Perhaps Mr Littledyke will retract his statements about PGDs for drugs in East Anglia when I show him mine, up to date, signed by the Chief Executive and the Medical Director (who is on the board).

If the paramedic cars are unlawful, one wonders why the police haven't prosecuted me or the trust as I have driven one since 1991.

ECP, Witham, Essex

Rightfully the healthcare Commission undertook an in-depth report into Staffordshire, it found in the main that problems lay around the use of drugs by persons employed that had not been subjected to Patient Group Directions, and that a Medical Director was not in place to issue such directions, and the poor setting up of Doctors out of hours services. The advice given from the 100 page report is very clear THAT ALL AMBULANCE TRUSTS MUST READ IT AND ACTION IT. Talk about when the horse has bolted 2004-2007 was the period the report covered and it is published in 2008. These practices are common place throughout the UK especialy in East Anglia and in many other ambulance trusts who provide ECP to Doctors surgeries and to Out of Hours services and who do not have PGDs or even written Doctors directions as required by the 2000 Medicines Act. Ask any Paramedic for a copy of his PGD he has to have it and signed by the Chief Executive, The Medical Director (who must not be a board member) and a lead Pharmacist.Morphine in kit bags yes it appears it is common practice with Paramedics. When I brought this to the attention of East Anglia thay claimed to be a law unto themselves, but the management were ex-staffordshire and perhaps whilst many items are good, they also learned some of the very bad habits. Paramedic cars are unlawfull as are the First responder vehicles who may not have been insured to undertake blue light work, as you cannot insure for an unlawful action. Now they must all act and do it right from day one i.e. the 9th April 2008, what they should have been doing for the past 10 years acting lawfully and not as a law unto themselves.

Peter Littledyke, Peterborough, Cambridgeshire

'Staffordshire Ambulance Service NHS Trust were motivated by the best intentions.'

Really? I think that innovations implemented in the way described have nothing to do with best intentions and everything to do with the managers being smart arsed meddlers looking for plaudits from the DoH. I am reminded of the imbecilic proposals made from time to time by managers in the Health Services in Derbyshire which undoubtedly would have been implemented were it not for clinicians at meetings between staff and managers. Issuing drugs in this way is a criminal offence, and steps should be taken to identify the persons responsible.

Bill Q, Derby,