Shocking ambulance survey is microcosm of NHS attrition

I’ve received a copy of an atonishing, eye-opening survey of ambulance staff in an English NHS Trust.  This survey covered the experience and opinions of paramedics in South East Coast NHS ambulance Trust, but its findings could just as easily have come from almost any part of the NHS under this government.

These findings have special significance for places like Stafford, who face long ambulance journeys to urgent treatment if plans to close their hospital go ahead, and great relevance to the care issues that the government has used to demonise NHS staff. And they make chilling reading.

This survey consists of 5 questions, plus comments from those surveyed. The survey percentages and a few of the comments have been published on the GMB union’s website, but as far as I know this is the first time most of the comments have been in the public domain.

The first couple of questions might not seem that gripping at first reading, but bear with me, as they’re important – and the responses that follow them are crucial for a proper understanding of what is happening in our NHS at the moment. Here they are, with responses:

“Front-loaded service model”

Do you feel that the Trust’s move towards a front loaded service model will meet the increasing needs of the service going forward?

NO 94.5%
YES 5.5%

A ‘front-loaded service model’ is a different model for responding to ambulance call-outs.  According to a document by the SECamb Trust, it is part of a package of cost-saving measures introduced in 2010 under the coalition government. According to a Department of Health (DH) document, a

“Front-loaded model” is an expression used to describe a reduction in the proportion of traditional ambulances in a fleet and an increase in the proportion of fast response vehicles

Fewer ambulances, and more single-person ‘fast response vehicles’ to get to a scene – in theory faster, but this is often not the case and when they do arrive, in practice it is without the right training and equipment needed to actually meet the needs of injured or seriously ill patients, as these respondent comments show:

Patients are being made to wait longer for an ambulance response; the longest one i have been to was 7.5hr. Patient’s health is being put at risk..Rarely are we..kept in our own area to work and find ourselves either on the coast or in Surrey. The people in this area are having to wait much longer than is acceptable for an ambulance. It doesn’t matter that they live in a rural area, we have ambulance stations based in rural areas to cater for them, but the ambulances are never kept there. There are too many cars and not enough ambulances. Cars are having to wait long times on scene waiting for backup. Recently i felt grateful that i only had to wait 1 hour for my backup.

Another comments:

Patient safety is in peril because of the number of life threatening calls where “there are no resources to send”.

The same respondent continues, and shows how the new system is set up to cover the reality of the situation:

This includes when the clock has stopped because a single responder is on scene, but has requested immediate assistance from a crew, because of the patient’s condition.

Meal breaks

Have the Trust got the Current meal break policy right?
NO 94.5%
YES 5.5%

Meal breaks may not seem like a huge deal. But when they are routinely unavailable, it is symptomatic of a general overstretch that can only result in burned out staff and a system stretched to breaking point.

And that can only result in danger to patients and staff alike, as comments show:

I feel that as a dispatcher some of the things that I am now being either asked or are expected to do put both patient & crew at risk. I feel that the current meal break policy is completely unworkable. Nobody wants dinner at 1030 in the morning when if they finish or should finish at 1900. The only allowing 1 of each option on break at the same time doesn’t help either, everybody finishes up being outside of their meal break window, we get pressure then from management for not getting crews eating earlier & crews finish up eating in stations or response bases that they don’t want to be in. Also the amount of late signs off, especially in make ready areas in unacceptable & is putting both crews & patients at risk.

Another wrote:

It is unacceptable for them to say that every day there is an ‘unexpected’ rise in customer demand. The only times that we should be so short staffed that patients have to wait a long time for an ambulance or that crews go without breaks are during a business continuity incident (ie unexpectedly severe weather) or a major incident. If it is occurring at any other time on a regular basis then this is grossly negligent. My long term health is suffering as a result of doing my job.

And another:

I personally feel that as crews we are being run ragged. Exhaustion is impacting on everyone and morale amongst staff are low. Night shifts are to long and we often drive around unnecessarily. The lack of a break has detrimental effects on staff in general.

And another:

Now we are either getting our only meal break of the day just 3.5hr into the shift, and at 10am i am not ready to eat lunch, or we are getting our break so late we are being forced to travel to another station to take it.

Risk of career and livelihood

Do you have concerns that current working policy’s together with management and operational pressures may result in you possibly placing your registration at Risk?

NO 9.5%
YES 90.5%

9 out of every 10 staff in the Trust – all, not just paramedics – feel so harried and overstretched that they believe their registration, on which their career and livelihood depend, is at risk.

Exhaustion makes for mistakes that might have serious consequences for a patient’s health or even cost a life. Being overstretched leads to haste, another source of errors, slips and omissions. Putting both together is a deadly mix – yet that feeling has become so endemic that almost every staff member faces it routinely.

This is the real context of the tales you might read in the media – if there’s any truth to them at all – about ‘poor care’. And context is everything.

Dangerous to patients? Zip it.

Do you feel that there is a general cultural fear about speaking out about patient safety and operational workloads within the Trust?
NO 7.75%
YES 92.25%

Staff are afraid to speak out. But what they are afraid to speak out about is the safety of patients in the context of unbearable operational workloads – workloads that have become unmanageable as Trusts try to spread dwindling resources ever thinner under a government that absolutely refuses to acknowledge the reality that its cuts and hidden siphoning of NHS funds have created.

Are you concerned that the ever increasing workloads and shift patterns within [the Trust] are leading to a growing detrimental effect upon Patient safety?
NO
YES 100%

Asked whether the cumulative effect of the changes that are being implemented by the Trust – changes that began in 2010 under the coalition government and which are driven by pressure to cut costs – are endangering patients, 100% of staff responded ‘yes’. Not a single dissenting voice.

This situation does not just apply to a single ambulance Trust – nor even to all the country’s ambulance Trusts. It has become a pervasive reality within the NHS and lies at the core of all the media’s NHS horror stories – those that are not complete invention, at least. 

The government is desperately contorting to avoid admitting it, but cutting spending on health is dangerous to patients – and in spite of its claims to the contrary, the government is cutting spending and has been exposed doing so.

We’re in a period at the moment where, in spite of doing everything possible to set up the NHS to fail, Jeremy Hunt and his government colleagues are trying everything to shift the blame onto NHS workers while not only ignoring but knowingly exacerbating the root causes.

Simultaneously, they are claiming to be promoting openness and transparency and accusing the previous government of cover-ups.

In spite of calls from almost all quarters for the government to set minimum NHS staffing levels, or at least minimum levels per type of ward, Hunt has resolutely refused to consider it. David Cameron has claimed that the government will put £500m extra into the NHS to cover the nationwide crisis in Accident and Emergency departments – but this is mere spin.

The crisis in the NHS – one inflicted under this government in spite of it blaming everyone from the Labour party to a 10-year-old change to rules on GPs working out of hours – goes far beyond A&E departments, as the Hunt and Cameron know full well. If the money ever really goes into A&E, it is almost certain to be money moved from somewhere else rather than genuinely ‘extra’ – a ruse for which the government has a lengthy history.

But it’s doubtful that the cash will ever genuinely reach the needed areas in the first place. This government also has form for claiming it has spent extra on the NHS when in fact it has only budgeted to spend it at some time in the future.

Instead, the government continues to ignore the massive understaffing in the NHS that has been highlighted by both the Francis inquiry and the Keogh report – and using the resulting problems to damage public confidence in the NHS and to close hospitals.

The desperate results of this survey show the effects of that tactic, that war of attrition – results that are being repeated across the whole NHS in England as staff, and management, desperately try to hold together straining seams.

It must not be allowed to succeed.