I can't blame bigwigs in the NHS for the meltdown of our 999 service. It's fundamentally our own fault that the service we depend on to save our lives is breaking down. We call 999 at the slightest sniffle, which means paramedics and ambulance drivers find it impossible to keep up. They're run ragged trying both to respond to every call and hit the government's response time targets.
What I can blame the bigwigs for (by which I mean senior management in the NHS London Ambulance Services) and do in this week's Spectator cover story, is that they have responded to the crisis in a catastrophically counterproductive way, with the result that their paramedics are fleeing the service. So many staff are leaving the London Ambulance Service (LAS) for example that it predicts a shortfall of 600 paramedics — that's a third down — by the end of the year. They're so desperate for staff, they're trying to recruit from Australia.
LAS management claim to be baffled by the exodus, but I've spent a month speaking to whistle-blowers and former LAS paramedics and during the course of my little investigation I've concluded that the LAS (and perhaps this applies to other services nationwide too) have made three terrible mistakes:
Mistake 1: Rather than admit to being beyond breaking point, the LAS management has begun to use protocol designed for terrorist attacks as a routine way of dealing with call volumes. There are seven colour-coded levels in the 'Surge plan' designed to manage crises. Surge Red indicates a crisis, it is the third most serious call. Surge Purple is the second most serious call after Surge Black. There has never been a Surge Black called on record. So consider:
Mistake 2: Rather than take care of their hard-working, badly paid and experienced staff, ambulance service managers (and again, I think this is true nationwide) have allowed an awful culture of fear and bullying to take hold. Paramedics are regularly threatened and disciplined by their management for making the sort of tiny errors that would be normal in any job, let alone one as chaotic as emergency care. To a man, the paramedics I spoke to said that the attitude of their immediate managers was the biggest problem at work, and more stressful than treating and transporting patients, however critically ill.
Some comments made by anonymous paramedics:
'We love our work and try hard, but everyone's paranoid now, and we all think management is out to get us.'
'There is a dominant culture of fear and paranoia. If you complain, management will strike you off the register.'
'They send ambulances to any old call, even if it's not urgent, just in case someone complains. There's no thought for frontline staff.'
'The scary thing is that the LAS is driving hard-working staff to suicide.'
I have heard more than once that the management of the LAS have a list of 'suicide risk' paramedics that they keep en eye on for fear of bad PR. I have no way of corroborating this, but the fact that it's widely believed to be true is in itself worrying.
Mistake 3: Though listening to paramedics was worrying, perhaps most alarming was reading the minutes of the London Ambulance Service Trust's monthly board meetings which make it clear that the very top brass — in particular the Chief Executive and the NEDS -- are either ignorant about the crisis in their own service, out of their depth, or unconcerned. The minutes of the London Ambulance Service's most recent board meeting (on Tuesday 29 July 2014) make surreal reading. These people are often paid 4 or 5 times a paramedic's salary, and this is what they have to contribute by way of solutions to the crisis:
My own suggestion to the board would be that if Theo de Pencier is being paid to offer this sort of advice, then the cash-strapped LAS might quite easily do without him.
My enquiries focussed on the London Ambulance Service, which is the largest and most over-stretched trust. But there's every indication that services in the rest of the country are suffering in the same way. Here's a roundup of local news stories which suggest this is a national problem:
‘It's more stressful than working in the police or the fire service. Someone will go to a child death, which is awful, and from there they can immediately go to another. But anyone would go to pieces after that job. That's made irrelevant if the targets need to be hit.... The morale of the staff can be measured by sickness levels. It is low. The volume of calls has gone up, as has the pressure.’
'As much as the service says they are recruiting, a substantial number of staff are still leaving due to moral being so low. There are staff shortages in the Watford area and management are trying to paper over the cracks by offering extra shifts on overtime.'
‘The increase in high priority incidents is stretching the available ambulance resource to a point where at certain times patients who are less critical are getting an attendance that is much longer than they expect. This is generating a circular problem with rising sickness rates amongst staff which means even less resources to meet the continually high demand.'