and buses per litre of fuel, which experts say is due to the much tougher testing faced by heavy vehicles.
For three decades, with barely a blip, the UK capital has been going from strength to strength. Nothing has stunted its potency and growth, not the 7/7 bombings or the 2011 riots, not Black Monday or the 2008 global crash, not even the original Millennium Dome. Its economy drives and subsidises the rest of the country, its still-new tier of regional government – the mayoralty and the Greater London Authority (GLA) – has been a success and it has hosted a triumphant Olympic Games. Its population, after shrinking through years of managed decline, is now at an all-time high, and may hit 10 million by 2030. But London enters 2017 with a question mark after its name. Might its golden age be coming to an end?
After the fireworks, the New Year begins amid unaccustomed unease. The heavy, grey cloud above is Brexit, with major employers in an international city whose wealth has been built on financial services pondering their options for the future. Meanwhile, austerity, albeit moderated by Miliband-ish measures from Theresa May, continues to erode from below. It doesn’t lighten the general mood that armed police officers have become a routine feature of everyday London life. In all these circumstances optimism is essential, but staving off its opposite will require fortitude and skill.
The mayor, of course, has a big part to play in all of this. Sadiq Khan’s 2017 will involve the Labour man in unending nagging of and negotiating with the Conservatives in charge of national government, hoping to secure the best possible post-Brexit deal for the capital and, by extension, the country. His panel of Brexit advisors, bankers, accountants, Peter Mandelson and all, doesn’t delight those who think he’s insufficiently left-wing. But pragmatism is an essential mayoral art: if you want a bunch of Tories to take you seriously, you don’t surround yourself with Corbynites.
Policy delivery will begin with Khan hailing a freeze on those public transport fares that Transport for London (TfL) sets, but not the universal one some of his election campaign statements and a line in his manifesto claimed. Political opponents will attack him (again) for that, and for the demands he is making on TfL’s finances as a whole as his first mayoral budget, covering all GLA functions, comes under closer public scrutiny.
Khan’s new “hopper” fare, which enables bus passengers to catch two buses for the price of one during a 60 minute period, has given him – not to mention a lot of Londoners on low incomes – a quick early win. But this initiative, though welcome, needs to be seen in the context of falling bus ridership, something TfL can ill afford given its increasing dependence on fares revenue.
This, in turn, is a consequence of worsening road traffic congestion, which London’s economy could do without. Congestion also harms air quality, another issue the mayor has sought to make a fast start on. He is set to kick-off implementing his anti-pollution policies by introducing an emissions surcharge (the so-called “T-charge” on toxicity) on high-pollution vehicles entering the congestion charge zone early in 2017, but will be urged by critical friends to go further with his policies as a whole.
Holding down public transport fares is one part of a broader attempt to address London’s high cost of living, which leaves too many of its households, including around 40% of its children, struggling to make ends meet on unacceptably low pay and excluded from many of the city’s many riches. Housing costs are, famously, a huge factor in this and also hugely difficult to control. The mayor’s housing team has assembled a purposeful strategy for getting more homes built for sale, rent or a combination of both at prices ordinary Londoners can afford. Khan will hope to be able to boast of initial successes as he embarks on the vast task of trying to better match housing delivery to the city’s social and economic need. The backdrop to all this is the ongoing three-year monster mission of writing a new London Plan.
There are going to be tensions. Hammered by successive grant cuts and hampered by limits on their freedom to borrow to build, some of the capital’s boroughs, often Labour-run, are becoming ever more adroit at finding ways to meet at least some local “affordable” housing demand, but these can mean private sector partnerships involving publicly owned land that don’t always work as well as planned. The available alternatives – largely, small variations on doing nothing – aren’t all that attractive either.
Squeezed between the same rock and hard place we find shortages of school places and health and social care provision also having their impact at borough, and indeed neighbourhood level. Dynamic boroughs and the mayor alike are trying to get more more purchase on low-cost childcare and improving post-school skills training, as the city strives for greater autonomy in the running of its affairs.
A striking thing about the politics of London is the high degree of consensus about the benefits of devolving power over such things as welfare programmes, property taxes and infrastructure investment from Whitehall. Agreement crosses party lines and unifies business interests, social sector campaigners and more. There is strength in that solidarity. London will need every ounce of it to keep on prospering in 2017 and beyond.
Staff at one of the country’s biggest ambulance services had to log emergency calls manually overnight because of technical issues in the control room, delaying response times.
