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Revealed: The hidden crisis in Britain's ambulance services

Paramedics are fleeing. Needless callouts are mounting. When will the government notice?

30 August 2014

9:00 AM

30 August 2014

9:00 AM

Last month I wrote about the weird exodus of paramedics from London’s ambulance service. Flies would blanch at the rate they’re dropping, and so I was curious — and also anxious. Everyone who lives in this heaving city relies upon 999, and 999 relies upon paramedics.

The official reason, given to me by Mr Jason Killens, the tough-sounding director of operations at the London Ambulance Service (LAS), was that they’re leaving because they’re underpaid. But as I wrote back then, I wasn’t convinced.

It turns out Mr Killens wasn’t quite convinced either, because since we spoke, the LAS have begun an internal inquiry into the matter — and as it happens, inadvertently, so have I. Over the past few weeks I’ve been swamped by emails and letters from desperately unhappy paramedics. I’ve spoken to many of them; and can now present the results of my own inquiry. It might also (sad to say) be of interest to the other NHS ambulance trusts around the country — all nine of them from north to south, because it seems increasingly clear that London’s problems are echoed nationwide.

First you need to understand that London’s 999 service is on the very edge of melting down. The number of calls has risen dramatically and ambulances are sent willy-nilly to all manner of pointless non-emergencies. There are supposed to be systems in place that sort the hypochondriacs from the heart attacks, but for one reason or another they are all inadequate. The operators at 111, for instance, are untrained and risk-averse, so they send ambulances to the slightest sniffle. For a 999 operator, the words ‘chest pain’ or ‘difficulty breathing’ automatically mean an ambulance, though it’s often just a panic attack on the line. The service is so stretched that ambulance crews no longer return to their stations to recover between emergencies, but must circle the city all shift long and often do overtime.

So it’s hard, gruelling work, but this in itself isn’t why paramedics are dropping out, nor is it the fault of the ambulance service. It’s just the familiar bloody crunch of a free service, one to which people feel entitled, colliding with limited funds.

What is the fault of LAS management, though, is how they have chosen to respond. They have a duty of care to their exhausted paramedics; they should be thinking hard about how to improve the system. Instead, in a panicked bid to save face and hit targets, they have taken to cracking the whip over their frontline staff — driving them on until they snap or break down.

Last week I had an email from another whistleblower: ‘Surge Purple called again. Help!’ ‘Surge Purple’ is a perfect example. The ‘Surge Plan’ is what our ambulances follow when there’s an emergency. Surge Amber means a mini-crisis; Surge Red is bad news; Purple means a major incident or a catastrophic situation. A Surge Purple was declared during the 7/7 London bombings, for instance: it’s a serious call.

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Surge Purple means the whole front line of the London Ambulance team — 999 call dispatchers, drivers and paramedics — racing flat out, working overtime, getting by on adrenaline in place of sleep. It means staff on holiday or sick are badgered to come in. It should by definition be an almost unheard-of measure, but Surge Purples are being called regularly these days: two in June this year, more in July — and why? Simply because there are far, far too many calls to deal with. Managers fear they won’t hit the government-set targets, so they press the panic button and up the pressure on already run-ragged ambulance crews.

It’s not just cruel; it’s dangerous too. During one Surge Purple, the LAS apparently decided that all ambulances should respond to all calls — even non-emergencies — on ‘blue’, meaning lights on, racing top speed. Under normal circumstances an ambulance will only drive on blue if the patient is critically ill, because it’s risky and stressful, but despite complaints from the crews, the LAS was said to be adamant. So London sounded with sirens. Blind-tired drivers served frantically around town, dodging pedestrians. Why? Not to save lives (it perhaps even endangered them), but just to catch up, to pretend it was all OK for one more desperate day.

Even in these circumstances, if their immediate bosses, the duty officers and area managers of the ambulance stations, supported them, London’s paramedics might not be opting out. But if the emails and letters I’ve received are to be believed, a culture of bullying, fear and paranoia has crept in. Frontline staff are working beyond the point of normal endurance — skeleton crews on week-long Surge Purples — but if they become ill, from lifting heavy patients or from stress, management gets difficult. If you begin to sift through local news stories, you can see this panicked bullying has become the reflex response of management in ambulance services around the country — a product perhaps of the wrong people, over-promoted and at sea in the chaotic system. Just as a bad workman blames his tools, so an incompetent manager blames his staff, and for want of any other answer, simply pushes them ever harder.

Last December the Worcester News reported that a whistle-blowing paramedic with the West Midlands service had claimed staff felt ‘downtrodden and bullied’. In April this year Dr Anthony Marsh, head of the East of England ambulances, edged his head above the parapet to warn that staff were ‘tired, overworked and frustrated’. Just a few weeks ago, a source from South Central Ambulance Service told an Oxfordshire radio station that there had been a huge exodus of staff, because they felt undervalued by their bosses. ‘It’s us versus them between the front-line crews and management.’

Paramedics suffer badly from post-traumatic stress disorder, far more than the police or the fire brigade, but they work harder, retire later, and there is no room these days for mistakes. If, in the general run of handing patients over to A&E, a single box is left unticked, disciplinary proceedings begin. ‘Make a mistake on your paperwork, and you may as well kiss your job goodbye’: I’ve heard this many times. I’ve been told of staff being disciplined for simply questioning management’s decisions, and of nervous breakdowns. A former paramedic with the East Midlands service told the Nottingham Post, ‘Someone will go to a child death, which is awful, and from there they can immediately go to another. Anyone would go to pieces after that job. But that’s made irrelevant if targets need to be hit.’ I had coffee with a former member of the LAS who claimed there was an unofficial paramedic suicide-risk list held by HQ. As he spoke, his eyes flickered anxiously from right to left, as if management might be listening. Paranoid, yes, but far from unusual. To a man, I’ve found they’re terrified of management.

And this is why Jason Killens has so many ‘unknowns’ on his paramedic ‘reasons for leaving’ chart. They don’t dare tell the truth. Management has the power to strike paramedics from the register. They might want to work elsewhere in the health service and they worry about reprisals.

Now, I expect at this point Mr Killens has already planned a cross letter to The Spectator. But these aren’t allegations — this is simply what staff say to someone who they think might care.

The London Ambulance Service top brass claim to be concerned about the crisis in their service, as well they should be. They say they are taking steps to improve the working lives of their ambulance crews and recruit new frontline staff. But my light reading these past few weeks has been the minutes from their monthly board meetings and they’re as puzzling as the emails from the paramedics are disturbing.

Take July. Each board member present had a report in front of them which laid out, in graphs and bullet points, roughly the picture I’ve painted above: ambulances run almost constantly on emergency ‘code red’; use of Surge Purples (which I assume are technically supposed to trigger some sort of inquiry); the haemorrhaging of staff. There has also been a ‘steep rise in the number of complaints received by the Patient Experiences Department’. So why, then, does no one seem to care? Last month’s minutes start with a little talk from a deaf member of the LAS, and the first concern of the service’s chief executive, Ann Radmore, is that not enough is being done to make it easier for people who are hard of hearing to join the service.

She then addresses the ‘staff turnover’ issue, but it’s almost as if she’s never spoken to a paramedic: she suggests that they’re all leaving just because there is such a demand for their skills elsewhere. The board seem united in thinking that the answer is not to improve a London paramedic’s lot, but to ship more in from abroad. A chap called Nick wonders about recruiting from China; someone else mentions that a recruitment drive is to begin in Australia. A chap called Theo de Pencier, who I hope was joking in a black sort of way, suggests that next year’s Rugby World Cup might ‘also attract people to work in London’. De Pencier also worries about the impact of poor air quality in London on staff health. Then they all disperse until next time.

It’s nice that Theo’s concerned about the air quality — next perhaps he’ll suggest letting them eat cake — but it’s terrifying to see how little any of the board seem to understand the problems on their own front line.

So the first recommendation of this Spectator inquiry is that if Mr Killens and Ms Radmore want to keep their paramedics — and they urgently need to — they must begin by listening to them. This of course goes for every chief executive of every ambulance trust across the country. I’ve heard more than once that the much-admired former chief exec Peter Bradley spent an hour and a half in each station every year, chatting and trying to understand. Perhaps Ms Radmore might do the same.

After listening to them, they’ll understand that no amount of recruiting from Australia (where I gather Jason Killens is currently scouting about) is going to help. Staff will come, and then will leave, and the trouble will continue.

My second recommendation is that the management comes clean. Paramedics are the canaries in the coal mine of 999. They’re dropping out because the whole system is poisonous. You can’t operate on Surge Purple for ever. Jeremy Hunt, the Secretary of State for Health, and his team were concerned about the comments from paramedics under my previous article. Mr Hunt was worried enough to promise to look into the issue, so now is the time for all those in charge of these miserable, collapsing ambulance services to stop hoping the problem will just evaporate some day, and take action. They should join together to urge the Health Secretary to reconsider 111; make sure ambulances are reserved for proper emergencies; and, most of all, treat paramedics with the respect they deserve.

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Show comments
  • lailahaillallah

    It’s not only the Ambulance Service. The same is happening with GPs- another story HMG wants to keep the lid on till after the election. De-professionalisation, a tick-box culture, government target that are impossible to meet, and therefore result in pay cuts, constant media sniping in the right-wing press, and… I hate to say, it, about 8 years now of regular erosion of pay. Much better terms abroad in Aus, NZ and Canada.

    Like the ambulance service, there are some feckless people out there who use Primary Care as a sort of social service for their end-stage social problems.

    Interesting time. I wonder if the NHS will fail this winter? What do I mean by that? I mean people of all ages dying unnecessarily for want of an ambulance or a staffed NHS hospital bed. It will only need a modest flu epidemic to do it; we didn’t have one last year.

    DOI- I have recently taken early retirement as a NHS GP because of the above. I know of 5 in my city who have done so, or who are doing so, this year.

    I await the “GPs are idles useless scum” flaming, but can cope with it.

    • Al

      GPs have it tough. They have an unmanageable and increasing workload. But their struggles are incomparable with those of ambulance staff.

      GPs aren’t routinely bullied by incompetent, desperate managers; they aren’t working for thirteen hours straight on an almost-daily basis and therefore getting insufficient rest between shifts; they aren’t damaging their backs carrying obese patents up and down stairs. Ambulance staff do a more physically demanding, emotionally draining and dangerous job for around a quarter of the money GPs get and they’re much more likely to get sacked and struck off.

      • lailahaillallah

        “GPs aren’t routinely bullied by incompetent, desperate managers; they
        aren’t working for thirteen hours straight on an almost-daily basis and
        therefore getting insufficient rest between shifts” Sadly, often they are- ask a GP.

        I agree, we rarely carry patients, though I can tell you I have done it a good many times in nearly 30 years.

        Yes, we were paid about 3-4 x what an ambulance man/woman is, but then we mostly take a lot more clinical responsibility, and from day 1 at medical school it takes 10-11 years to become a GP, minimum. We also pay about £6k a year in indemnity. For today’s students, that means leaving UNI with a massive debt, so I don’t belittle what the Ambulance Service does, but I would like to see an article about the imminent crisis in medical manpower which is surprisingly absent at the moment, and the reasons for it.

        • Al

          I’d be interested to see a similar article about the problems in general practice and the imminent crisis in medical manpower as well – it’s an area that I, along with most of my former colleagues in the ambulance service and the public at large, know very little about.

          Nonetheless, it’s quite difficult as an ex-paramedic to believe that GPs have it anywhere near as bad as ambulance staff do. Yes, there is more clinical responsibility, but at the same time very few of your patients are acutely unwell. Those that are can be referred to A&E, given a letter and sat in the waiting room to wait for an ambulance. As medicine goes, primary care is a pretty low-risk area of practice wouldn’t you say?

          Most NHS staff have it tough at the moment and on the one hand I think we should exhibit nothing but empathy in forums such as this. On the other hand, I think working during the daytime from Monday to Friday in a warm surgery seeing primary care cases while earning in excess of £100k a year is a much better existence than speeding around London in the middle of the night from one call to the next, stab-vest at the ready, without a break, for £32k. That’s not to say that you haven’t earned the right to such an existence after 11 years of training, much less that GPs are idle useless scum… but I don’t believe, in the context of this article, it’s fair to say that “the same is happening to GPs”.

          Still, congratulations on getting out, I hope you’re enjoying your retirement and I hope that the issues making both of our former existences so much more miserable than they should have been one day get resolved.

          • Tamsin

            GPs do at least work inside, in a warm, well lit environment most of the time.

  • IXION

    It is not just in medicine.

    I am a Criminal legal aid lawyer- (If Lailahaillallah) thinks his Gp’s comments are going to get Idle useless scum trolling just wait until they start on me).

    We have cuts cuts and more cuts. (In fact the only public service which has had a 75% cut in 7 years, in funding).

    Our mighty lord chancellor has said he does not see why anyone should have good lawyer on the public purse to defend them an ‘ adequate’ service is all that is required. And if you earn more than about £45,000, win loose or draw you are paying your own legal costs- ask Nigel Evans

    Same as above,massive over working, de-skilling, etc etc.

    • lailahaillallah

      I wouldn’t troll you at all; my son is half way through his 2 year trainee period as a solicitor with a large London firm, and he says there is no way he would consider criminal work. I know of few who do now, so you are spot on.

