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The ambulance service: what about the workers?

Roger Kline, 12 September 2013

See also:

    The Best Workplace: improving service quality, resource use and job satisfaction through staff involvement
    The Duty of Care: practical guidance for healthcare professionals

2013 has not been a good year for England’s ambulance services. We’ve had the 111 crisis, queues of ambulances waiting outside A and E departments, regional industrial disputes and now a stand-off over sick pay.

As if all that wasn't bad enough, it comes on top of evidence in the NHS staff survey that ambulance staff are more likely than other NHS employees to feel negative about their working lives.

According to the report of the NHS staff survey, “it is important to note that ambulance staff work in a distinct and different environment to others in the NHS and they report poorer experiences on many of the issues picked up by the staff survey.” The numbers below justify that observation all too well:

  • Only 40% of all NHS staff were satisfied with the extent to which they felt that their Trust values their work, and this figure is lowest for ambulance staff (23%)
  • Only 35% of all NHS staff said that communication between senior managers and staff is effective, and this figure is the lowest for ambulance staff (20%).
  • Under a third of all NHS staff (30%) feel that there are enough staff to enable them to do their jobs properly; this score is lowest amongst ambulance staff (21%).
  • Just over half (55%) of all NHS staff, but only 40% in ambulance trusts, would recommend their organisation as a place to work.
  • While 63% of all NHS staff said that if a friend or relative needed treatment they would be happy with the standard of care provided by their organisation, for ambulance staff the figure was 57%.
  • 68% of NHS staff overall felt able to contribute to improvements at work but that fell to 44% for ambulance staff.
  • The percentage of all NHS staff reporting well structured appraisals in last 12 months was 38% but it fell to 20% amongst ambulance staff.
  • Fewer ambulance staff (75%) than all NHS staff (81%) said they received job-relevant training, learning or development in last 12 months.
  • More ambulance staff (84%) said they worked extra hours, but the figure for all NHS staff was 70%.
  • 38% of all NHS staff reported they have felt unwell as a result of work-related stress in the preceding 12 months. This figure is 44% for ambulance staff.
  • Twice the proportion of ambulance staff compared to all NHS staff (32% and 15% respectively) reported experiencing physical violence from patients, their relatives or other members of the public in the previous 12 months.
  • While 30% of all NHS staff reported that they experienced bullying, harassment and abuse from patients, their relatives or other members of the public in the previous 12 months, that figure rose to 48% amongst ambulance staff.
  • Whereas 27% of all NHS staff reported feeling pressure to attend work when feeling unwell, that rose to 38% for ambulance staff.
  • The percentage of all NHS staff witnessing potentially harmful errors, near misses or incidents in last month was 31% for NHS staff overall but rose to 38% for ambulance staff.
  • However, the percentage of all NHS staff reporting errors, near misses or incidents witnessed in the last month was 90% but this fell to 81% amongst ambulance staffs.
  • 72% of all staff said they would feel safe raising concerns at work but that figure fell to 62% among ambulance staff.
  • If they did raise concerns, only 55% of NHS staff felt confident that their organisation would address concerns but for ambulance staff the figure fell to just 42%.

These statistics are yielded by data collected from 9,000 ambulance staff, and they paint a grim picture of the the service's workplace culture.

The excellent research published this week from Mary Dixon-Woods and colleagues reiterates that “good staff support and management" in the NHS is "highly variable", despite being "fundamental to culture" and "directly related to patient experience, safety and quality of care”.

You cannot read the ambulance staff survey results without wondering what on earth is being done, as a matter of urgency, to better support and value such an important workforce.

So here are three questions:

  • Does anyone know what ambulance Trust employers are doing to tackle the problems revealed in the survey?
  • What is NHS England doing about it?
  • Is there any chance Jeremy Hunt could take time out to ensure ambulance Trusts take on board the research evidence and recognise that a skilled workforce with high morale, well-treated and feeling able to raise concerns is a precondition for the ambulance service we all deserve?
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