It is understood London ambulance service’s computer system crashed, forcing staff to record details of calls by pen and paper for nearly five hours on one of the busiest nights of the year.
A spokeswoman said staff were trained to deal with such situations and were able to prioritise responses to those in greatest need.
The deputy director of operations Peter McKenna said: “Due to technical difficulties, our control room was logging emergency calls by pen and paper from 12.30am to 5.15am.
“Our control room staff are trained to operate in this way and continue to prioritise our response to patients with life-threatening conditions, using the same triage system as usual.
“We also have additional clinicians on duty to offer control room staff clinical advice if it is needed.”
The biggest hospital in Europe has been ordered to improve security on its maternity ward after inspectors found that mothers “might leave the unit with the wrong baby”. Some babies born at the Royal London hospital had no name tags – which could lead to them going home with the wrong families or even being given medication meant for another baby, according to the Care Quality Commission (CQC).
Inspectors said there was a “lax” approach to checking babies’ name bands. Even the head of midwifery at the hospital, in Whitechapel, east London, was unaware of a baby abduction policy, the regulator said. Inspectors found there were not enough midwives on the delivery suite to provide safe cover, and midwives said they had been ordered by managers not to raise concerns about low staff numbers.
There was a “mixed” view about how caring staff were: one mother told inspectors she was treated as “childish” because she was upset that her baby had been taken into special care.
Inspectors who visited the hospital in July this year said they also observed some “intracultural issues and some bullying behaviour” between groups of midwives, and between midwives and patients. Doctors and midwives on the postnatal ward referred to patients by their bed numbers rather than by name, according to the CQC.
Last year 4,645 babies were born at the Royal London, which is the largest stand-alone acute hospital in Europe.
The CQC has ordered the Barts health NHS trust, which runs the hospital, to improve security in maternity “urgently” after rating the service inadequate. The trust said it had already taken steps to address baby safety concerns, including the introduction of new baby ID tags. Overall the hospital was rated “requires improvement”.
Some of the other issues highlighted in the report include:
A two-week backlog of outpatient appointments waiting to be booked and some patients waiting for over a year for follow-up appointments.
The nutrition and hydration needs of patients were met, though in some busy departments this was enabled by patients’ relatives.
Nine “never” events were reported at the hospital between August 2015 and July 2016 – wholly preventable errors. These blunders included a surgeon leaving an object inside a patient after finishing an operation, the extraction of a wrong tooth, “wrong-site implants” and incorrect medication being given to a patient.
During the inspection, some patients in A&E had to wait an hour and 20 minutes for an initial assessment from a medic, though national guidance suggests the majority of people should be assessed by a clinician within 15 minutes.
Some medics had to complete mandatory training in their own time or during their holiday leave.
Professor Sir Mike Richards, chief inspector of hospitals at the CQC, said: “We were most concerned about the standard of care around maternity and gynaecology services. Staffing on maternity wards was sometimes inadequately covered. But most worrying of all was the lack of a safe and secure environment for newborn babies. At the time of our inspection we raised this with the Royal London hospital as a matter for their urgent attention.”
A spokeswoman for the trust said: “We acted immediately to improve the security of babies at the Royal London hospital. It’s important to stress that these reports are based on observations from five months ago. Since then we have subjected our processes and procedures to forensic scrutiny.
“As a result, we’ve introduced new baby ID tags, we’ve reviewed our procedure for locking down the hospital, and refreshed our policy. We have recirculated our policy to all staff and now test it every single month. Women should be assured our services are safe and we will review our processes regularly to ensure they remain safe.”
On 9 December 1952 the Great Smog officially ended – for five days a thick layer of air pollution, mostly caused by coal fires, had covered London and caused the deaths of thousands of residents. 64 years later the London Mayor has committed £875 million to tackle the problem. This week the Royal Society of Biology hosted an event on air pollution and health (#greyskythinking) and the Royal Society of Chemistry will run their annual Air Pollution conference next week. After two centuries of fatal London fogs, what have we learnt?
Fogs were relatively common in London in the 1700s, but by the early 1800s these had become deadly, as the smoke and fumes from industrialisation and urban growth were trapped by calm, still air. It was not just the pollution that was a threat to life and health, but also the traffic, and newspapers were full of tragic stories of accidents: in the 1837 December fog the Times reported that “an aged female named Jane Wilson” was “knocked down by a cart and severely injured” and Chelsea resident Mr Phillips was thrown out of his chaise into the road where a “cart passed over his right thigh, and fractured it dreadfully”. Animals suffered too – in 1873 the annual cattle show at Smithfield market was ruined by a December fog that left the “fat cattle…panting and coughing”, and many of the animals collapsed and died.