  • David12

    Nothing ‘free’ is valued: if each response to a 999 call were preceded by a recorded message along the lines of, “If this call is judged to be frivolous, you will be charged with the cost of the ambulance and its crew, which may amount to serveral hundred pounds,” the number of time-wasters would fall dramatically.

    • Dan Cotruta

      Who judges the frivolity – if someone you cared about said they felt very ill and required an ambulance would you really want the added stress of being charged if a third party decided your call was frivolous?

      The answer here is not more fear, it’s better training for the public, for the 111 operators alongside improved support for the amazing ambulance crews.

      • ExEEASTPARA

        Simple,the A&E staff and Paramedic(s)involved decide.
        If we are happy to put our faith and trust in these professionals to recognise and treat our nearest and dearest who have suffered significant injury or illness,then we must also trust their judgement on whether a person has misused or abused a frontline emergency ambulance resource.

        All too often there are people who require A&E with a minor injury,who could easily self present,but call for an emergency ambulance instead because it’s free,it’s there and they know they will not be charged- there are also those who have no intention of going to A&E in the first place but just want to be ‘checked over’.
        So they get ‘checked over’ or get their transport to the A&E and then sit in the waiting room to be seen,in the meantime a potential patient is out there having a heart attack or a seizure and is having to wait for a crew.
        If a person is taken into hospital by an ambulance and ends up in the waiting room and the A&E doctor,nurse and Paramedic involved agree that inapprorite use has taken place,then they should have the power to award a charge.
        There would have to be some exceptions to this rule however,and the elderly being a realistic example.
        If a person has a genuine illness or injury which appropriately warrants a 999 Ambulance then that person or family members need not worry about the potential of being charged. At the same time however,members of the public must also start taking more responsibility for themselves and their actions and change this ever growing ‘it’s my god given right’ attitude towards the emergency services.
        It has unfortunately got to the stage now with resources being stretched at such a critical level and seriously ill patients being failed because they have to wait a long time for an ambulance that this may have to be a serious consideration for the future.
        Serious change in the services nationwide is not the only requirement,the public has to change too.
        I am a Paramedic and have been frontline for 10 years and also left this year,no doubt for similar reasons of the majority who have recently been leaving other services.
        I am in no doubt that I am already a healthier and happier person since leaving this year,I see my friends and family more,I’ve actually got Xmas off this year in my new job( had to work x7 Christmases out of my 10 years service).
        I have no intention of returning.

        • LovinThatI’mGone.

          We’ve tried this in Canada. If the doctor at the ER signs the ambulance form saying it was not required, the patient has to pay several hundred dollars instead of several tens of dollars. The problem is that, if challenged, the doctor has to show up in court to defend their statements. The other problem is that until you have a definitive diagnosis (which can take days) no one can say for sure that it was really not necessary. I posted a long bit about this in the comments. The problem, as you know, is that we really can’t tell how sick someone is in the field. I had a hyperventilating teenager once who was upset about being dumped by her boyfriend. I ALMOST left, and wouldn’t have criticised myself too badly if I had, but something bugged me about the call. Turns out she downed a bottle of Aspirin and was in metabolic acidosis. That was a total, lucky fluke that I decided to take her.

          • Michael Barnes

            Very useful point; it is not always clear what is a real illness. However there is no rule that the decision whether someone is faking it has to be made on the spot! Virtually everyone has a phone and their number can be traced. The billing can be done much later on, even on the discharge letter. We now have contactless payment cards. Real ‘time wasters’ will get charged, the sick, frail and elderly will continue to be treated as before. The only unknown problem will be those of no fixed abode(‘NFA’) who frequent our EDs….

          • LovinThatI’mGone.

            That’s not unreasonable, but you’d probably get more savings out of picking the top two dozen ‘frequent flyers’ and getting social aid involved. One ambulance service in Australia did a study (can’t remember which one) and found that just a few people (less than 10) were costing the service about 6 million a year and hundreds of hours of wasted time due to system abuse. Targeting the most flagrant abusers is probably the best bang for your buck.

            The danger is that if you tighten up too much then good people with legitimate complaints – the ones we really want the system to work for – will hesitate to call because of all the ads they’ve seen saying “Don’t call unless it’s an emergency” and the people they’ve heard about who called and were charged hundreds of dollars for it.

            Also, if you can’t decide if someone didn’t need an ambulance on the spot then they needed it. That was my point about the uncertainty of illness. Someone calls because they went for a long walk and now their calf is sore. Sounds like BS! But they call for an ambulance, and the paramedics fill in a ‘system abuse’ form, leave the hospital and go on their way. Patient goes into ER and has a heart attack. The calf pain was actually intermittent claudication, a sentinel sign for heart attacks, strokes and the like. Then the patient gets a bill for hundreds of dollars for ‘abusing’ the system, and it gets in the media and the paramedic service is embarrassed.

            If WE can’t tell, then we WANT people to call us so that they can get checked up. It’s really hard to know if someone is legitimately sick, even with medical training. It takes a long time. How can we criticise someone with NO medical training for calling us to check them out when we create a system and advertise that that is exactly what it’s for?

            I’ve found that the vast majority of patients I’ve seen are sorry to bother us. I’ve had little old ladies with a pulmonary embolism apologising for wasting our time!

            I think focusing on the very few people that consistently do abuse the system and getting other social services involved to figure out what is going wrong with those people will help. Beyond that, we’re either going to have to spend billions to keep the system going as we’ve come to expect it does, or start triaging and accepting that we’re going to miss a fair percentage of ‘sick’ patients and that people are going to die. This has gotten to what we define as a ‘mass casualty incident’ (more patients than resources) and when that happens you have to make hard decisions about who not to treat.

          • Michael Barnes

            Thank you for a very thoughtful reply. I agree with what you are saying and remain anxious about those sensible stoics and the frailer, polite elderly patients. Focusing on ‘frequent flyers’ aka ISU(intensive service users) is both evidence based and sensible. In fact it is bizarre that this point needs to be repeatedly emphasised and complex arrangements to target those ‘abusers’ are not hardwired into every hospital and ambulance system!!! I spotted a suspect client fairly recently whom it had taken the local health service 2 years to ‘sort out’. This is quite common in my albeit limited experience. Commonly these people have serious undertreated mental health problems as well as social problems. There may be hidden Dementia with super added Depression. Social isolation is the elephant in the room! However this was not the point I was trying to make. I am just as concerned about the other maybe 15-20% of non-ISUs(apologies for the ugly phrase) who actually have no real needs. Some of these may in fact be relatively young, healthy, articulate and affluent. It is their presentation that distracts people from the ISUs but also interrupt the serious day-to-day work. It is a rather wicked problem which no one seems to have tackled head on. The whole debate becomes suppressed by the argument over how to achieve real savings and re-invest that money into core services (or cut staff numbers). The need to introduce ‘means testing’ causes all serious people to sigh, shrug their shoulders and walk away. I feel that this is a fallacy. Firstly, this misses the moral issue of treating according to need and not want. Secondly we unintentionally isolate ambulance use by saying ‘well we had to bring them in anyway’ as if this has little effect on the overall health economy. In London, for example the very same individual may be able to attend multiple NHS institutions under different aliases albeit using the same DOB and address! Staff who work frequently in A&E casually laugh at these everyday occurrences. The surveillance system must not be arbitrary, excessively punitive or simply a blunt deterrent. It would ideally be cost neutral or even make savings but fundamentally the main determinant should be improved health outcomes..?! It needs to be be more educational and essentially irritating e.g. like your local tax, the utility bill, NHS prescription charges or even a parking ticket. The latter example may seem strangely out of place but it is a small example of situations where adults absolve themselves of responsibility when the reality is that they had little excuse other than complacency.
            In the UK it may well be possible to nudge commissioners to be more responsible for targeting their ISUs early. The current system appears to do this but because different agencies and health professionals struggle to communicate quickly and effectively these ISUs hang around for a long time without any challenge. Even with better IT and connectivity it is unclear whether there is a desire to tackle the huge problem of ISUs….

      • s.p

        With a computer system designed to react to certain words and dispatch an ambulance with no further discussion about the ACTUAL complaint, there is no room for the staff to make decisions.
        Computer says no

      • David12

        It is called “triage”.

      • Fergus Pickering

        Training for the Public? What do you mean by that? Do you mean anything? When something is free then everybody wants it all the time. What about a tenner an ambulance?

    • Eric Bowyer-Wilson

      In France, before the call is taken, a short recorded message informs the caller that the caller’s number has been recorded, and any misuse of the service will be sanctioned

      • lailahaillallah

        Er.. yes, but that is never going to happen here, is it?

        • Eric Bowyer-Wilson

          Well probably not. They couldn’t admit that anything good could come out of Europe.

    • John Smith

      You are correct that no one values anything that appears to be free to them.

      If we had an insurance based system, where the extras were charged, the demand would plummet & the service level increase.
      and no one would be harmed .. .

    • John Smith

      and people would die because they can’t tell the difference between indigestion and a heart attack.

    • John Smith

      and people would die because they can’t tell the difference between indigestion and a heart attack.

      • lailahaillallah

        Sadly, a lot of us doctors can’t do that- another reason for the Daily Wail trumpeting that we send “too many emergencies to hospital”- and yes, my practice had an ECG machine, and yes, I can read an ECG but you cannot be sure, even with that.

      • David12

        And even more people will die if we no longer have any ambulance service at all. Maybe I did overstate my point somewhat, but desperate cases require desperate measures and I think deterrence has a part to play in that scenario. The Fire and Rescue Services have a similar problem with hoax calls which some misguided individuals find amusing. They too need to distinguish between the genuine and the false, and somebody has the invidious task of determining that difference.

        • Fergus Pickering

          Misguided? Criminal is the word you want.

      • Michael Barnes

        This seems to be a recurring fallacious argument. Please look up the limited literature. International evidence does NOT suggest that in mixed-approach (public/insurance) funded health systems in advanced European economies they have high mortality from cardiovascular OR gastrointestinal diseases!! Of course they spend more overall in GDP on healthcare so maybe that is the difference…? The aim should be to almost eliminate the fear, deterrence element and encourage the healthy and wealthy(including politicians..!) to pay more taxes but ALSO to improve housing quality, elevate educational standards, enhance social services provision and community mental health care. Ahhh… Utopia.

    • devondevon

      David although 999 calls have increased we are also suffering due to the way 111 works. The old NHSdirect was manned by medical staff so more calls could be handled on the phone, now 111 is using non medical staff backed up by a clinical supervisor who oversees the call takers. If certain answers are given then an ambulance is summoned which makes sense if the person describes symptoms of an MI or stroke, the troubles begin when certain benign conditions also trigger the same response, for instance a healthy 20 year old who has been coughing all night might complain of some aching in chest, send an ambulance they might be having an MI, a person with a sore throat due to an infection, send an ambulance they have an airway problem, and our favourite someone with sudden diarrhoea and vomiting because they have picked up a 24hr bug, send an ambulance because they have abdo pain which has the added joy of putting ambulance staff in the vicinity of someone with a highly infectious condition so not only are they placed at risk but so is every patient they see for the rest of that shift! Now not only is this adding to the work load but if a call taker takes a call that they need to pass on to the clinical supervisor and they are not available due to being busy on another call then they’ll send an ambulance so they can close the call and move onto the next, because at the end of the day the private companies that are running the 111 service have to turn over calls quickly in order to take as many as possible and increase their revenue! As many as 30-40% of 999 calls are generated from the 111 service at busy times!

  • Adam Selene

    At last, a journalist who is asking the right questions.

    Every time I watch a press conference or read an article about yet another ambulance “incident” and the Chief Executive is wheeled out to assure a concerned public that the relevant trust is actively recruiting several hundred additional frontline staff, I despair. Big deal, I think, never mind about the new recruits, what about the hundreds who have departed; the new intake will not even bring the head count up to what it should have been at the time of the “incident” let alone providing any additional capacity!

    If LAS put as much effort into retaining their existing staff as they do into recruiting new members they may go someway to reducing the haemorrhage of personnel. Staff moral is at rock bottom and falling fast, I have worked in many different organisations during my career, in both the private and public sectors and even in organisations that have been failing, I have not encountered such a level of management disengagement. I have never before felt the need to join a union but purely to cover my back I have now done so although to be honest, the multiple unions representing ambulance service staff are about as much use as a soap herring! We need something akin to the Fire Brigades Union or Police Federation that actively represents the staff. Currently the only figure matching staff leaving LAS is the numbers of staff who are cancelling their union subscriptions.

    We have a situation where educated and often highly qualified people are being micromanaged to within an inch of their lives and not surprisingly are unhappy about it. The working conditions have changed radically over even the last five or six years and I would suggest that unless a person has worked regularly on a front line ambulance within the last few years, they have no idea what the job now entails; this unfortunately includes many senior managers. The feeling on the ground is very much that you go into management because you cannot cut it clinically and allegations of incompetence, cronyism and Masonic connections are rife. Take the chief executive posts, trusts are finding that even after several recruitment cycles that they cannot find suitable candidates. Is this because the Richard Branson’s and Alan Sugar’s of this world can see the writing on the wall? East of England for example has had no Chief Executive of its own for some time and is now sharing one with West Midlands!

    It’s wonderful that senior LAS managers are taking steps to improve the opportunities for the hard of hearing but to quote Matthew 7:3

    “Why do you see the speck that is in your brother’s eye, but don’t consider the beam that is in your own eye?”

    Keep up the good work.

