Under-funding is the real issue behind tragic failures - Dani Garavelli

Whenever I read reports criticising the emergency services for their response to major incidents, I am gripped by a protective instinct.

The scene outside the Manchester Arena in May 2017
The scene outside the Manchester Arena in May 2017

To me, the responsibility for Grenfell lies with those who allowed cheap, combustible cladding to be placed on a tower block housing hundreds of people. Just as the responsibility for the Manchester Arena atrocity lies with Salman Ramadan Abedi, the suicide terrorist who blew himself and others up after an Ariana Grande concert in 2017.

For frontline workers who have the misfortune to be on duty during such disasters, I have little but sympathy. I picture them caught in the kind of chaos it’s almost impossible to train for: dedicated, but fallible, making heat-of-the-moment decisions, some of which will turn out, in hindsight, to have been misjudged.

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Others will find themselves at the mercy of hierarchies and procedures which prevent them acting in the way they would choose. In such circumstances, it seems invidious to play the blame game. Still, as John Saunders, chairman of the Manchester Arena inquiry, said, if we don’t identify mistakes, there is no prospect of preventing them in future. A thorough investigation is the least that is owed to the 22 concert-goers who died that night, and the hundreds more who were injured.

Saunders is clear catastrophic errors were made. Some of his findings defy belief. Only three paramedics ever entered the City Room where the bomb was detonated at 10.31pm, and their focus was on triage rather than treatment. The first ambulance was not deployed to the scene for 30 minutes, and it took more than two hours for the fire service to turn up. The evacuation of casualties to a designated clearing station was ineffective, with 36 people still waiting to be moved at midnight.

As so often, there were failures of communication both within and between the different services. There was no multi-agency rendezvous point (RVP) and no multi-agency control room talk group to allow control rooms to talk to one another. Not everyone knew what Operation Plato - the pre-arranged response to a suspected marauding terrorist - entailed, while vital major incident updates - known as METHANEs - were erratic, and, once delivered, went unshared with other services.

This lack of coordination had a dire human cost. Saunders concluded at least one, and possibly two, of the 22 victims might have survived had the response been more effective, while traumatised survivors have spoken of their feelings of abandonment as time ticked slowly by.

Those representatives of Greater Manchester Police (GMP), British Transport Police, the North West Ambulance Service and Greater Manchester Fire and Rescue Service, who last week apologised for the failures, seemed genuinely (albeit belatedly) contrite. Their attitude contrasted favourably with the routine shamelessness of Tory politicians whose relentless attacks on public services have eroded their capacity to tackle domestic emergencies, never mind atrocities on the scale of the Manchester bombing.

Sadly, neither the inquiry itself, nor the emergency services’ acceptance of its findings are sufficient to guarantee change. We know this for sure because so much of what happened in Manchester carried echoes of previous disasters. As at Hillsborough, we witnessed critically injured people carried on advertising hoardings. As at the 2005 London bombings, there was a greater focus on processes than individuals, and a lack of equipment such as triage cards and stretchers.

Meanwhile, government ministers have welcomed the report while continuing to ignore the part they have played in the brokenness of so much of the country’s social infrastructure. “It’s right that we reflect and work together to learn from this tragedy,” Home Secretary Suella Braverman said. Yet Saunders believes cuts resulting from austerity contributed to the inadequacy of the GMP’s planning for emergencies.

In the five years since the Manchester Arena bombing, there has been no let-up in such policies. Public services have been pared to the bone, with further cuts to come, raising the fear that, across the country, emergency services may be even less equipped to deal with a major incident today.

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This is particularly true of ambulances. Almost daily, we hear horror stories about patients waiting hours for paramedics to arrive. A recent report from the British Heart Foundation suggested such delays were contributing to up to 230 avoidable heart deaths a week.

The report applied to England, but the delays are spread throughout the UK. Most are not the fault of the ambulance services. They are caused by hospital logjams. Ambulances are stuck outside A&E departments waiting for their patients to be admitted. They cannot be admitted because A&E is full of patients waiting to be transferred to wards. They cannot be transferred to wards because the wards are full of patients waiting for care packages before they can be discharged.

Social care has taken a hammering north and south of the border. Last week, Sarah McClinton, president of the Association of Directors of Adult Social Services (ADASS) said the situation in England had “never been so bad”. At the same time, Scotland’s Deputy First Minister John Swinney confirmed he was cutting a further £400m from health and social care to help cover staff pay deals and meet rising inflation costs.

If social care continues to be under-resourced, ambulances will go on spending hours outside A&E departments. They will be unavailable to attend major incidents regardless of improved protocols. This is true of all the emergency services. The more their budgets are eroded, the more they will be forced to focus on crisis management at the expense of long-term planning. Public inquiries such as the one into the Manchester Arena bombing are important, but unless wider, systemic issues are addressed, Saunders’ forensic scrutiny will have no real impactat all.