The Victorians are famous for their public health activity – ambitious sewer schemes, the introduction of Medical Officers of Health, and vaccination programmes – so why did they struggle, as we do, to deal with deadly air pollution?
The Illustrated London News, Volume 10, 1847. The men and boy carrying lighted torches are acting as guides to the carriage and pedestrians: fogs were often so thick it was impossible to see across a street. Illustration: Wellcome Library, London/Wellcome Library, London. Wellcome Images
If it’s everyone’s fault, it’s no one’s fault
One problem lay in the fact that the smogs had many causes. Heavy industry was one source, but so too were the railways and steamer-boats,and particularly domestic coal-burning fires. Various societies were formed to campaign for what was often called ‘smoke abatement’, but they met with resistance. At a meeting of the ‘Noxious Vapours Abatement Association’ in Manchester, a representative from the Health Committee of the Salford Corporation (like a modern city council) won applause from a working class audience when he objected to smoke abatement because
“he would be sorry to see a persecution commenced against the manufacturers, for if they were driven from the borough, where would the bread of the working man come from?”
If ‘big business’ wasn’t going to reform, why should individuals? Smoke abatement campaigners seem to have thought that education was all that was needed: in 1881 the Smoke Abatement Committee opened a smoke-prevention technology exhibition in London which attracted an extraordinary 116,000 visitors in just a few months; all the installations were independently tested to make sure that the manufacturers’ claims were accurate. Yet this did not lead to a mass take-up of smoke-reducing technology, and an attempt to force changes by passing a law regulating domestic smoke failed in 1884.
Some industries had been regulated by the Smoke Nuisance Abatement (Metropolis) Act of 1853, but only in London, and this excluded some factories such as glass works and potteries. Rather oddly, a lot of the discussion about this Act focused not on the health risks of smoke, but on the expense of laundry caused by the dirty air of London (estimated as high as £2 million) – as one member of the House of Lords suggested: “The smoke so affected the clothing of the working classes that it was computed every mechanic paid at least five times the amount of the original cost of his shirt for the number of washings rendered necessary.”
Front cover for booklet advertising Peps cough and cold tablets in 1913. The ‘peril’ refers to deaths from respiratory diseases during heavy fogs in cities. Photograph: Wellcome Library, London/Wellcome Library, London. Wellcome Images
Who pays the price?
Even if it saved on washing bills, there was a genuine fear that over-regulation might lead to job losses. Worse, the Victorians were also concerned that reforming domestic fireplaces would actually make people sicker, rather than healthier. Although open fire places were serious sources of coal smoke pollution, they had one advantage over more efficient systems: they created draughts. Through most of the nineteenth century medical professionals thought that disease was spread by ‘miasmas’, clouds of harmful matter. One way to tackle the danger of miasma was to ensure air did not become ‘stagnant’, and open fireplaces helped to create a ‘healthy’ circulation of air.
While the larger, airier homes of the middle and upper classes could be ventilated in other ways, investigations into the slums and basement dwellings of the poor suggested that open fires were vital. Of course, this could be solved with serious slum clearances and massive investment in homes for the poor, but it proved hard to justify that expense on the grounds that it would prevent air pollution. In any case, reformers worried, people were ‘sentimentally attached’ to their open fires, and resisted technological change.
Suggestions to solve the smoke problem remained small scale: taxes on new stoves or fireplaces, restrictions on certain manufacturing plants, the formation of small local societies to help people buy efficient stoves ‘by instalments’, and so on. But one problem not tackled was the rather obvious one: pollution travels. Responsibility for enforcing anti-pollution and anti-smoke laws rested, by the late 19th century, with local governments and the London County Council, so if pollution was blowing in from a factory in an uncooperative neighbouring jurisdiction, there was nothing councils could do to enforce the limited rules that existed. In 1914 central government was finally persuaded to set up a committee to reconsider the legislation about pollution, but its work was interrupted by the outbreak of war.
It was not until 1956 that a Select Committee’s recommendations, pushed by backbenchers against a sceptical Conservative government, led to the passing of the 1956 Clean Air Act, a direct response to the smog of 1952. For the first time, this Act regulated domestic fireplaces as well as industrial furnaces, and created smoke control areas where only smokeless fuels could be burnt.