    • Jack

      I do chortle at these mass recruitment promises. I’d love to know where these “several hundred in the next year” paramedics are coming from, especially when it took me two years to qualify (and it’s going to be longer soon as the course changes). Other trusts? Nope. Abroad? That’s a scary thought.

  • Jonathan Clarke

    I wonder how much of a factor the new NHS out of hours arrangements are? From my own experience, NHS direct worked well and was a good place for some basic medical advice. We’ve had to call 111 a few times over the last couple of years, when our child has been sick at the weekends, and after answering a bunch of questions like, “is your child conscious?” or “are they bleeding from their nose or mouth?”, we have always been referred to our local hospital, even when we felt this was excessive.

    In isolation, these sort of policies can appear to save money, but it doesn’t appear to have considered the knock-on to other services. As an aside, I’d struggle to think of many jobs as simultaneously physically and mentally taxing as a paramedic.

    • James

      If you had judged prior to the event what the upper threshold of action required was why did you call at all? If you know best then don’t call. With any telephone triage system some things simply cannot be ruled out and an immediate referral to a healthcare professional is required.

      As the parent with your actual eyes and hands on the child if you do not agree with the disposition delivered then apply your own commonsense and do what you feel is right – but understand that the system itself by nature has to be more risk adverse than you do and you have the power to make your own calls.

      Basic medical advice can be easily obtained from a pharmacist – those much underused and seemingly forgotten healthcare professionals.

      • Demoralised

        I am just in the process of finishing in the Ambulance Service after 40 years. During that time I haver never had a complaint made against me until last October when a GP attending a job I went to mishandled a patient who later died. He then went on to make a complaint against ME! Despite the fact that I dealt with the job correctly. It has taken me 8 months to discover exactly what the complaint was. During that time although a statement was taken from me, I was not questioned about this complaint and so was unable to give my side of the story. I am so demoralised and fed up that I am packing in.
        All the good work I have done over the years is ignored. “You are only as good as your last job” a colleague said to me. How right he is.
        So instead of finishing next year with sadness and regret about leaving a job I loved, I now cannot stick a minute longer in the job.
        When I started in 1970, Ambulance Services were local authority or County Council run, some with a joint Fire Service arrangement. Then in 1974, everything changed and, in my opinion, the worst thing that ever happened to the Ambulance Service, we became part of the NHS.
        Again, in my opinion, we should have been treated as a separate Emergency Service under Home office rule as per the Police and Fire Service. I believe that would have solved many of the problems we have today.
        Of course I could be wrong! But I don’t think being a trust, taking patients into hospitals run by a different trust who care nothing about Ambulance times, causing many of our problems by leaving us stood in corridors with patients at busy times, so we don’t impinge on THEIR targets!
        Our managers just don’t stand up to the Government or the hospital trusts to stop the closure of so many A&E departments.
        Well I have had my say, best wishes to all my friends and colleagues still in the Service I will miss you all, if not the work!!

        • lailahaillallah

          You are sooo right and I am sorry this has happened to you. It happens both ways these days though. in 34 years of clinical practice, 29 as a GP, I only had to make ONE clinical complaint about our local ambulance trust. It was upheld but I SPECIFICALLY said that I wanted the matter dealt with as one of education and NOT of discipline.

          Most of us are on your side mate and I respect you.

          • Demoralised

            Thank you for your words of support, it means a lot. I have worked for years with some very good and conscientious GPs, some of whom I count as friends. I wish I could tell you the full story of what happened, but I am still employed by them at the minute so I will keep quiet! Nevertheless again I thank you for your support and respect.

  • Diverman01

    My last employer, an NHS acute hospital Trust, has exactly the same mindset. Numerous staff have left from the ICU I worked in, which was a regional cardiac critical care unit. Staff who are coming up to retirement are not delaying it, in fact they are marking the days off until they walk out of the door. The management have no feelings for the staff, just fpr targets and statistics. Staff as in LAS are rung at home, and badgered about returning to work when ill or on days off, despite being informed that it against ECHR article 8 and management know this.

    With the decrease of experience, critical incidents are rising, care standards are falling and the Trust cannot recruit for the wards, so recruit on a misnomer of an ICU job and then move them frequently to the wards.

    Those who speak up are, ignored, vilified and subtly or not so subtly warned, and in nursing the proposed new validation by the NMC will leave staff open to pressure and outright threats from management about signing off revalidation.

    Managers who speak out are moved or eased out, and they are few and far between, those on the shop floor are even rarer, look what happened to the nursing whistle-blower in Stafford.

    Unless NHS management gets its act together and talk to the shopfloor it is doomed.

  • devondevon

    This isn’t only a LAS or even a city based problem, I work in a semi rural area and we are constantly flat out, often covering much larger areas with very few hospitals or additional back up. We’re handling more and more calls from people wanting to speak to a GP but we are sent instead, which means we have to deal with conditions that we are not trained to do so.

    • Paul Tindall

      It’s not even just a British problem. EMS in the US is having the same issues, though pay ranks higher on our list of grievances.

      • LovinThatI’mGone.

        Fair point Paul, but they’re paid more in the UK because they must have a degree to practice as paramedics, and they have their own licenses that they have to pay to maintain, and many paramedics at higher levels of training have masters degrees. That’s very different than the US where you can become an EMT in a little over a month (which is the majority of the US workforce) or a full paramedic (EMT-P) in about two years from start to finish. I’m not criticising or denigrating paramedics in the USA – not in any way, I know some great US paramedics for sure – but you can’t expect to be remunerated like a licensed professional (as they are in the UK) when you don’t have the training or responsibilities of one.

  • Jack Dees

    The LAS have been under immense pressure for years and this article comes as no surprise to me. Bullying management practices have crept back into the police and even academia. The lead comes from the top, i.e.government.
    A serious matter that no-one else has mentioned is a little matter of legality. Ambulances are only entitled to exceed speed limits (which is why they run on blue lights and sirens) in an emergency.
    If an ambulance has an accident speeding, or running red lights in a non-emergency situation the driver will be liable, as will the manger(s) who instructed him/her to do it.
    Are you listening Unison, managers. Good grief, beyond belief.

  • ronald donaldson

    the whole system is rotten. the nhs is far too risk averse because its afraid of getting sued. also the ambulance services only care about meeting targets. MEETING TARGETS AND NOT GETTING SUED. that is it. when the whole culture changes the lives ambulance staff and people in this country generally will get better. im not holding out for this in my lifetime (im in my 30s)

    • James

      What choice have the trusts got? If they don’t meet these targets then the funding is cut. This is, as so often the case, a government caused disaster.

      • Neither here nor there

        And what if all Trusts were to say: sorry, we can’t meet those targets. Fine us if you want, that leaves nobody to do the job? As long as Trusts bend over backwards to (seemingly) meet those targets the government will be encouraged to turn the screws even tighter!

        • James

          If all the trusts were to wilfully abandon the response system which they are legally compelled to attempt to follow then they would be legally liable for every bad outcome. They would be immediately failing in their duty of care and would be open to charges of corporate manslaughter. We all know the system is crap and wrong – but the changes need to happen at legislative level.

          If all the trusts fail the government will be rubbing its hands, because the bid bad privatisation is waiting in the wings – and I suspect the regulations will suddenly evaporate once private companies are failing to meet the targets.

  • Jacqui ‘Capability’ Collett

    As a 27 yr veteran of the LAS, who took early retirement while I still had some life force left in me, can quite honestly say that my years helping London were wonderful, and I would do it again in a heart beat.

    Radmore has absolutely no idea what it entails to be any kind of operational member of staff, so she will never understand the difficulties faced, therefore will be unable to address them. As for spending time on station talking to staff, well, good luck with that one ‘cos there is never any one there, they’re all out saving London. The only time I met Peter Bradley was when he pinned my long service medal to my left boob.

    I get that everyone’s wrung out, we can and must blame management, but for me it was the style of management that was used, if you treasure your staff they will work as hard as they can, and there was no feeling of being appreciated and if things go tits up it’s always the crews fault, and we were hauled over the coals and never a thank you for a job well done, demoralise us for daring to get some refreshment or going to the toilet after handing over a patient at the hospital. Bring back hospital liaison officers, ED knows when a vehicle is on the way, get a liaison officer to a) get the tea organised, b) make sure there’s going to be no problems handing over, c) offer some kind of counseling following a bad job.

    There are many reasons why new Paramedics are leaving, uni medics do the courses as a stepping stone to some other career, but judging by the attitude I experienced while working with them on relief it was because they joined having the preconceived idea that it’s all blood and guts. It’s not, nearly every job I attended was alcohol or drug related, entailed comforting the discarded elderly who were either lying in there own excrement at home during the night, or had fallen during the night and been on the floor up to 3 days (hello neighbours!!), the whole care/social system is broken, not just the ambulance services, (and as for society, don’t get me started on that one). I can’t begin to tell you all the ‘non-ambulance’ jobs I’ve attended in those years. I must have actually saved 27 peoples lives, one for every year of my service and I remember them all, I’ve comforted, put bandages on, wiped bottoms, made cups of tea, switched off tv’s, changed light bulbs and fuses, cuddled the bereaved, mopped up drunks off the streets, chased mental health patients and showed new parents how to parent, so if you don’t want all the other roles that being part of the LAS entails then don’t join, it ain’t all glory. As you can see, that list is the majority of our work load. What it is, is a rewarding career, despite being incredibly busy and exhausting. And if you think I’m missing the point about exhaustion and mental strain, I’m not, try doing the job full time, bringing up a baby single handed and then tell me I missed the point.
    What needs to happen is that the Clinical telephone advice team needs to be reinstated, a secondary triage system that probes further into the call, carried out by experienced road staff who, like me were physically/medically unfit for operational duties, and there’s plenty of them being ground down or slung out on capability, I finished my career in that department before they said it was a waste of time and didn’t save any ambulances(empire builders eh?) and as soon as that department was folded, you saw longer waiting times, increased demands for ambulances etc. at least while they were having a secondary triage they were being referred to gp’s walk in centres, dentists, mental health teams etc.
    I was given a job as Clinical advisor by 111, and I took it so I can rightly explain to you all with preconceived ideas that 111 is the root of all evil, it’s not, if any red flag symptoms are brought to light during a triage, and the system wants to raise an ambulance, then the health advisor consults with a paramedic or nurse prior to an ambulance being dispatched, likewise if ED is recommended it’s not because there’s nothing wrong with the patient. What all you folks that poo-poo it have to understand is that telephone triage is difficult and you have to ask the right questions in the right way. Software is authoured by GP’s, the questions are good and absolutely have a reason to be asked, there is good supporting information to help the triager understand the essence of the questions they are asking. So, to some people, with very little understanding of signs and symptoms it might seem that we are erring on the side of caution when we suggest a treatment centre/ambulance, but there is generally a good reason for it, and if you don’t want our advice why did you call in and ask in the first place…. Why don’t you consult that 24 hr GP Dr Google? Well most of you have and he scared the crap out of you hasn’t he, and that’s why you’re calling 999/111 isn’t it? At the end of the day all you medics out there bemoaning 111 have got to realise that death doesn’t give a crap how old you are, if I want a patient assessed immediately of course I’m going to advise them to see their own GP in 3 working days…NOT…it’s going to be you, so get over it.

    • Eric Bowyer-Wilson

      Well said.

    • AEA

      I agree well said

    • Michael Barnes

      Fantastic post, quite brilliant, Thank you very much indeed. Could you post it or something similar somewhere else to give it a wider audience…?

  • Gwangi

    Well, London is London – with insane property prices caused by irresponsible mass immigration which has made so many house-owning lefties rich, with price rises per year exceeding their salaries.
    Ambulance crews earn a pittance compared to doctors, nurses and NHS managers.
    But how about we stop all sponge payments claimed by police for so-called ‘dirty jobs’ (the sort that ambulance crews do every day) and increase the pay for ambulance crews and give better conditions too?
    Ambulances struggle to meet demand all over the UK, (in south Wales taxis and pold cars are used a lot to get patients to hospital) but I do not think it is a struggle to attract applicants for jobs anywhere but London.

    • lailahaillallah

      I know of someone who is just joining the police in London and it seems that rather than catching criminals, they are mainly being used as an auxiliary service to plug the mile-wide gap in mental health services, social services and the issues to do with substance abuse on an industrial scale in the Dystopia that is London.

  • Dave

    Having left the Ambulance service 4 years I find it surprising that you people are now harping on about bullying tactics etc its been happening for years but is always covered up by BS press release saying how great the trusts all are ,what they fail to tell you is the immense amount of massaging the figures they have done to come up with these fabulous figures.
    A lot of my colleagues have now left or been burnt out due to management continually taken zero notice of the stress felt by the crews and only interested in meeting the targets.
    A lot of the time now if you call 999 you will be sent a a very inexperienced crew or indeed a non qualified crew to deal with your loved one.

    • Dominic Colella

      Very true!

    • lailahaillallah

      Did you know that now ( and for a few years) ambulances are made to stack up and wait outside the ED as to admit them would mean a breach in the 4 hour target? So they are not available to go to the next emergency! Incredible, but true.

