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:
- Surge Red was enacted ‘almost every day in June’
- On 23 June the service received up to 350 calls per hour and had up to 200 people at a time on hold. It couldn’t cope, the surge plan was escalated to purple and a major internal incident declared. Surge Purple is the level of incident that was declared on the day of the 7/7 bombings
- It isn’t an isolated incident — it happened twice in June, and again in July
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:
- The Trust’s Chief Exec Ann Radmore begins the meeting by wondering ‘whether there was anything that could be done to make it easier for people who were deaf or hard of hearing to apply for jobs at the LAS.’
- The London Ambulance Service has gone to Australia to recruit – but even that might not be enough. ‘Nick Martin asked whether the recruitment campaign should focus on other countries such as China and Philippines. David responded that this had been considered.’
- ‘Theo de Pencier suggested that the 2015 Rugby World Cup might also attract people to work in London.’
- Theo de Pencier, a Non-Executive Director, also makes the helpful suggestion that the quality of London’s air may be of concern to paramedics.
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:
- 12 December 2013 – The Worcester News runs claims from a paramedic whistleblower that West Midlands Ambulance Service staff feel ‘downtrodden and bullied’
- 19 March 2014 – the NHS staff survey showed almost half that staff in the East of England Ambulance Service had witnessed harmful errors or near misses in the last month. A paramedic told the Eastern Daily Press: ‘For the last two to three years there has been a steady decline in the staff survey results and it is pretty bad. There is nothing more demoralising than turning up to a job where patients have been waiting ages for an ambulance to show up.’
- 19 April 2014 – Bedfordshire News — Dr Anthony Marsh, head of the East of England Ambulance Service Trust said that staff are ‘tired, overworked and frustrated’
- 8 May 2014 – The number of frontline ambulance service workers in the East Midlands Ambulance Service taking time off with stress has more than trebled over the last five years, from 61 to 217, the Nottingham Post reported. 48,000 working days were lost due to staff sickness. Bosses said the figures were partly down to increased strain in the job. And a former paramedic told the paper:
‘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.’
- 30 July 2014 – A paramedic from the East of England Ambulance Service NHS Trust told the Watford Observer:
‘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.‘
- 5 August 2014 – A source tells Jack FM, an Oxfordshire radio station, that ‘there has been a huge exodus of staff… they don’t value us. It’s us versus them between the front line crews and management’
- Even at the South West Ambulance Service Trust, one of the better-performing in the country, staff sickness rates are running at 5.9 per cent (the target is 4 per cent). That’s 7,660 calendar days in June alone
- In the North East Ambulance Service Trust the proportion of staff who reported suffering from workplace stress in 2013 increased to 55 per cent from 41 per cent
- The North West Ambulance Service NHS trust has seen 11 per cent more 999 calls, and 14 per cent more high-priority ‘red incidents’ in May and June 2014 than the same period the previous year. The board says:
‘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.’