Although a milestone in public health, just 60 years later Londoners are dying, again, from polluted air. Although the London Mayor has announced that funding for this problem will be doubled the challenges remain essentially the same faced by the Smoke Abatement Leagues in the 1800s: the causes are complex, some pollution is (thought to be) linked to economic growth and jobs, there are social reasons why people resist changes (especially if they require personal sacrifices, such as giving up car or air travel) and the miasma of pollution still travels across regional and national boundaries. Do we have any new solutions?
Air quality alerts have been issued at bus stops, tube stations and roadsides across London because of high pollution levels, said a spokeswoman for the mayor of London, Sadiq Khan.
The alerts will notify Londoners on Thursday evening during their commute home from work.
People in London who suffer from lung or heart problems have been warned to avoid strenuous exercise. The risks from heightened levels of air pollution enveloping the city have been exacerbated by settled and cold conditions, which have prevented pollutants from being dispersed.
Individuals at risk have been warned to particularly avoid outdoor exercise, while those with asthma may need to use their inhaler more often, according to the London Air Quality Network, based at King’s College University.
Anyone from the wider population who experiences sore eyes, a cough or sore throat should also consider reducing their physical activity, particularly outdoors, the pollution monitoring service said.
Air pollution campaigners called on the government and city authorities to restrict traffic during smog episodes.
“When pollution episodes are high, the mayor should introduce emergency traffic restrictions to bring pollution levels down quickly,” said a spokeswoman for Friends of the Earth.
“The solutions proposed for dealing with the latest smog have things backwards: the first step should be restricting traffic not people.
“It’s outrageous that those with vulnerable lungs, including children and the elderly, are told to stay at home when the air is bad. Everyone should be able to go about their business, without being afraid of the air they breathe.”
According to the London Air Quality Network, winter smogs are formed when pollutants from traffic and industry are trapped at ground level because of a temperature inversion.
The pollution is a mix of ultra-fine particulates of unburned carbon, known as PM2.5s, and the toxic gas nitrogen dioxide (NO2) which is largely created by diesel cars, lorries and buses.
Thursday’s pollution episode took place on the same day as Nice, the government’s independent health advisers, proposed that councils in England should be given powers to set up clean-air zones. This would allow them to restrict certain vehicles entering some areas.
About 9,500 people die early each year in London due to long-term exposure to air pollution, more than twice as many as previously thought, according to new research. Air pollution is now Britain’s most lethal environmental risk, killing about 40,000 people prematurely each year.
Air pollution monitors showed high or very high pollution along all major London roads, with extremely high pollution recorded in the city centre. On Thursday, a Defra pollution monitor on Marylebone Road also registered very high levels.
Khan made tackling London’s air pollution a priority issue in his election campaign. This summer he announced his intention to issue alerts for high pollution. However, there have been no incidents of particularly high pollution until now.
Khan said: “Londoners need to know when the city is suffering from high pollution levels so they can take any necessary appropriate measures to protect themselves from poor air quality. This is particularly crucial for Londoners who are vulnerable, such as asthma sufferers.”
Look at it this way: UK economic growth is slowing, public borrowing will be higher than expected and the government no longer thinks it can balance the budget by 2020. Much of this is down to Brexit. Good old Boris. We’ve got our country back. Now we are free to scavenge for consolations from an autumn statement that seeks to limit the damage done by the referendum outcome, including in resilient London, the Remain City on which Leave Nation may depend more heavily than ever in the worrying years to come.
Chancellor Philip Hammond remarked that “for too long, economic growth in our country has been too concentrated in London and the south-east”. True, but that is also what you would say to a British euroscepticism that often goes hand-in-hand with hostility towards the capital. And though Hammond gave London’s mayor, its boroughs and its politicians of almost every type nothing like the transformative devolution package they desire, he did do some things to suggest that the government grasps that it cannot afford to ignore the capital’s pleas for more autonomy. He also observed that it is “one of the highest productivity cities in the world”, with Britain’s other big urban centres lagging far behind.
Sadiq Khan has been fairly positive about what Hammond announced, no doubt partly sincerely but also very mindful that his City Hall looks like having to keep on doing business with Conservative governments for at least as long as Jeremy Corbyn leads the Labour Party. He offered the glass-half-full view that the chancellor’s measures are “the first steps towards a major devolution deal for the capital”. In her own words, so did London Councils chair Claire Kober. We’ll see.
