Author: Alan Lofthouse
Published in: Summer 2018 Edition of Ambulance Today Magazine
At the end of 2014, and early 2015, we went through a period of industrial action in the NHS over pay involving two 4-hour stoppages. In the ambulance sector, many staff were not prepared to come to work, even under emergency life and limb cover arrangements. This led the government to put the army on standby. So, what happened and what have we learnt?
Why were staff not prepared to come in? Well the answer lies in the fact that ambulance staff have been raising issues with workload, pressure, demand and lack of support for a number of years. Trouble was no one was listening. Performance dominated Trust boards and finance fixated commissioners missed the warning signs.
Here came an opportunity for staff to make themselves heard. They voted with their feet in the knowledge that their legal right to take lawful industrial action would protect them. When it came to settling the dispute, we made sure that ambulance staff wellbeing was part of the final settlement.
So, what has happened since then? Well, we have been working to develop a collaborative approach between Ambulance Employers, Trade Unions and NHS Employers to improve the mental health and wellbeing of the ambulance services workforce.
We started by bringing together staff and employers to discuss the challenges each group faced. We have to recognise, whether we agree or not, that there is a policy of austerity in government meaning budgets are increasingly tight and the expectation is that employers will do more with less. However, this policy leads to problems for employers as staff leave jobs for less stressful and better paid work leading to recruitment and retention problems.
Employers listened to staff concerns about working conditions, not just for the operational staff working on ambulances, but also the staff working in the contact centres and corporate services. Fewer people doing more work in an increasingly challenging environment. This is not easy listening for employers, many of whom work in managerial roles to help support staff in the delivery of 999, 111 and PTS services. Ultimately, they have little control of the government’s public sector funding policy.
However, they do have to deal with the consequences – the dropping job satisfaction, morale and motivation; the loss of organisational commitment and discretionary behaviour. This leads to a worsening engagement, stress symptoms and burnout. Then they have to account for increasing absence rates and unfilled shifts.
At first it seems like an impossible puzzle with too many pieces that don’t seem to fit together. How do you improve wellbeing, especially when you know what is making people unwell, but it feels out of your control and when taken as a whole it seems an impossible task?
We started by grouping the pieces of the puzzle together based on the key issues.
Mental health and resilience. Helped by Mind and the Blue Light Programme we know that ambulance staff are more likely to suffer from mental health problems but less likely to do anything about it.
Bullying and harassment. Whether it is a manager and staff relationship, a control and road relationship or a hospital and ambulance relationship, we know they are already strained. Cultures in ambulance services need to change. External and internal pressures lead to poor behaviour but we need to eliminate bullying.
Reducing violence and aggression. Too many times we read reports about staff being assaulted. I have written about this subject before and no one disagrees – we need to tackle this issue. With the right focus on prevention and prosecution we can reduce the harm caused by violence.
Leadership behaviour. Ambulance staff take on managerial roles and then are not given the support or training needed to discharge their duties. We hear of senior management teams that are out of touch with staff. Line managers have a major role in supporting and developing staff. Senior management need to give them the training, autonomy and trust to support their staff.
Working patterns and role design. Ambulance work takes years off your life! More and more evidence shows us that long hours, shift working and night working is bad for us and leads to preventable diseases. Some staff like working longer shifts to get longer periods of time off, but with no guaranteed meal breaks and the likelihood of a long shift overrun it’s time we looked seriously at this issue to make work less demanding but recognising peoples’ needs to spend time with their friends and family.
Equality and inclusion. The experience of BME ambulance staff is of inequality in career progression, increased experiences of harassment and bullying and underrepresentation at senior level.
Recognition and staff engagement. Each year the NHS Staff Survey shows how poorly engaged ambulance staff are. They are the lowest scores across the NHS. I do not honestly think it is deliberate but you get very little recognition for a job well done, whereas you do hear about a missed performance target or a complaint. Ambulance services need to get better and reap the rewards of telling staff they recognise the effort they are making, especially in difficult times.
Healthy lifestyles. Last but by no means least. Ambulance work does not lend itself to healthy lifestyles. Shift work, late night snacking on poor quality food, combined with lack of consistent exercise and the physical demands of the job are a bad mix. However, looking after your own health is important and we want to see more employers supporting staff to live more healthily.
The real trick for the national bodies, employers and trade unions will be getting the buy-in from staff and for them to trust that this is more than just a new initiative. The benefits are proven and what we have been saying for a long time. To get good patient care you need to start with good employee care. At the end of the day, healthier happier staff = healthier happier patients.