  • snorkmaiden

    Could not agree more, I work for a rural ambulance service and it’s exactly the same – it’s increasingly not unusual to be 7 or 8 hours into your shift and still not have had a break or even time to check your vehicle (although if kit is eventually found to be missing it will still be our fault). I also completely agree with devondevon, that we’re often going to things we haven’t even been trained in, usually because someone actually wants a doctor but the doctor hasn’t got the time or sometimes the inclination to go out. The 111 service (which where I work is run by our ambulance service) sends us to all sorts of things we shouldn’t be going to (every 20 year old with a chest infection becomes ‘chest pain’, etc). On Tuesday I did a night shift where we were out all night, every job apart from one involved alcohol and/or tablet overdoses, we are constantly late off, and management told a recent station meeting that we’ve never had it so good. I suspect they don’t really worry about staff retention because for some reason (I can’t work out why people would want to spend £27000 plus living expenses to work in a career with not a particularly great wage compared to other degree courses) students are queuing up to do the Paramedic Science degree course, so if experienced staff leave they can just get fresh recruits who start at the bottom of the pay band and so cost a lot less.

    • lailahaillallah

      I suspect that many of them really want to do Medicine but cannot get in, and hope this will help. Why anyone wants to do Medicine in the UK defeats me; I hope they all qualify and emigrate.

      • Fergus Pickering

        Because the pay is good.

  • Guest27

    thank you for writing this. A very accurate article, at least as far as frontline staff are concerned! I am leaving next week. I’m scared but also feel like it’s time to move on. The fear culture and total lack of personal life has gone on too long.

    I didn’t give the real reasons for going during my exit interview – because of what you’ve said – fear. And more than that: it’s too difficult to explain to someone higher up who either doesn’t get it or doesn’t want to.

    I asked about being kept on their books as a bank paramedic. Thinking that they would be appreciative of this as paramedics are so needed at the moment. And I didn’t want to leave entirely – there’s still a big part of me that wants to work for this service purely only because this is MY CITY and I want to serve it. And I’m a competent medic.

    They said no – because of my level of sickness. (Higher than what they expect but probably not higher than what any sane person would expect). I felt like I’d been punched – like I must be terrible at my job because they didn’t want me. And then later on – outraged that they are TURNING DOWN DESPERATELY NEEDED MEDICS BECAUSE OF PREVIOUS SICKNESS HISTORY.

    • Dominic Colella

      Well I am not surprised. They would rather have student paramedics as they are cheaper by the hour and expendable.

    • Diverman01

      Don’t give up being a paramedic, go into the private sector, you may meet many friends from the past.

  • London Ambulance Service

    London’s frontline ambulance crews are professional and compassionate clinicians doing their very best to respond to the increasing demand from Londoners.
    We are making things better by recruiting up to 500 more frontline staff, doubling the number of paramedics who can provide clinical advice over the phone to callers who don’t need an ambulance, and changing our shift patterns so more staff are on duty at our busiest times.
    Our staff want to work in a less pressurised environment, have more career opportunities, better support and development, and action to make it more affordable to stay in London. We are working hard to make this happen with the help of our partners within the NHS and across London.
    We are indebted to all our staff for their commitment while we are making these improvements.

    • Diverman01

      Management spin again, talking to ex LAS crews in the private sector, they are happy to be out of the NHS system. Reading this article, there is one solution, listen to your frontline crews, don’t accept what you are told by your middle management as they will put the best spin possible on it to enhance their careers. An example, some years ago, when the RAF Chief of Air Staff visited a station, he would go into aircrew and ground crew, crew-rooms, exclude all the station management and would have a free and frank exchange of views with the guys flying and on the flight-lines servicing the aircraft and those in the offices. This allowed him to take the tempreture of his force. How many LAS managers have been brave enough for that sort of conversation with staff and in particular that the staff do not fear any retribution.

      Go forth and seek the truth, by that you may receive answers.

    • Penina Scullion

      We heard the same story in New York City. I shudder to think that LHS might face a similar suicide salvo as we saw amongst out employees a couple of decades ago. Some things that must be put into play… Management must have real YEARS of street experience in EMS, or they will never understand their employees stresses, they must not cave in to ignorant politicians’ demands. Intake operators MUST gave hands-on patient care experience, and should continue with CME and rotating back out in the field to maintain their experience and instinct for triage, not forced rigidly to use the litigiously based flip-charts with no wiggle-room that services around the world use. I dearly miss my career, and feel compassion for my brothers and sisters on “the other side of the pond”. In solidarity, Lt. Penina Scullion (retired), NYC*EMS/FDNY*EMS.

    • Adam Selene

      500 more frontline staff to replace how many experienced staff who have left?
      Case in point re my original comment.

    • Travis Bickle

      Applying the argument of correlation equals causation loosely and conveniently as you appear to have done here and if you are to believe this article arguably you are making things worse for the 500 new frontline staff who will come into a profession that is on its knees. Do you hear and understand what this report is saying or do you deny it? I am breathless with anticipation at your response.
      Your rhetoric is polished but you have spectacularly missed the point and your response is clearly directed to the concerned population who might be aghast at how this may impact upon them in their hour of need rather than the tired and frazzled paramedic, technician, support worker…

    • lailahaillallah

      I cannot believe someone wrote this; a wind-up surely? Pure management speak,

    • Anon (naturally)

      I can almost see the (insert organisation here) in this statement. If indeed it was written by the LAS.

    • Martin

      Complete and utter BS from our “management”, as usual. Nothing but ” spin”.This is why staff continue to leave in droves. Watch out for privatisation after the inevitable crash.

  • Broken

    What an interesting article. I couldn’t have written it better myself. After 11 years working for the Scottish Ambulance Service (who I don’t believe are included in your service count, but I might be wrong), I have been forced to resign this week to look after my own health. Having tried everything over the last year to keep myself doing the job that I love, including a period of sick leave for stress, it is clear my employer does not care. I am a very healthy adult, a keen interest in sports of any nature and still in my early 30s. But the stress of all the little and big things that are ignored, brushed under the carpet, covered up, and lied about to the public has got too much. You can always find people who want to become a Paramedic, replacing the older, experienced, broken staff that have had to walk away. There seem to be more and more student technicians every shift I turn up. And questions are rarely asked as to why anyone’s leaving. In my opinion, the only reason anyone has shown any interest in me leaving is because I basically had a breakdown at work (and my new manager is new into management and still cares and thinks they can make a difference). As someone else says, I’m getting out while I’ve still got a bit of fight left in me. I realised I can’t stop caring about the level of service that is being provided. My family – everyone’s family – deserves a better ambulance service (and NHS) than what they are getting. In my opinion, it’s only because the majority of calls don’t require an ambulance any faster, or the most experienced staff to attend, that more people don’t die. This is the first time I’ve ever written anything on this subject online, as there is always a fear of being sacked or being struck off the register. (See Guest27’s comment below). To be honest, if speaking out to make the service better for everyone means I get struck off, so be it. I’m young, healthy and have the drive to turn my hand at another career. If I’m forced to turn my back on a career I find rewarding and the most enjoyable thing I’ve ever done, so be it. If wanting to make the provision of emergency care to everyone is not a quality that is desirable in a Paramedic, then strike me off the register. The only thing I want to gain out of speaking out? One day, someone might listen and make it better for those that are left. It’s too late for me.

    • lailahaillallah

      Sorry to hear that but I bet you would be very valued in Aus or NZ. If no family ties- go for it mate.

      • BD

        Are u a paramedic in australia? I don’t think so. If u were ud realise its the same issue here. Also ud realise because internarional paramedics, not just from the uk but from south africa etc, are flooding in willing to go for ‘2yr holiday & pay’, the situation is getting worse. International paramedics are willing to work for less and are less invested in helping australias paramedic crisis. No offence to international paramedics, the ones Ive met are great, but there are internal . problems which their presence is allowing the govt and private ambulance services to abuse and overlook.

      • cait

        Unfortunately in Australia this is an all too familiar tune. Over run, abused by the public and by the hospitals.

    • Broken

      And, unbelievably, after a manager in my ex-employer read this, I was informed that if I took any form of contract with them again (I was begged to stay and considered a bank contract to keep my skills up) I would have to be investigated for posting the above comment. Taking some responsibility for an employee’s mental health is clearly above them.

  • Seamus Harper

    All man made systems will fail when over worked or badly maintained.
    The paramedic’s first, the nurse’s next the doctors, the drugs needed and then the surge of the sick and outraged will swamp the elected, the same elected who created this mess and will now place blame on the sick and injured.
    Enjoy your Socialist Paradise before it fails like they always do.
    The Nanny State has never worked and never will.

  • Dave

    There we go it didn’t take long “london Ambulance Service” a classic management line indeed,by the time you have trained your 500 a 1000 would of left .
    If you bully staff they will leave/if you leave them out all shift they will leave/if you dick about with the rota they will leave …can you see a pattern through those management glasses yet..

    • Diverman01

      Same as hospitals, and look what happened at Stafford following management who ‘bullied’ and shafted the staff, people died.

  • Inside Person

    Please, please do not let this drop. As a long serving paramedic working in WMAS I’ve seen the slide to this level over the last few years, and it’s not just in the ambulance service. Something brought up by the Francis Report into Mid Staffs that regularly gets lost, under the ‘flower vase’ – gate accusations (flower vases were removed long ago from wards due to cleaning and health problems – but that’s another story) is the blind obedience to targets set with no sensible thought.

    “Hitting the target, but missing the point” is a regular cry from staff. For example, the ambulance services’ 8 minute target for all Red 2 and above emergencies is all senior managers often care about. But this can produce some strange outcomes. Arrive in 7 minutes to be confronted by a corpse that has been dead for weeks is a pass; arrive in 9 minutes to someone just about to die who, through good use of knowledge and skills, you save is still a fail that could have you visiting the clinical manager to explain why it took you so long. Then there are the ingenious ways to ‘improve’ your figures without ‘falsifying’ them, similar to the difference between tax ‘avoidance’ and ‘evasion’. Upgrading calls if an ambulance arrives before 8 minutes (ie, stubbed toe suddenly becomes life-threatening if a crew is just a couple of streets away). Passing the call to a ‘clinician’ to assess your symptoms stops the clock if your struggling to get a crew there. Software that books crews in arrival when they are near the property, if you live next to a dual carriageway this will book the crew as arrived if they pass by even if they have to travel to the next junction and then travel another 5 minutes to your house. The list goes on (deny this LAS).

    All the time the management become more remote and ignorant of what is happening, living life on expenses that equate to more than a paramedics annual wage.

    Foolishly they truly believe that all the paramedics and technicians can be replaced by straight out of university and college. These guys could possibly be great clinicians when they’ve had a couple of years, experienced a couple of multiple fatal patient RTCs, dealt with a cot death, talked a suicidal od into going to hospital and comforted a person whose just seen their partner of 60 years pass away.

    The guys leaving the service now are the old guard, broken and demoralised. Being slightly melodramatic, if you are a student of history you will know the story of the cry that allegedly went up from Napoleon’s army at the battle of Waterloo when his battle hardened ‘elite’ troops began to retreat.
    “La Garde recule. Sauve qui peut!” (The guard is retreating. Save yourselves.)

    • James

      “Hitting the target, but missing the point” may well be the cry – but who set these targets? It wasn’t the trusts themselves. Patient outcomes would be the obvious way to assess performance but would require a huge amount of follow-up work and the creation of yet another tier of management.

      The stubbed toe can only become a Cat A if the triage had not been completed prior to arrival – unless some trusts are figure fiddling. I have also never encountered clinician call backs being arranged to massage figures.

      If all you say is true at LAS then my own trust is either honest or naive.

      • Inside Person

        Hi. I don’t know which trust you work for or your role, so I cannot comment on the honesty or naivety of your trust. The relevance of the 8 minute target has been disputed for some years, some experts even arguing that the dogmatic pursuit of this target can do more harm than good.

        http://emj.bmj.com/content/27/10/729.extract
        We have started moving toward clinical performance indicators such as Utstein comparators for cardiac arrest, a step in the right direction, without the system going into meltdown. But many senior managers would hate to see their beloved ORCON target go as they have built their whole reputation on hitting it. So rather than face upwards and express concern over the targets (set by government) they would rather shout and bully downwards, a rather cowardly trait. It is almost old Soviet USSR style in it’s lunacy “We have made 10,000 tractors as instructed this year comrade Stalin. (Unfortunately the farmers only needed 1,000; so 9,000 are rusting next to the factory. And of the 1,000 delivered 50% broke down in the first month as we were so busy hitting your target)” So we end up with a bunch of despised ‘Yes-men (and women)’ running the service and the rest of the NHS. Is this the real problem in the NHS?
        The examples of how trusts ‘improve’ (I did not say fiddle, as that would be illegal) come from talking to staff in control centres, something our bosses hate us doing. I actually feel sorry for them as I can walk away when frustrated by managers.
        Calls do automatically become red if the crew arrives before you’ve finished triaging – so take your time triaging if you can. A paramedic should be able to identify a ‘load-and-go’ within 1 minute at the most, why would it take a call handler 5 minutes when the person has already said their reason for calling is they cut their thumb 2 days ago (genuine call that went red as I arrived after 5 minutes).
        Clinicians can call back red patients who are not going to have an 8 minute response to ‘reassure them’ and at the same time use the Manchester triage system. They can downgrade the call to a green 19 minute response. Very tempting to the odd misuse when your figures are down? Why only call those patients who will not get a 8 minute response and not all red patients to ‘reassure them’ or better triage them.
        Automatic ‘on scene’ is open to abuse, just set the parameter to booking on scene 1/4 mile from the address. Problem is that if the CAD books the vehicle on scene at 0900, and the clinicians report shows primary survey at 0910 there could be questions later as to why the delay. But try calling EOC manager to have the CAD times changed to accurately reflect this.
        It’s this target driven/obsessed rather than outcome and goal driven environment that creates a perfect breeding ground for the less than honest and spineless managers that find their way to the top, not just an NHS problem. The very managers who then bully and demoralise the staff with little care, other than for their own career. So who is ultimately to blame? Those that create this environment, or those that seek to exploit it?