Top of the mayor’s thank you list for now is the £3.15bn the Greater London Authority will receive to help start the building of over 90,000 “affordable” homes by financial year 2020-21. As a single sum, this is the largest yet devolved to a London mayor, though the headline figure is slightly misleading in that it partly confirms funds already agreed as well as including an additional settlement for the future, covering the rest of Khan’s mayoral term.
Essentially, City Hall’s share of national spending on housing has been renegotiated and, in all, the capital has now got over £2bn more heading its way than it had before. It’s what the mayor was hoping for, and gives Khan and his team not only more cash but also – thanks to their new best friend, housing and London minister Gavin Barwell – greater flexibility to fund a range of what the mayor describes as “new homes for low cost rent, London Living Rent and shared ownership”. But hear the silence where even Boris Johnson once called for councils to be given more leeway to borrow to build for social rent. A lost cause, for now, it seems.
Hammond has also said he will devolve the adult education budget to London government from 2019-20, something else London politicians of more than one party have been in favour of for some time. The same goes for the transfer of the budget for the work and health programme – forthcoming successor to the plain old work programme – to London subject to “meeting certain conditions” (the same arrangement has been made for Greater Manchester, by the way). This should enable London’s boroughs to better help the 19,000 hard-up households to be pinched by the benefit cap. Whitehall, though, is holding on to the money for 16-18 year old skills training. London would like that too.
Khan has also welcomed further investment – to the tune of £492m to London and the south-east combined – in the London local enterprise panel, through which the mayor, businesses, the boroughs and Transport for London (TfL) collaborate on facilitating employment and growth and he expressed approval for a £1bn nationwide fund for digital infrastructure. Like Shelter’s Kate Webb, he was pleased by the abolition of letting agency fees (and I gather that City Hall is considering what that means for the mayor’s own, planned not-for-profit lettings agency). But he’s expressed disappointment that nothing was done to make childcare in London more affordable and that control over south London suburban rail is not to be handed down to TfL, though in the latter case he might not be much surprised.
Crossrail 2? Nothing doing. Hammond put Birmingham and the “Northern Powerhouse” first, but at least invited capital to produce its business case, which the London Chamber of Commerce and Industry says it is pleased about. Nothing much for London’s GPs and patients either, according to Michelle Drage of their representative body, which says that 35 practices have closed in the capital in the past 12 months and 45 since the last general election. Add to that the complete absence of help across the UK for NHS and social care services as a whole and the outlook for London as it wrestles with the latest reform programme has not been brightened. Meanwhile, local government in general continues to be savaged by cuts. Devolution is good. Pity it sometimes looks like the only way London can make the best of a bad national job.
A report from thinktank the King’s Fund says the latest government plans for reorganising health and social care in England have been kept shrouded in secrecy by NHS England and taken little note of the views of the public and frontline staff. This will come as no surprise in London, where there’s been great annoyance that draft plans produced in October were not immediately opened up for general scrutiny by Londoners.
Two local authorities went ahead and published anyway. “There’s no way the NHS can produce these plans in secret,” tweeted Camden’s Labour leader Sarah Hayward when her council became the second in the country (after Birmingham’s) to unveil the 68-page draft sustainability and transformation plan (STP) for the North Central London area, which also takes in the boroughs of Barnet, Islington, Haringey and Enfield. “There is a national crisis in both the health and social care systems,” she said in a statement. “Both need to change and we recognise they could be more efficient. As the provider and commissioner of social care services in Camden, we want to be sure that future needs are reflected in this plan.”
The other borough to publish was Lib Dem-controlled Sutton, which fits into the South West London organisational “footprint” along with Croydon, Kingston, Merton, Richmond and Wandsworth. Sutton leader Ruth Dombey acknowledged some “strategic engagement” on the part of the various local NHS bodies involved and said boroughs had been informally updated on the progress of their STP. However, she said that central NHS’s not allowing the general release of its provisional version “is raising worries about its content and the process around its development”. That’s why she put the 61-page South West London draft STP out there smartish.
In all, five STP “footprints” cover Greater London out of the 44 in England as a whole. The other three are: North West London (encompassing Brent, Harrow, Hillingdon, Ealing, Hounslow, Hammersmith and Fulham, Westminster and Kensington and Chelsea); North East London (Barking and Dagenham, City of London, Hackney, Havering, Newham, Redbridge, Tower Hamlets and Waltham Forest); and South East London (Bexley, Bromley, Greenwich, Lambeth, Lewisham and Southwark).
