By Paul Burnell
Kellie Allen will never dial 999 for an ambulance after her family's experience when her father collapsed in the street with a heart attack.
Mr Allen suffered a cardiac arrest and later died at Newark Hospital
Rather than wait for an ambulance to take her to hospital she says, "I would rather take my chances and drive myself or drive my family there.
"I would never have any confidence in ringing 999 for any emergency."
Her loss of confidence in the ambulance service dates back to October when her father Paul Allen, 53, collapsed near Newark market place.
Cry for help
When her brother Mickey arrived at the scene, Mr Allen was lying on the floor, with the paramedic trying to attach the sticky pads of an ECG machine.
"They weren't sticking to him because it was cold,", Mickey told BBC Radio 4's The Report.
"My dad was taking gas and air and crying in pain, and all this went on for probably an hour and 15 minutes."
Having already phoned to request an ambulance to take Mr Allen to hospital, the paramedic radioed again.
"He got the response that there wasn't one coming, it had not been dispatched. He then said a few choice words to the person at the other end."
Mr Allen's son and the paramedic tried to lift him into the paramedic's car where he could be laid flat.
"We tried lifting my dad but he was physically unstable, so we gave up on that idea."
He said the paramedic phoned round to try and find any means of transport to get Mr Allen to hospital.
Eventually a colleague who was driving a patient transporter responded.
Mr Allen was then taken to hospital in a vehicle that did not have flashing lights, a siren or specialist emergency equipment on board.
Seventy-five minutes after the first 999 call, Mr Allen arrived at Newark Hospital, but died later that day.
Mickey asked the doctor if his father might have survived had he arrived sooner.
"The doctor couldn't say whether it would or not, but he said the quicker you get to hospital the more chance of survival you've got."
Kellie Allen says although the paramedic arrived in minutes, what her father needed was hospital treatment:
"The paramedic did all he could for my dad but the response times he got after the paramedic arrived just let my dad down," she said.
"You look at my dad's case, and you look at it on paper, the paramedic arrival target was met so......probably all the boxes would have been ticked apart from the end box where my dad died."
East Midlands Ambulance Trust is investigating the exact circumstances of Mr Allen's case.
It would not be interviewed by the programme, but said it had met the family, who had asked them to deal with the matter privately.
The Allen family's concern about targets is echoed by unions and academics. In particular they criticise the practice of sending first responders (paramedics or trained volunteers) to the highest category of emergency cases like Mr Allen's.
Unions allege this is a quick way of ensuring that ambulance trusts meet their target to arrive at the scene of so-called "category A" incidents within eight minutes of the initial 999 call.
"This is known in the service as the front loaded model," Unison's national ambulance officer Sam Oestreicher told The Report.
"We've got concerns not just about the quality of patient care that a single responder can deliver, but also that they can't transport the patient back to hospital, and we've had reports of single responders getting to a patient and having to wait 90 minutes for an ambulance," he added.
Further concerns are expressed by Janette Turner of Sheffield University's Medical Care Research Unit who said that getting to people quickly was now being seen as a proxy for good service.
"If they get there in seven minutes and the patient dies they've succeeded, if they get there in nine and the patient lives, they have failed because they haven't reached their target," she said.
She added that the response time has become more important than the patient outcome.
Nigel Edwards from the NHS Confederation which represents ambulance trusts in England, acknowledges it is time to review the target framework.
"A solution might be to move to a measure in which we measure the outcome of what's done rather than just the process, so what was the outcome for the patient?" he said.
However, Health Minister Mike O'Brien defended the current use of targets.
"Targets help to drive improvement, and we have seen ambulance trusts making progress following the changes to performance requirements from 1 April 2008," he told the programme in a statement.
"Investment and improvements in ambulance services include increases in frontline staff and emergency medical dispatchers as well as new vehicles, equipment and technology so patients get a better quality, faster service," added Mr O'Brien.
The Report is on BBC Radio 4 on Thursday, 10 December at 2000 GMT. You can also listen via the BBC
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