        • James

          The 8 minute target is a joke and is only really relevant for arrests – but hey ho.

          I don’t know about WMAS but my trust uses Pathways, it takes no time at all to triage the serious calls and an age to triage the minor ones, especially as you have to start a negotiation process with the caller when you’re about to suggest they follow a non-ambulance pathway. If the caller is uncooperative, as is often the case when presented with a thousand seemingly irrelevant questions then the process takes all the longer. These callers also have a habit of suddenly mentioning more serious symptoms just when they are being told they won’t be getting an ambulance.

          I can assert however, that at least in my trust, no triage is ever delayed on purpose – the call takers aren’t even fully aware of the vehicle ETA. It is also worth noting calls that have missed the 8 minutes are also made red if triage was not complete. This happens a lot.

          My trust calls back all patients where the response time will be missed, we only retriage if the patient says their condition has changed. 30 minute calls are often then made red because of deterioration.

          Yet talking to road crews has taught me many myths exist about control and belief that we can just change codings. No knowledge of the behemoth of a triage system call takers have to use means crews do not understand why calls code the way they do.

          Other than that I agree with you entirely, it is a thoroughly flawed system.

  • Ian Smith

    A very interesting article concluding with reference to the minutes of the LAS senior managers meeting which was a sad indictment of our PC world which is a world so distant from reality. Over the years the ambulance service has moved on in leaps and bounds with training, vehicles and technology etc. However since the birth of the service it has always been the case that we have had an ‘unlimited demand placed upon a limited resource’. We need to scrap the government targets, initiate a public education programme immediately and maintain this permanently if we are to reduce the increasing demand. Additionally I would encourage the adoption of a more robust triage system to identify calls that do not require EMS attendance. If an ambulance crew does attend, then allow staff to consult with A&E on their findings at scene and confirm if it is agreed that the patient should use alternative transport/treatment or stay at home and see their GP. There will always be exceptions to the rule, but we need to see true attempts made to reduce the increasing demands placed upon staff. Reduce the workload, allow proper meal breaks, provide regular support training and then you may find a happier more valuable workforce. Has anyone compared the complaints to the actual demand on the day. How many people can function at 100% continually throughout a relentless demanding shift dealing with so many diverse emergencies and patients needs while trying to achieve target times. It is an impossible task, please pay attention to reality. You do not need Australian or Chinese paramedics, you need to retain and look after the ones you have.

  • Simon Chalder

    I am a paramedic of 8 years who has had enough and left this month from North East AS. I am glad someone is actually reporting the realities of this job. My colleagues Ive left behind need the support now more than ever

  • James Blake

    Thank you so much for writing this, thank god someone is escalating an issue that’s so multi faceted and pervasive, front line staff don’t even know where to start, in my ‘patch’ staff are perceived as the problem, not a recent and unprecedented increase in demand, we currently operate at 96% of total capacity, but are perceived as ‘lazy’, we’re not, we’re exhausted demoralised and burnt out……keep up the good work, keep digging, broaden your search, this is nation wide and it’s an epidemic

    • Diverman01

      This is happening to the front line hospital staff, managers more concerned with throughput, statistics and how the place appears to the media, but do not give a damn about the people delivering the care. The people in nursing are retiring in their droves as soon as they are able, emigrating to Australia or New Zealand or as two colleagues did to the Channel Islands on a fantastic package, from band 5 and 6 to not far off £40,000 a year as band 6 equivalents, and so much less stress.

      Managers treat the staff as mushrooms, kept in the dark and fed bullsh1t, or just not even kept in the dark and worked like pit ponies and are in their view expendable. My last Trust has been trawling Europe for ICU staff, next trip I suspect will be all points east.

  • CommonSense

    I am a serving Police Officer, I have great respect for the ambulance service crews as they work all through the day and night, like the Police do. Strange that in our small town on any given night that there are more firefighters asleep than there are Police and Paramedics combined patrolling the streets!

    Maybe we should get better value out of all our 999 services! Firefighters are trained in first aid, they could also attend many lower level / repeat callers to ease the strain, and if the call happens to develop into an emergency, then they at least have a vehicle capable of transferring patients quickly and safely to hospital

    Just a thought

    • Flintshire Ian

      Funnily enough, that is the same thought that I was having as I was reading the article. A combined fire and ambulance service would be much more efficient in its use of staff resources. Firefighters could also work as specialist ambulance crew,, even if they are restricted to patient transport services, when they are no longer fit for operational firefighting duties.
      I bet the FBU and UNISON will not be keen – but tough- that makes it an even better idea.

      • John Smith

        In France, it’s the Pompiers who turn up at RTAs, when we had a prang they sent 6 Paramedics, excellent service and some of them spoke English. I don’t think a lot of British tax payers would be willing to pay for it though.

        • lailahaillallah

          You are dead right: we British think things should be FREE- that they should somehow grow on trees and someone else pay for it. Successive governments have colluded since about 1947.

    • Eric Bowyer-Wilson

      This is how it is done in France. The “Sapeur Pompiers” run all the ambulances and para medics in rural areas as well as operating the fire service;

    • Livia

      Or you could have five less coffee breaks a night and do something yourself

    • lailahaillallah

      Where I live (rural Hampshire) at night there are a total of SIX police officers on duty and almost all the stations are shut. So I’d say the blue line is very thin. I don’t think the cross-cover idea can work well however,

    • Tamsin

      in Devon and Somerset the retained Fire fighters (in rural areas) are co-responders who attend emergency calls and hold the fort until the ambulance arrives and very good they are too.

  • Mary O’shea

    At last-the subject is in the open…LAS staff are indeed in the position where individual managers are attempting to victimise them,including having twitter and Facebook accounts searched for anything that could be deemed as ‘bringing the service into disrepute’
    It is felt that the service (and staff) are being run down as a plan to privatise,with the belief that certain managers all the way up the ladder having financial links to private ambulance companies.
    Private ambulance companies are already under contract to the NHS-they are in very similar vehicles to the LAS,and wear VERY similar uniforms -which I have been told is to ‘re-assure the public’

    As a member of the public I don’t want to be re-assured by what someone is wearing, I don’t want to be treated by a company who is more interested in profit,than health
    One question:
    What is more important
    A: an ambulance getting to a patient in under 8 minutes
    B: a paramedic saving a life

  • https://sites.google.com/site/deanjackson60/home Dean Jackson

    What the writer is describing is, of course, intentional sabotage of the ambulance system throughout Britain. Why? To further destroy the confidence of the public in their government. Why? Why else–if you were paying attention to the real news: Moscow & Allies tasked the operation, and many more such sabotage operations to come, the ultimate purpose being that when the EU collapses and the new union with Russia emerges, a union from the “Atlantic to Vladivostok”, then the British public will be more than supportive in joining the new union, having had enough with the ineptness of Parliament…

    Now read these two revealing quotes from Soviet President Mikhail Gorbachev and former Soviet minister of foreign affairs Eduard Shevardnadze, and what they have in mind for Europe in the near future:

    “Editor’s Note: The phrases ‘From the Atlantic to the Urals’, ‘From the Atlantic to Vladivostok’ and ‘From Vancouver to Vladivostok’ are interchangeable in the strategists’ lexicon. In the course of his Nobel Peace Prize Lecture, delivered in Oslo in June 1992, Gorbachev said: ‘Our [sic] vision of the European space from the Atlantic to the Urals is not that of a closed system. Since it includes the Soviet Union [sic], which reaches to the shores of the Pacific, it goes beyond nominal geographical boundaries’. Note that Gorbachev, who had been out of office for six months, referred to the Soviet Union, not Russia. In an interview on Moscow Television on 19 November 1991, Eduard Shevardnadze continued speaking as though he was still Soviet Foreign Minister: ‘I think that the idea of a Common European Home, the building of a united Europe, and I would like to underline today, of great Europe, the building of Great Europe, great, united Europe, from the Atlantic to the Urals, from the Atlantic to Vladivostok, including all our territory, most probably a European-Asian space, this project is inevitable. I am sure that we will come to building a united military space as well. To say more precisely: we will build a united Europe, whose security will be based on the principles of collective security. Precisely, collective security’. These statements by key implementers of the strategy reflect the central strategic objective of asserting ‘irreversible’ Russian/Soviet hegemony over Eurasia, thus establishing the primary geographical component of the intended World Government.” — ‘The Perestroika Deception’, by KGB defector Major Anatoliy Golitsyn.

    http://www.spiritoftruth.org/The_Perestroika_Deception.pdf

    and here’s more on the upcoming “Atlantic to Vladivostok” union…

    http://www.russkiymir.ru/russkiymir/en/publications/interview/interview0004.html

    When the new “Atlantic to Vladivostok” union materializes, Communist strategists will have achieved two goals, (1) the further isolation of the United States in the world; and (2) the disbanding of NATO.

    The fraudulent “collapse” of the USSR (and East Bloc) couldn’t have been pulled off until both political parties in the United States (and political parties elsewhere in the West) were co-opted by Moscow & Allies, which explains why verification of the “collapse” was never undertaken by the West, such verification being (1) a natural administrative procedure (since the USSR wasn’t occupied by Western military forces); and (2) necessary for the survival of the West. Recall President Reagan’s favorite phrase, “Trust, but verify”.

    Notice that not one political party in the West demanded verification of the collapse of the USSR, and the media failed to alert your attention to this fact, including the “alternative” media. When determining whether the “former” USSR is complying with arms control treaties, what does the United States do to confirm compliance? Right, the United States sends into the “former” USSR investigative teams to VERIFY compliance, yet when it’s the fate of the West that’s at stake should the collapse of the USSR be a ruse, what does the United States do to confirm the collapse? Nothing!

    It gets worse–the West also never (1) de-Communized the Soviet Armed Forces of its Communist Party officer corps, which was 90% officered by Communist Party members; and (2) arrested and detained the 6-million vigilantes that assisted the Soviet Union’s Ministry of the Interior and police control the populations of the larger cities during the period of “Perestroika” (1986-1991)!

    There was no verification, de-Communization and de-mobilization.

    • https://sites.google.com/site/deanjackson60/home Dean Jackson

      Part II

      “Last month I wrote about the weird exodus of paramedics from London’s ambulance service.”

      The police in Scotland are also leaving their jobs in high numbers, as sabotage is taking place within the constabulary…

      http://www.scotsman.com/news/scotland/top-stories/surge-in-officers-quitting-police-scotland-1-3519619

      Expect the same sabotage to occur in constabularies in England, Wales and Northern Ireland.

      • lailahaillallah

        It’s not the Marxists mate, it is Cameron wanting to make it fail so he can say, “Look what a mess, let’s get Virgin to do it”. Bit like PFI- looks good on paper but will cost the UK a LOT more and certainly no longer “free at the point of delivery”.

        • https://sites.google.com/site/deanjackson60/home Dean Jackson

          “It’s not the Marxists mate, it is Cameron wanting to make it fail so he can say…:

          You’re not getting it! One more time…

          When did Cameron or any political party in Britain call for the VERIFICATION of the collapse of the USSR?

          Get it now?

          • lailahaillallah

            I think you have forgotten your medication.

          • https://sites.google.com/site/deanjackson60/home Dean Jackson

            I took the red pill Morpheus offered me, which allows me to see a picture of Lenin’s head and four Soviet nationality emblems next to the masthead of the Russian Ministry of Defense’s official newspaper, which is STILL called “Red Star”. I’m also now capable of seeing the Communist Party of the Soviet Union’s emblem–the distinctive Soviet Red Star emblem–still on Russian military aircraft and naval vessels.

            Would you like me to ask Morpheus to contact you, so that you too may take the red pill and disconnect yourself from the Matrix?

  • Guest

    I joined EMAS expecting the ambulance service to be similar to the fire service, decent and regular training, a quality service I could be proud of and, adequate kit and management that looked after their staff. I got the opposite on all counts. It was a big mistake and by all accounts nothing has changed. I can remember all the genuine emergencies I went to in 5 years. It was a tiny fraction of the work we did.

  • FormerPara

    I joined EMAS expecting the ambulance service to be similar to the fire service, decent and regular training, a quality service I could be proud of,
    adequate kit and management that looked after their staff. I got the opposite on all counts. It was a big mistake and by all accounts nothing has changed. I can remember all the genuine emergencies I went to in 5 years. It was a tiny fraction of the work we did.

  • FormerPara

    Para’s are selected for their ability to walk into a situation and take control. So naturally the ‘do as you are told or lose your job’ mentality of most (ex military?) managers goes down like a cup of cold sick. I’m sure many will agree with me that on the rare occasion a manager is a decent person that actually understands how to get the best from educated and passionate people and therefore becomes popular with the staff, they get sidelined by the other managers and it kills their career.

  • John Smith

    Is there anyone left who is competent, in terms of leadership, in the Public Sector From Midstaffs, to Rotherham, its always about weak leaders

    • https://sites.google.com/site/deanjackson60/home Dean Jackson

      “Is there anyone left who is competent, in terms of leadership, in the Public Sector”

      And what precisely tells you the co-opted public service isn’t doing precisely what it’s ordered to do? Government bureaucrats obey their superiors, who obey their superiors going all the way up to Parliament and 10 Downing Street. How is that not known to you? You are aware of the chain of command, aren’t you? Time to awaken and see the Marxist saboteurs doing their work in weakening the public’s confidence in their government and institutions.