The draft STPs for the full quintet all have now been published, so at least – some will say at last – everyone can now have a look at what’s in store: see the North West one here, the North East one here and the South East one here. Passions have long been running high about these templates for reform, with some seeing them as exacting yet in some ways also potentially beneficial devolutions and integrations of vital services and others doubting they amount to anything other than mechanisms for ruthless cuts, closures and privatisations. All concerned with their creation have been feeling the strain. Now comes the anxious and heavy scrutiny.
In London, the debate has been taking place very much in the context of meeting the particular needs of a city with such a large, diverse and shifting population. The case for proper input from patients and practitioners seems exceptionally strong here. The Kings’ Fund report concludes with a summary of recommendations about the development of STP’s nationally. Several ring very true for the capital. They include:
Involvement in the STP process should be strengthened at all levels within the health and care system, particularly among clinicians, frontline staff and local authorities.
Meaningful involvement of patients and the public in the plans has not happened so far and must now be a priority.
National bodies in the NHS should ‘stress-test’ STPs to ensure that the assumptions underpinning them are credible and the changes they describe can be delivered. Realism is needed about what can be achieved within the timescales and funding available. Honesty is needed in communicating these messages to politicians and the public.
It’s 6.45am at Camden ambulance station in north London, and the day shift is just beginning. Andy Donovan, who will drive the ambulance I will accompany for the next nine hours, is making me a cup of tea. His more senior paramedic partner, Dean Lowes, is running a few minutes late. When he does arrive, Lowes looks very sorry for himself: he’s got an ear infection, picked up on a friend’s stag weekend in Budapest. Lowes is the ambulance’s first case of the day. They nip off to the nearby Royal Free hospital in Hampstead to get some ear drops. Paramedic, heal thyself.
All this delays us for more than an hour, and we’re not ready to “go green” – telling the London ambulance service’s call centre near Waterloo station that they are available for a job – until after 8.30am. Lowes, who along with Donovan is featured in the BBC’s new three-part series on London’s overstretched ambulance service, is suitably embarrassed. “This never happens to me,” he says. “I’m never ill.” But full marks for at least getting here. Crewing an ambulance is challenging at the best of times.
Soon after going green, our first assignment comes in, flashing up on a monitor at the front of the ambulance. It’s just about as unpleasant as it could be. One word: “HANGING”, and the location. It is a “Red One” – the top-priority call sign, meaning life-threatening. Lowes and Donovan’s speed of reaction is electrifying. One moment, Lowes had been playing a Kings of Leon track on his mobile and saying how much he liked the band; the next, the ambulance is tearing south towards King’s Cross.
The call comes through at 8.49, and we get to the scene five minutes later. My heart sinks when I realise it is student accommodation. Two policemen are arriving simultaneously, and we all head up two floors in the lift to a stuffy, antiseptic white corridor. I go up with the policemen, who are bemoaning the fact their car was the closest to the scene. “You had a feeling it was going to be a funny day,” one says to the other. “You said you had a feeling in your bones.” “Yeah,” says the other with a grim laugh, “I should shut the fuck up.” In situations like this, black humour is sometimes the only way out.
Lowes, as senior paramedic, is first into the little study-bedroom. He has to decide if the student, who appears to have hanged himself, is dead, or, in the official language they use, to declare “life extinct”. It takes him just moments to satisfy himself that he is. The student is pronounced dead at 8.57. I can’t bring myself to look at the body – the young man is fully clothed – for too long. What strikes me most is how peaceful he looks, and how red his hands are – the blood drains down to the hands and feet, a sign he has been dead for several hours.
Within minutes there are half a dozen police on the scene, taking a statement from the traumatised fellow student who discovered the body, talking to the staff in the hall of residence, looking through the young man’s possessions to establish his identity. It has ceased to be a medical emergency and become a police inquiry – and a personal tragedy for the family who do not yet know what has happened. It appears the young man, who was 23, was anxious about a dissertation he had failed to deliver. What a terrible, pointless waste.
This is a shocking beginning. A suicide by hanging is rare. It is the first Lowes has witnessed. “He looked like a wax dummy,” he says as we wait downstairs while he does the paperwork to certify the death. “It’s when you see his passport and the picture of how he looked when he was alive that it hits you. That humanises it.” Having been a body, he becomes a person. “I try not to look at a dead person’s effects too much,” says Lowes, “because you start to build a little story about them.” “You can’t go into it too deeply,” adds Donovan. “There’s a lot of stuff you lock in the box.”