      • Eric Bowyer-Wilson

        Obeying orders is nor necessarily the same as doing a good job.

        • https://sites.google.com/site/deanjackson60/home Dean Jackson

          “Obeying orders is nor necessarily the same as doing a good job.”

          You don’t understand, the Marxists are doing a good job!

          See my comments below for what you’re obviously not aware of…

          • John Smith

            Sounds more like a conspiracy theory . Any real evidence to back it up?

          • https://sites.google.com/site/deanjackson60/home Dean Jackson

            “Sounds more like a conspiracy theory . Any real evidence to back it up?”

            Of course, read my comments below? There’s your proof.

          • John Smith

            Yeah I did. Its full of russian bollox?

          • https://sites.google.com/site/deanjackson60/home Dean Jackson

            “Yeah I did. Its full of russian bollox?”

            In other words, you’re admitting you don’t know what is meant by…

            “There was no verification, de-Communization and de-mobilization”?

            If the essence of that simple and succinct sentence has gone over your head, then maybe you should confine your reading to the Sun magazine.

    • Skip Kirkwood

      It’s bloody tough in this day and age. Leaders to the right thing – and when they do, in scenarios like this – they’re simply fired. Stick your neck out too far and it gets chopped off.

      A little intellectual honesty across the board wouldn’t hurt. You can’t have things for free, and if your “target” is doing better than you are doing today, you may need more resources!

      Are there targets for good clinical care too?

  • s.p

    First of all i would like to say thank you to the author/journalist who has taken the time and become a voice to our service at a time when we genuinely feel nobody cares. At all. Bar my family on the frontline. We constantly feel we are alone. Especially with a management that is almost Orwellian in its desire to harrass and pummel us into submission or quitting.
    Dont get me wrong. We love the job but the crap that goes with it is making our lives hell.
    I work for a service close to but separate from LAS and it is not remotely a surprise tha we are all in the same boat. Another 30 left in the last month. Just in a small area. to be replaced with…….nobody. So even more pressure on the few left.
    Progression from within might make staff feel wanted. Nope thats not going to happen. The few youngsters who join the degree programme leave to a man within a few months of qualification to be replaced with…..nobody.

    I wish the mamagement and government would realise just how close they are to losing everyone. Do the government care or is the inexorably increasing pressure to push the trusts to fail so their private business friends can take over. That is what it feels like.

    Please keep pushing this subject. Please. You are close to almost being a national voice for us. Its not as if we have anyone else….

    • Jack

      I can relate to this comment so much I’m almost tempted to say we probably work together.

      • s.p

        In which case beers are on me

    • Mary O’shea

      A cynical response could be -less long service redundancy payments to be paid out for pre planned privatisation

    • Broken

      I worked for the Service furthest away from LAS (Scotland) until last Friday (when I had to get out before my own health deteriorated irreparably) and I feel like I worked with you too! No-one is fixing it from the inside, I can only hope the author can fix it from the outside – please!!! Those that are left need help before the stress and depression gets too much. They’re completely tied to a service that doesn’t care about anyone, thinking a newbie probationer technician is easier to manage till they learn the ropes and that they can replace an experienced Paramedic. Now that people are coming into the job younger, with fewer family ties, how many people are going to get their Paramedic ticket, a little experience and then emigrate? I feel like the managers will only notice when not a soul turns up to man an ambulance one day and only then because they’ll have to look into why ORCON is so bad…

  • John Smith

    It needs to be privatised, just like the more successful european countries. A monolithic NHS does not work in the 21st Century

    • lailahaillallah

      Oh, like the security for the London Olympics?

      • John Smith

        Yes LOCOG have a lot to be held to account for .. .

  • pobinr

    Millions of immigrants who call an ambulance for anything as they don’t have a GP

    • John Smith

      That’s a very sweeping generalisation especially as we read many comments from people complaining about migrants filling up GP surgeries, your source of information please.

      • lailahaillallah

        Don’t worry- it’s false. Most immigrants DO have a GP. I had loads od East Europeans on my list and generally they were very decent people too. Slightly odd ideas about how you access the service, I agree, but in Poland, if you have a headache you go and see a neurologist, who does a CT scan on you. They have a negative perception of GPs, not realising that 90% of UK GPs CHOSE it as a profession rather than being “failed hospital doctors”.

        • Fergus Pickering

          A lot of neurologsts in Poland, are there? How do the Poles pay for it?

    • Adrian Midgley

      No.

  • Binding&Hoche

    would be interested to know if any paramedics have been ‘encouraged’ to abuse AMBER End of LIfe Care system…ie any unofficial ‘don’t admit to hospital, they’re over 80 anyway’ ? And any ‘mistakes’ in GPs codings for AMBER care pathway only? They were paid to ask ‘the surprise question ‘ as part of the Gold Standards Framework and mark up 1% of their lists….are many non-consensual/incorrect codings coming to light yet?

  • Binding&Hoche

    Some countries use a different colour code for ambulance crews…http://en.wikipedia.org/wiki/Hospital_emergency_codes – bit dangerous recruiting abroad?

  • Heff Lgm

    Neither is this just a British problem.
    Ignorant, lazy, incompetent managers are doing the same in Australia, where many British Paramedics end up!
    So you have a situation where Australian ambulance services are running a recruiting drive for British Paramedics, while Britain’s ambulance services are recruiting in Australia! How much is that costing, and how far would that money go, if the crews weren’t being bullied?
    Wholesale sackings at middle to senior management levels are required. It won’t happen.

    • Fergus Pickering

      Managers, all managers, are overpaid. May are incompetent nincompoops.

  • Kristea123

    I used to work for the Fire Department of New York City as a paramedic and it’s amazing to see that we face the same exact problems. We also have a high turnover caused in part by many frivolous emergencies. Many people in NYC are on Medicaid, free government healthcare, so they don’t have to pay for an ambulance ride or emergency room visit. Of course these people find no problem or consequence in calling for an ambulance for a tooth ache or other such non-emergent complaint. Often they don’t want to have to pay for a taxi or subway fare so they call an ambulance.
    In the summer we are also over worked. The daily call volume doubles or triples in the summer. Many people are mandated to stay for overtime. This is compounded by more personel calling out sick to avoid insanely busy call volume. I recently resigned and am now in medical school. I loved working as a paramedic but I rarely ever used my life saving skills. I felt more like an abused taxi driver.

    • lailahaillallah

      For God’s sake DON’T be tempted to come and work in the NHS as a doctor when you qualify- but good luck to you anyway.

  • rightrightright

    In 2005 my father was ambulanced to a West Midlands hospital. I went with him and chatted to the accompanying paramedic who told me that a new fleet of ambulances was soon to be introduced. These machines were to be equipped with listening/recording devices, presumably to spy on the paramedics as they worked and, even more horrible than that, on the groans and distressed ramblings of the patients. No idea whether, or when, this system was introduced. The paramedic did say, very calmly, that he was fed up and looked forward to leaving the service. Incidentally, he was a smashing bloke – level, kind, professional, with a pragmatic yet soothing manner which comforted my very elderly father. Such a man would be a great loss to the service.

  • extech

    I left the LAS after I was disciplined for eating half a sandwich during a 12 hour shift. Apparently it was unreasonable of me to expect to eat during work time. When I complained it took over a year to get anything like an apology, during which time I had a complaint upheld against another senior manager for his incompetence and near-bullying attitude when he dealt with the matter. Strangely, this manager was promoted shortly afterwards and was put in charge of a whole sector, responsible for hundreds of front line staff. It seems that nothing has changed since i resigned, the management have no clue how to manage their staff welfare has never been a concern.

    • https://sites.google.com/site/deanjackson60/home Dean Jackson

      “…i resigned, the management have no clue how to manage their staff welfare has never been a concern.”

      In fact, the management of LAS is proceeding as planned, since sabotage of the service is the objective, otherwise there would be no such seeming “incompetence”.

      See my comments below for more on this subject, which will clue you in to the broader issues facing not only LAS but other government agencies throughout Britain, proving intentional sabotage of those agencies…

  • Guest1974

    This article is both compelling, damning and true. I work for the LAS and have done for almost four years – I know I’m a relative newbie compared to many. However, the changes I have seen in those four years have been immense.
    I am not a member of road staff. The control room is where I hide out, so I cannot comment on what our much valued (by our level anyway) paramedics, EMTs and A&E support crews are going through each day. I only know that I absolutely could not do the job of any of our road staff.
    In control we regularly deal with abusive patients or relatives of patients over the phone. We deal with hoax callers, regular callers, people who call up just to abuse you or make sexual remarks down the phone. When reported, we are mostly asked “what do you want me to do about it?” To give credit where it is due, we do have one or two extremely good managers and lots of great supervisors, but they are incredibly few and far between.
    The same fear culture that exists on the road, exists in control services. The phrase “to cover my back” is uttered far too often. People are afraid to go sick if they are unwell, thus leading to them spreading whatever they have and more staff becoming unwell. Managers regularly advise staff at back to work meetings (when they happen – often they do not) that “people die when you are off sick” and “you out extra pressure on your colleagues by going sick”. Blaming the staff for the service’s failure to recruit.
    Chronic illnesses are met with constant threats of job loss. You are sent to occupational health, they make recommendations which are mostly ignored. Some of my colleagues have been threatened with being dismissed due to “capability” because of issues like work based stress. Stress caused by the service. Stress that the person has tried to combat and has done everything the service has asked for, but without basic managerial support they find themselves between a rock and a hard place, so essentially end up losing a job that they love.
    We phone back patients who have waited four, maybe five hours for an ambulance. We apologise for the delay and assure them there will be someone attending as soon as someone is available – without really ever knowing when that will be. I’m sure some patients no doubt die because of these delays. We sometimes have delays answering calls, a queue building up of possible life threatening emergencies. Yet we have some managers who do not know how to take a call and never have.
    I was amazed by the notes from the meeting above. I’m amazed that these are reasons that our upper management actually think that people are leaving. It’s none of those reasons. It’s because we are all being treated like dirt. Like disposable people, bums on seats essentially. I’ve come to realise that senior management don’t actually care about the people who are looking after London. As long as the numbers are good then it doesn’t matter how dissatisfied people are. After all, they can always roll our the excuse of “well, we are an emergency service”.
    I love serving London. In my opinion it is the best city in the world, but until management step up and realise what all their staff are going through on a daily basis, this service is going to fail,

    • https://sites.google.com/site/deanjackson60/home Dean Jackson

      It’s called sabotage.

      See my comments below explaining the reason for the sabotage taking place within British government agencies that heavily interact with the public (and the sabotage is slated to get worse and broaden its reach)…

  • Jano

    If I’m on a train journey I’ll usually buy either the New Statesman or The Spectator, depending on which appears to be the least reactionary and have the most original content at the time.

    This was such a well-written, clear expose of the state of the ambulance service (or, by the sound of it, the lamentable management) that I’d definitely reach for The Spectator first on the next occasion I’m whiling away time at WHSmith.

    Incidentally, given the fact that this kind of ‘management’ seems endemic in many public (and certain private) organisations, I would be interested to see a longer article from you analysing why these kind of people gravitate so easily to these well-paid positions from which they subsequently wreak havoc on the ‘stakeholders’ below.

    Reminds me of Orwell’s quote: “A family with the wrong members in control; that, perhaps, is as near as one can come to describing England in a phrase.”

  • stebbie1953

    This is not a new problem. I joined the ambulance service in 1973, undertaking paramedic training in 1976 and working in six different services around the UK eventually becoming a CEO in 1987. At that time virtually all the serving CEOs and Dir of Ops had come up through the ranks having been at the coalesce and thus understood the issues facing the operational staff. Nowadays the management of the service has reverted to what it was pre- 1974 whereby the majority of positions are filled by non-experienced people who are bogged down with targets, policies and other issues which prevent a good level of service. The other issue is related to response times which essentially haven’t chanced since OR ON was introduced in the early 1970s. Essentially the ambulance service are still responding to quantitative targets rather than qualitative ones. Eight minutes for example is still far too long to respond to a sudden cardiac arrest as for every minute defibrillator is delayed survival falls by ten per cent; therefore if the chain of survival is not immediately implemented the best chance of survival is only 20% .

    Get back to basics, get people in the top tier who have experience in all departments of the service and things will improve.

  • IMHO

    I’m going to start by echoing my appreciation for Mary Wakefield actually trying to get to the bottom of this issue and voicing what seems to be her genuine concerns.

    I’d also ask her to keep going because in two short articles she may have done more good for front line ambulance staff than ambulance unions.
    Please note, I am not union bashing and I would love nothing more than to have Mary sit with union reps who have the big picture rather than relying on individual stories; all be they numerous and too many to coincidental or just a gripe.

    People have commented on cronyism, nepotism, bullying, harassment, frontline staff afraid to speak up. Yes the LAS are implementing changes but in the opinion of many front line staff that I have spoken to, these changes are to the detriment of their staff; call takers, dispatchers and Road Crews.

    We can look at GPs opening times and their out of hours cover. We can talk about the risk adverse 111 system. We can talk about ambulance services and A&E departments being victims of their own success by hitting so many time targets.
    We can even discuss the wider issues within society and the amount of calls attended to shops, restaurants, transport companies and police officers to check ‘someone over’. We can…………….. The issues are varied and complex.