A paramedic team leader turns up. He doesn’t say so, but Lowes and Donovan know he is there for their welfare – to make sure that having to deal with the young man’s death has not affected them too severely. “If you want to take a bit of a break, that’s fine,” the team leader tells them. They don’t particularly, although they do have a fag standing next to their ambulance. The morning is hot, and people stroll past the student block, laughing in the late-summer sunshine, not realising that inside a promising young life has been extinguished.
By 11am, they are ready to roll again. They go green, pressing the button that declares the ambulance available, and in a second – literally – their next assignment flashes up. It’s another Red One – a cardiac arrest in West Hampstead, a couple of miles to the north. The siren screams, I lurch around in the back of the ambulance feeling sick, and Donovan swears at the vehicles that block his way, costing him vital seconds that could mean the difference between life and death.
Call handlers at the emergency operations centre in Waterloo. Photograph: Glenn Dearing/BBC/Dragonfly
The job is undeniably exciting, or at least seems so to me. Horrible, of course – no one wants to discover dead bodies – but also fascinating because of its unpredictable nature. You have no idea where you will go next or what you will have to deal with. “That’s the beauty of it,” Donovan had told me earlier. “You never know what you’re going to from job to job.”
It’s like roulette, I suggest, and he tells me that is exactly what they call the last job of the day. If you go green with, say, half an hour left of your shift, the call centre will play “red roulette”. Instead of giving you a less urgent call (categorised from C1 to C4, depending on the degree of seriousness), they will give you something life-threatening. It seems mad, but the logic is that whatever you do is likely to take hours – every callout seems to generate a mountain of paperwork – so you may as well go to something that is worth your while. A practical, if heartless, way of looking at it. Paramedics often work 12-hour shifts, and I can’t imagine what it’s like to get a final Red One at the very end.
We get to West Hampstead in about six minutes. Another ambulance is already on the scene, as well as team leader April Barter, who has come by car. I bumped into her earlier at the ambulance station in Camden, and she was complaining about having nothing to do that morning. Now she has something to do. A man in his 60s has had a cardiac arrest – a heart attack in which his heart has stopped completely – and the struggle is on to save him.
The man is lucky. I hadn’t realised where we were when we arrived, but then it dawns on me – it’s a bridge club, and dozens of middle-aged and elderly card players are watching the paramedics’ attempts to revive their fellow participant. Even before the first crew arrived, some medically trained members of the club had starting giving him CPR (cardiopulmonary resuscitation), that pounding of the chest that aims to kick the heart back into action. Without their prompt action, he would be dead. The paramedics continue the CPR – by now his chest looks as if it has caved in, but apparently this is quite normal – and administer defibrillation, an electric shock designed to correct his heart rhythm.
After half an hour of attention, his heart is functioning again and he can be taken to hospital. He is still unconscious, but has a reasonable chance of surviving. His bridge partner, who tells me they had just played a very successful rubber, offers to go to hospital with him, while his wife is given the news at home. There is an impressive calm at the club as the man is carried out. Who knew bridge could be an extreme sport – or bridge players so unflappable?
A cardiac arrest involving two crews generates an especially large volume of paperwork, and we are stuck outside the Royal Free for more than an hour while all the forms are filled in. Soon after we deliver the man to the hospital’s heart centre, Barter tells me he has regained consciousness. “The fact he’s awake, his eyes are open, he’s moving around tells us his brain has more oxygen. Although potentially it has been starved of oxygen for a short period of time, that’s a really positive sign and it’s a potentially good outcome for him. That’s a massive lift for us. Good times.” She says she is “buzzing”. “If I can make a difference to one person in a day, then I go home happy,” Donovan told me earlier. It looks as if he and his colleagues have made that difference today.
It is that difference, rather than the material rewards of the job, that attracts Lowes and Donovan. “You don’t do this job if you want money,” says Lowes, who is 37 and comes from the north-east of England. “It has other benefits. You go home and you sleep at night. You don’t take any work home with you. You might take some kind of emotional stuff away at the end of the day but, as far as the working day is concerned, once you’re finished, you’re finished.”
Lowes, who is a fully qualified paramedic, tells me he earned £36,000 last year. Thirty-year-old Donovan, a friendly, buoyant east Londoner who is one rung below his partner in terms of clinical qualifications, says he earns £20,000 a year basic, which rises to about £28,000 with the inner-London allowance, rest-break compensation (they will typically work through their breaks) and overtime, lots of overtime. They are contracted to work 37-and-a-half hours a week, but can do up to 56. Without the overtime, they would struggle financially. The staff need the relentless pressure on the service to earn enough to live.