    One person already mentioned ‘The Private Sector’. Again I’m not opposed to capatilism but an ambulance service should not be a profit making organisation to line the pockets of share holders “Equal care based on equal need” will be a thing of the past when the Private Ambulance Sectors (PAS) fully take over. As the previous person mentioned, PAS are obtaining more and more contracts. Their vehicles look like the genuine article and their staff even dress like NHS trust ambulance service EMTs and Paramedics. “This reassures the public” No! In many cases it simply cons the public into thinking they are getting the real McCoy!

    If private ambulances want to operate as patient transport services then they should not look like the emergency services.
    That said I can tell you of a private response car that is funded by clubs, attends only clubs and deals with their own issues in house. A fine example of the way things should be done and a responsible approach by these venues to meeting their obligation to their clients without burdening the NHS ambulance service unnecessarily.

    I can also point you in the direction of at least one private ambulance service were I know the staff are abusing the right to run on blue lights.

    Mary, why don’t you take a look at the number of private ambulances ?

    Why not also take a peek at how many people in management & medical directorate positions within statutory ambulance trusts have links to the PAS & private medical providers.

    Conflict of interest? Maybe?

    Would I go as far as to suggest they are deliberately running down the ambulance services to make gains through their own private contracts?

    I couldn’t suggest that because I’d get the sack from the service I work for. I really wouldn’t want to be that cynical and would hope that bad decisions are just bad decisions rather than something so sinister as to destroy such a valuable service.

    *******NOW******* Paramedics & EMTs are a pragmatic and dedicated bunch.
    We all know ambulance services are reading these articles and your replies. Perhaps not necessarily listening but they are reading.

    If Mary Wakefield decides to continue to look at the plight of ambulance staff, what are the answers?

    What needs to be done to stop the rot?

    This might be your only chance to voice your opinion so lets hear it.

  • disqus_JXTaH3N9kU

    Another excellent, and depressing, article. One of the great problems in this country is the unthinking obsession with targets. They almost invariably, and invariably in poorly-run organisations, become overwhelmingly the most important factor in what management think important. More important than what their own staff are feeling and thinking ( and God forbid anyone in a poorly -run management culture would ever actually talk to their staff ) and certainly more important than what a customer or end user actually wants. Poor managers can – and do – manipulate pretty much any target anyone
    ever wants to set but they can’t manipulate what their staff actually
    think. I said it last time, and I’ll say it again: the first thing the ambulance service (and many other organisations – including Rotherham council – should do is to scrap virtually every target that exists and start again without them. The depressing aspect of the story is that instinct tells me this is the last thing the management will actually do.

  • marsupial

    South east coast ambulance has exactly the same issues. Paramedics do 12 hour shifts, often without a single meal break. They also run at “reap 4” to meet targets and treat their employees as disposable. Hence a mass exodus.

  • eddie2005

    NHS services are being put out to private tender. The NHS is a cost-efficient service, relative to other OECD health services. But privatization means that services need to deliver profit as well as care, and private contract managers need to drive costs down, if they are to compete with more cost-efficient, patient-focused public services. Enter the management turd, with an MBA and a bullying manner, squeezing productivity gains from the worker, and invoking austerity to refuse corresponding pay rises. Costs rise and services decline – just as they have in the energy sector, the telecoms sector, the transport sector. You can’t even question the management turd, because of commercial confidentiality. Privatizing health is anti-democratic. This is what you Tories want. You can’t even be trusted to write an honest article about the health service that you’re destroying

  • LovinThatI’mGone.

    I’ve been a critical care paramedic, had PTSD, been a GM in an ambulance service and now I’m a lecturer in paramedicine at a university, starting into my PhD. I’ve worked in paramedicine on 3 continents. The problem here – the real problem – is simple. The problem is that it is really, really bloody difficult to tell if someone is sick.
    That’s it.

    That’s the problem.

    It takes doctors HOURS in the ER to figure out what is going on – and often they don’t. And that’s with the benefits of tests we can’t possibly do in the field. Sprained ankle, that’s BS, right? Not if limb goes ischemic. Having gas – crap call right? Not if it’s an ectopic pregnancy or a mesenteric infarct. Someone has a flu and calls us – ridiculous right? Not if they’re going septic. You just can’t tell. ESPECIALLY not over the phone! That’s utterly bloody impossible.

    So IF we raise the bar and say “We’re not going unless it sounds like they are really dying” then the sprained ankle, sore belly and flu patient could die. In fact, some will.

    And then there will be a lot of hand wringing saying “Why didn’t they come?? My X died because the ambulance service said they weren’t sick enough AND THEN THEY DIED!!!” and everyone will think that somehow the ambulance service made a mistake. But we didn’t. Until you’ve spent more time than paramedics have, doing more tests than paramedics have, you simply can’t tell how sick someone is. You need a hospital. As a society we are going to have to accept that either (a) we need to pour millions-to-billions into health care to keep up the service we’ve come to expect or (b) we have to start triaging and accept that fact that people are going to die because of it.

    The heinous pressure that management is putting on paramedics is a passing of the buck of pressure that the public is putting on politicians, and that the politicians are putting on the ambulance managers. Believe me, if the head of the ambulance service said “ENOUGH! We either need more money, or we need to accept that we can’t do it anymore and people are going to die” they’d be fired and a new ‘yes-man’ (or woman) would be warming the seat the next day. Nobody wants to face the truth.

    Understanding the problem is really easy. Coming up with a solution is still something I don’t think I could do. And yes, this is a global problem. There’s no doubt about that at all.

    • lailahaillallah

      Same critique levelled at GPs. We too work in a low-tech environment without access to a CT or MRI immediately. I agree with you. It only needs one case to go pear shaped and it is the individual clinician’s fault.

  • lgrundy

    Another consequence of the massive explosion in the number of people living here that occurred under New Labour and has continued under the Coalition.
    Millions more people = hundreds of thousands more 999 calls. Hardly rocket science is it?

  • Terence Hale

    Hi,
    “Revealed: The hidden crisis in Britain’s ambulance services”. It’s just a matter of organization. With a Mr Whippy and DHL function to stop them falling asleep is needed.

  • SeenBothSides

    Interesting article. I will always support the paramedics and I believe absolutely that they are at breaking point, but this article lost my interest with the allegation that the paramedics suffer more stress and work harder than the Police and Fire Brigade. It would have been nice to state the source of this point, perhaps with some evidence rather than the usual journalistic sensationalism. The UK will always have problems with public free services until the word ‘entitled’ is removed from the vocabulary. Having lived in the UK for many years prior to emigrating to Australia, there is a completely different attitude here; one of self-reliance and paying your way. An ambulance call here costs around $500, which is generally covered by private health insurance policies if it’s an emergency matter, whch certainly prevents the inappropriate use of ambulances. Can’t afford private healthcare you cry? Perhaps it’s time to give up your iPhone/cigs or maybe just work extra hours.

  • lailahaillallah

    Somehow we have become Process-Driven rather than Results-Driven.

  • Hugh Gunn
  • Hugh Gunn

    My wife and I were on Clapham Common with grandchildren a couple of months ago. My six year old grandson fell from a piece of apparatus directly beside me, and we then waited for an hour for an ambulance. Double break of the forarm, and we had to wait a whole hour. The crew needless to say was great.

  • Chris

    I live in rural suffolk, and the nearest hospital is 1 hour away by drive, sadly we had to wait 3 hours for an ambulance to arrive. This was a real emergency as my mother had survive abdomens pains, but when the ambulance arrived they said all we can do is take her to A and E, well if we had known you cant do anything and will take her to AnE anyway, we might as well of put the seats down in the car and taken my mother by ourselves to AnE, admittedly this was a Saturday night so I guess most ambulances would be dealing with drink related incidents.

    Later after reaching AnE she had to wait 3-4 hours before a scan to figure out what the problem was and she was then diagnosed with bowel cancer sadly she passed away 5 weeks later.

    They need to at least in rural areas, have better access or on- call doctors to diagnose, normally a first responder arrives or something to diagnose.

    I am not critising the paramedics crew as i am sure they are stretched but the system itself.

    My mother waited in pain for 3 hours from an ambulance sent from the 3rd furthest hospital out of the 3 in the area, which is 90 minutes away compared to the 60 minutes for the other 2.

    Why not send one from a closer hospital?

  • http://twitter.com/WinstonCDN WinstonCDN

    Great Britain? Not so great. Most likely a third world country.

  • FB

    I think this problem is worldwide… I work in Montreal (Quebec, Canada) and it’s the same issue. Never enough ambulances because of all the non-emergency calls.

  • DrCrabbit

    Sad to see the use of Britain when the Health Service in Scotland is fully devolved. Surely you should have used the term England. The Scottish Government does spent more per head on health than is spent in England – but no journo ever looks for the areas where in Scotland spending per head is less e.g the arts. It’s not a story that fits the headlines.

  • https://www.facebook.com/AmbulanceMinisterOnNightshift Ambulance Minister on Night Sh

    Thanks again Mary for campaigning on these extremely important issues! For readers who don’t know, there is a very active social media campaign group (3700 strong on Facebook) who are protesting against the government’s proposal to increase the retirement age of frontline ambulance staff to 68 – but the discussion and issues inevitably go to the heart of the deteriorating working conditions and increasing demand pressures on the UK ambulance sector, and highlight just how completely out of touch the government and DH are with the realities of paramedic life. I’ve just posted up a 5 page briefing paper which runs through some of the key issues (and quotes you!), which some of your readers might be interested in. Thanks again! https://www.facebook.com/AmbulanceMinisterOnNightshift

  • Natalie Blenman

    It’s not the paramedics fault, it’s their lack of funding. My children who have a rare medical condition called adrenal insufficiency, had a head on collision last week. They have their own emergency injections for times of trauma. My daughter was given hers by her dad but my sons needle was missing. Their dad called the ambulance service to explain their medical condition and that they had an ambulance protocol furthermore, that my sons needle was missing. They refused to send an ambulance as they were ‘operating a limited service’. So if they can’t come out for a head on collision involving a 3 and 1 year old, what can they come out for?

  • BD

    Well tell them not to come to australia because its the same issue here.
    Also perth is so over run by international paramedics that its literally impossible to study paramedicine here. Ive been applying for 3yrs now and as a consequence have almost completed my nursing degree (which was meant to be an in between while applying for paramedics).

  • Adrian Midgley

    Hunt is more of an element of the problem than of the solution.

  • teepee

    I can’t comment on the LAS, but my experiences with other ambulance services have not been positive. On one occasion, for example, an ambulance was called by the district nurse for an elderly bed-bound neighbour who had obviously suffered a stroke. Although it was fortuitous that the DN happened to be there, her ‘weight’ didn’t improve the response. First a paramedic on a motorcycle arrived to conduct a pointless triage, then one of his colleagues in a car, then eventually two more in an ambulance. Throughout there was a singular lack of urgency. It’s difficult to know how to fix a service – and staff – that can respond like this. From my own experience and that of friends and colleagues, this is far from an isolated instance.

  • John Bird

    Mary – thank you for your very acute reporting on the crisis in LAS, however from my personal experience of another emergency service, you could replace any reference to LAS,Ambulance service and replace them with the word Police. The problems are very much the same, all resources are thrown at everything, risk averse and terrified to say “no” to anyone. Like the ambulance service, the Police are daily wiping the arses of society, unable and fearful to ever decline a service. The corporate risk aversion is heavily orchestrated, and leaves frontline often exposed, poorly managed and subject to regular hindsight management spanking sessions.
    But who cares about the Police, we are all corrupt useless non compassionate idiots unable to investigate simple thefts, and only interested in tipping off journalists.

  • Downtrodden

    Please spare a thought for the LAS call takers who are also under so much pressure everyday. They relentlessly take call after call only to be told today to speed up or there will be consequences! This is a typical bullying attitude of managers who are driven by targets to the detriment of staff and patients. Surprise surprise they are also leaving as they are demoralised, stressed and have had enough! It’s about time the LAS admitted they can’t cope and take care of the staff they have.

  • gogosi

    I used to work for South Central Ambulance Service and it’s hard to disagree with some of this.

    A couple of things you haven’t mentioned is the use of private providers to keep response times down and the waste of money on out-dated technology, the navigation systems particularly come to mind, costing millions yet a £50 phone does a better job.

    All proprietary software too with license fees, like the MS email solution they favour, when much better and cheap alternatives are available. Overall they are slow to move with the times in terms of non-medical technology, how many more Paramedics, Techs or ECAs could be employed if they embraced open source? (Nothing unique to the ambulance services, the majority of public bodies love wasting our money on software licences!)

    The use of private providers to fill gaps is maybe more significant, and last year – if I remember correctly – SCAS were top of the league for response, yet spent the most on private ambulance crews. That says it all. Obviously response times need to be considered, but they shouldn’t be everything.

    Then there’s the hospitals, they play their part. I can only speak from my experience but ambulance crews managing queues in corridors isn’t good for patient care, staff moral or the service’s budget.

    Too much to go into here but my impression is that we don’t have a National Health Service, we have a collection of local services that waste our money on bureaucracy and PR (how much does getting Foundation status cost a trust?) and don’t work well enough with each other. Having said that, the NHS is still one of the best in the world, I’m glad I don’t live in America.

    • gogosi

      Just to add something which is probably more important than all that.

      The root cause of the increased demand is our ageing population. This is only going to increase. We need politicians brave enough to think beyond the next election and open up some difficult discussions regarding quality vs quantity of life.

      As individuals we need the ability to make some hard choices ourselves, before we are dying in a skanky care home with no relatives visiting and ambulance crews coming out to every fall because carers can’t lift.

  • MerlinMedic

    I can add one thing management can do to understand what the crews are going through: ride the rigs. Take off your white shirt, put on the blue and ride as a third and see what the crews go through. That will be a start or end to it. If you BS your crews after that they WILL walk enmass.

  • Derek prior

    As an interested bystander with only a minor axe to grind – my daughter is a paramedic – I can only give a view which reflects my own feelings and those of my friends and many colleagues who reflect on this issue. We are not all Daily Mail reading, right wing followers but we do all seem to have a sense of fair play and right and wrong. We are disgusted that drunks take advantage of the free service, that the public at large see access to an ambulance in any situation as a right and finally that the Government, of whatever persuasion, seems incapable of taking difficult decisions

  • Gary Banting-Lee

    I am absolutely disgusted and appalled to see that while the LAS allows it’s demoralised staff to leave the service in droves, the Chairman and CEO is spending 100 of £1000s of tax payers money sending its officers to Australia and New Zealand to recruit Paramedics to fill its vacancies! (over the years many LAS staff left to go there to improve their working conditions and pay).

    To add insult to injury, they then broadcast it on the BBC News like they are doing something truly amazing for London and it’s staff!

    How about giving our own worn out and deflated staff a well deserved pay rise? You might just retain the few that still remain. Or is that money still being wasted on performance related pay to the bosses !!

    Clearly this CEO has absolutely no idea how to run a once World Class Ambulance Service !!!

    • Martin

      I fear it is too late Gary. They appear to have lost the plot. Are they telling the potential antipodean recruits the truth about workload and conditions? I fear not. They will come. Then they will leave when they see and feel the truth.

      This week the service has been failing catastrophically in its duty of care to London residents and ambulance crew staff. Calls have been held for over three hours in some cases (category Red2 calls that warrant immediate response). Why is this matter not newsworthy?

      Staff will still continue to leave or risk serious stress issues. LAS management continue cracking the whip whilst keeping their heads in the sand!

      • Gary Banting-Lee

        How very true Martin. I still have many friends in the LAS so I know the true state of affairs. Having been a senior manager in the LAS (now retired) and having done 32 years I remember the hard work we did to steer the LAS back to a world class ambulance service after John Wilby destroyed it. Unfortunately, Ann Radmore is doing the same. Strangely, Jason Killins said that I was out of touch and didn’t know the true story. In my opinion I dont need to be because I can see it. In the flesh.

        As you mentioned, ripe for chopping up for privatisation !!

  • Mary O’shea
    • Mary O’shea

      So now the LAS are ‘enticing’ students finishing their ‘paramedic degrees’ in Australia to come and work in London

      • Martin

        Mary, “enticing” may be the wrong verb in this instance. He looks a little to uncomfortable and “shifty” in the video. I don’t believe that Mr Killens trusts himself any more than the staff do!

  • Michael Wrate

    Late last year I had a chest infection.I’m asthmatic, it was a saturday, my GP was shut and I needed antibiotics and a short course of steroids (I’ve been asthmatic for a LOOOONG time) so I phoned 111 for an appointment at the local out-of-hours clinic. They announced they were sending an ambulance. Despite my insistence that really I just needed a doctors appoin… oh for…but… Fine.
    Ambulance arrived with two paramedics.Peak flow.Blood pressure. Temperature. Diagnosis: I have a chest infection and need antibiotics and maybe a short course of steroids. Upon questioning they told me that at least a third of their callouts were totally unnecessary and they were coming from the 111 service via untrained operators who were told to hit the big red button if anybody mentions shortness of breath (did I mention I’m asthmatic? If I called an ambulance every time I have shortness of breath I’d have to install a special parking bay and a coffee machine). I shudder to think how much money and resources are wasted in this fashion.

  • Rob

    Like a number of contributors to this discussion I have a history with one of the legacy county ambulance services before the formation of the current larger trusts and could see a number of issues starting to arise when I left the service 9 years ago.

    Prior to the introduction of the paramedic degree route my trust operated a clear programme of staff development where everyone started on patient transport services for a minimum of six months during which time they got their introduction to the service, experience dealing with patients, learnt the local area and the hospitals we served. After six months we could do an entrance examination for the Technician role (a position my trust did not do direct entry whilst I was there) if successful we went on a classroom based training course which also included three batches of technical examinations, scenarios and drugs papers. This only got us on the road as a Trainee Ambulance Technician (known as a TAT or 80%er in some services) for a year during which time we had a one day assessment at four and eight months and then a final two day examination at the end however your performance was closely monitored throughout this trainee year. Following graduation we had to do a year as a Qualified Ambulance Technician (QAT) before we could apply in a similar manner to do the Paramedic in house course which also involved hospital placements as well as time with an experienced Paramedic.

    This route provided a lot of benefits but then we have also seen a number of other changes that have impacted the ambulance service and the ability of the service to handle the modern challenges which I believe are behind the reasons contained within the article. These being:

    1. The patient transport services (PTS) in a number of areas has been privatised removing the flexibility to use PTS staff to help with the transportation of patients including the completing of discharges from A&E departments / wards which can present a bed crisis at peak times. It has reduced the number of potential staff that can be transferred to A&E duty so quickly as some of the basics would have been covered along with 1/3 of the driving courses required by emergency crews. It is worth saying that my service did eventually train PTS staff to do emergency driving to allow them to team up with a clinician on a transfers and GP referrals service as some jobs were suitable for a dual clinician and a PTS crewed ambulance but this also freed up the double technician and / or paramedic crewed ambulances for the emergency calls. My trust also had a number of PTS staff just awaiting a course date so we could put on extra courses relatively quickly if we needed more trainee technicians as we did not need to wait for people to work their notice and then complete the elements of the ambulance training that was covered in the PTS courses therefore within 11 weeks we could have a potential 25 new TATs on the road instead of 18-20 weeks through external recruitment (including 1 month notice period) furthermore replacement PTS staff were quicker to recruit and train so therefore the shortfall by this career development could be filled quicker by potential future Technicians and Paramedics.

    2. The removal of the Technician recruitment has seen Emergency Care Support Workers introduced but they are, as dictated by their agenda for change banding (based on when I left), more restricted in their skills and decision making than the TAT/QAT grade that they replaced. Furthermore the new Paramedic course is 3 years so we have to wait longer for new Paramedics to graduate whilst not recruiting the QATs/TATs that had the opportunity to make more clinical assessments then their replacement grade. Surely this must be having staffing implications?

    3. We have seen an increase in demand whilst the number of ambulances has not changed dramatically despite some patients now being taken further to get them to specialist care such as the trauma centres or stroke units which is a move I support as I believe it is only right to get the best possible care for the condition you have but I do wish resource levels would reflect the increased down time of vehicles these longer journeys to definitive care incur.

    4. The downgrading and closing of A&E departments – this has an impact on the time it takes crews to get a patient to hospital and therefore has a knock on effect as with the previous issue about less vehicles staying more local or just being available.

    Furthermore a number of hospitals now handling the increased footfall of patients due to neighbouring hospitals being closed or downgraded but whilst dealing with these increases they have not had the additional capacity added prior to the changes being implemented. This can cause congestion issues as these busy hospital are now dealing with the trend of patient number increases (9% at my local A&E) before even thinking about the displaced patient numbers.

    I recall 19 ambulances outside one such hospital but as these hospitals struggle then more patients are taken to the next hospital down the road so the problem just fans out until we have a situation where the problems overlap from two hospital downgrades where there is no further slack in the system – something that the I fear the plans for London A&Es may result in.

    5. I was lucky that during my time I delivered a baby and this is something I am immensely happy that I had the opportunity to do however the comments relating to the psychological strain on crews is most definitely an issue as I do not remember the exact location of the birth of the baby (at the patient’s home) but I recall and think about one sad incident every time I pass the incident site. Support is needed for crews as is an opportunity for downtime whether that is through the 12 hour shifts system (3 days one week then 4 the next to average 42 hours) allowing more days off to unwind or just providing an opportunity and easy access to debriefing services. I know of several cases where staff were exposed to particularly challenging circumstances and an officer was called to chat to the crew but then I have experienced the other end as well as seen my colleagues both on the responding vehicle(s) and the 999 ambulance call takers not get that support. I am sure that everyone can relate to the unique emotions that seriously ill and the deaths of young children or babies has – this also effects the crews and potentially the call taker especially if you have a number of calls where you have to instruct the parents how to perform CPR on their young child or baby. Support needs to be there but then in order to also maintain sufficient cover for the other calls coming in there needs to be a level of contingency built into the resource management system both in the communications centres and within the station group localities for the taking of staff offline to complete this crucial debrief.

    6. I still talk to a number of friends in the service and one thing I hear regularly is the no meal break issue – no crew wishes to see someone suffer and I accept there have been cases in the press about resuscitation calls where the nearest crew was on a meal break. Crews do not want to delay treatment but at the same time the work is both mentally and physically draining (try lifting a 23 stone person or pulling an 18 stone patient on a 9 stone stretcher across a gravel drive) and this will have an impact on the blood sugar levels of the crews. Crews want the best for their patients but how can they be expected to do that if they are suffering the effects of dehydration or hypoglycaemia? Is it right for crews to be driving up to 11 hours into their shifts without a chance to rehydrate and eat something and then be expected to drive using the exemptions from the road traffic act on blue lights when those working in an office have by law to have a minimum 20 minutes break every 6 hours.

    7, We need to rationalise what we respond to but we must also remember that there is an issue especially within the elderly community where they do not wish to disturb anyone including the GP over the weekend and therefore they wait until the surgery is open as they “do not want to be a nuisance” (quote from numerous elderly patients). Should the dispatching model be changed we need to reassure that measures are in place to help them because as a crew member we would prefer to meet them earlier than have them present several days down the line when their condition has dramatically deteriorated.

    Likewise there need to be additional support for assisted home living, respite care, care and nursing home provision so that we adequately cater for the needs of the patients. Community based mental health provision also needs to be reviewed to ensure that suffers are able to access support earlier to reduce the length of stays in hospital due to the lack of measures to prevent that sufferer hitting crisis point.

    Prevention is as critical as the treatment therefore with appropriate preventative care the cost to the NHS, Individual concerned (health and / or financially) and wider society could be reduced therefore allowing money to be redirected to other key areas of concern or even towards cures for common serious conditions.

    I enjoyed my time in the service but I do think that there are more improvements that are need to be made to help the staff feel more valued and more importantly to look after the staff welfare (a legal obligation under the Health and Safety at Work Act) through breaks, access to de-briefing facilities etc. Without these improvements the crews will be pressurised, possibly ill or near burnt out therefore encouraging many to leave which in turn losses vast experience which could make the difference.

  • William Iggy

    I left the NHS 6 months ago after 19 years. 16 in the LAS and 3 in EMAS. I’ve never felt better. I sleep better and my family say my sparkle has come back. With me it wasn’t a pay thing. When I worked in the LAS I took home home around £2200 a month..plus now days they get triple time for overtime on weekends and double time for some overtime shifts. On a 12 hour rota we work 13 shifts a month. That’s 3 days a week and 4 days every 4th week.. I left because I was sick to death of the penny pinching and politics. You need to ask Killens how he selected the staff to go swanning around down under. 3 of them are on family friendly rotas and get they still got “chosen” to go.

  • Jankers

    it’s true, an ambulance is simply seen as a big yellow taxi to the NHS express department.

  • bramhall

    Charging people for misuse or wasting time will incur the wrath of those for whom “free at the point of delivery” is a sacred mantra. Similar considerations could apply to misuse of A&E departments and even GP’s.

  • Bazza

    It’s the same everywhere, services are top loaded with managers who now tell usvwgat ti do and how to do it!
    In northern Ireland our stations used to run themselves, we were assigned to one vehicle for every two crews. We used to take tar off them and even Polish them, we covered our own shifts and never had a dropped shift in over ten years…….. But that wasn’t good enough, now we have managers and systems in place which don’t accomplish any of those things!!
    Not only that but “Agenda For Change” rules and regulations have all being implemented here but we have NEVER Been banded under the system
    …….. 11 years gone by……. So far!

  • Richard Laird

    Totally agree that Ambulance staff are stressed I would add that this does not apply solely to Paramedics but also to Technicians, Dispatchers and Call handlers but of course they are not at the glamorous end of things!!!! Sorry but I can’t remember the last time I read such a load of absolute drivel!! So many things taken at face value and not looked into! The driver of an ambulance is responsible for how it is driven and no-one else! If he/she chooses to drive under emergency conditions then that is their responsibility. If they are told to do so it is still their responsibility! If the call they are attending is not a red or yellow call then don’t drive under blue lights, you’re in charge of the vehicle not the manager or control staff! Staff off duty being badgered to come in? Rubbish, all they need to do is say No! Surge Purple for the 7/7 bombings maybe but suggesting that London has had several events as significant as 7/7 is totally ridiculous and is total propaganda from the press…as usual!

  • Hywel Griffith

    “I’ve found they’re terrified of management.”

    *cough* role of unions *cough* balance of power between employers and employees *cough*

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