The upside, apart from the drama of the job and the satisfaction of saving lives and helping people at moments of crisis, is the flexibility. “There are a lot of other things out there that I wouldn’t want to do, sitting behind a desk being one of them,” says Donovan. “At least in this job you’ve got a little bit of freedom. Once you’re out on the road, you’re your own boss.”
While the paperwork for the cardiac arrest case is being done, I talk to Gary Nicholls, one of the paramedics in the first crew to arrive. He has clocked up almost 24 years on the job – Lowes and Donovan have each done seven. “You never know what the next call is going to be,” he says. “That’s what keeps us interested. But it doesn’t matter what comes down on the screen, we can always deal with it. The workload can be relentless, but your colleagues are there to get you through the shift.”
The London ambulance service was put into “special measures” last year because of a number of failings, including staff shortages, poor response times, lack of leadership and concern that the service was ill-prepared to deal with a major terrorist attack. The cynic in me thinks the BBC series – and my ride in the ambulance today – are part of the PR fightback, and maybe they are, but there is no doubting the commitment of the dozen or so paramedics and backup staff I meet. This is a service under pressure, but by no means one that has lost heart. Nicholls really does believe they can deal with anything, including his first job that day – chasing a naked man who it was feared was high on drugs across Hampstead Heath.
It is already well past 1pm. The complexity of the jobs, the paperwork and the fact that you need a bit of a breather mean crews will only do four or five callouts in a nine-hour shift, and six or eight in a 12-hour one. Just before 1.30pm, Donovan and Lowes go green again. This time it’s a Red Two – slightly less urgent but still potentially life-threatening, a woman in Kilburn with chest pains and breathing problems.
She is sitting on the stairs of her house when we arrive six minutes later. She looks remarkably well, and within about two minutes of arriving Lowes has diagnosed an anxiety attack. She had a heart bypass operation five years earlier, and clearly fears a heart attack. She has already been to hospital for a checkup that day, and now wants to go back, despite getting the all-clear earlier. It is unlikely there is a serious problem, but Lowes and Donovan can’t take any chances, so take her to the Royal Free. It’s not their most productive couple of hours, but they talk to her respectfully, calm her down, deliver her to A&E and fill in a fresh set of forms.
It’s now 3 o’clock, and we’re on our way back to Kilburn. This time they’ve received a less urgent C2 call, after an earlier Red One to another fatality was aborted. The monitor in the ambulance advises “man in his 70s with severe behavioural change”. When we get to the flat, we find an elderly man close to collapse – probably through dehydration – and his wife at the end of her tether. She thinks he has undiagnosed dementia, and there are suggestions he can be violent towards his family, though today he can barely raise himself from the sofa.
It is an example of the social work side of paramedics’ work. They check him over physically, but he is in reasonable shape apart from the dehydration. What he may need very soon is a place in a care home. That is the shadow that falls across the conversation Lowes has in the corridor with the man’s wife – the sad but all-too-common conclusion of a 50-year marriage – while Donovan talks to the man’s son about sport.
As their appearance in the BBC series shows, they are very good at being de facto social workers, counselling the anxious, the elderly, the confused, the demented. “When I first started this job, going into people’s homes took a bit of getting used to,” says Donovan, “but because you’re wearing a uniform, in the eyes of the public you’re a goodie. You’re welcomed into most situations, whether it’s for social reasons or for emergencies.”
Lowes calls the man’s GP, who promises to come round. For the moment, there is nothing more that can be done. More paperwork and another cigarette in the afternoon sun. The shift is drawing to a close, and the crew do not fancy any red roulette. There is a general callout for an ambulance, any ambulance, to go to Victoria station, where a girl has fainted. They decide it’s too far and head back to base. That’s enough excitement for the day.
As we drive back to Camden, their monitor is reporting that University College hospital has been temporarily closed, St Mary’s in Paddington is accordingly under severe pressure and the Royal Free is “breaching” – A&E is missing its waiting targets and patients are being left in ambulances longer than they should be. It’s going to be quite a night shift, and Lowes and Donovan are happy to be out of it. But tomorrow they will be back, and who knows where the spin of the roulette wheel will take them?
Ambulance starts on BBC1 at 9pm on 27 September.
In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14.
