You only have to turn on the news, or read a paper, especially regional news and press, to see the latest horror story about your Ambulance Service. Whatever part of Britain you live in, city or countryside, there is a good chance that someone will have been badly affected by the failure of their local Ambulance Service to provide them with the proper care. You must have seen some of the more high-profile cases. Ambulances that went to the wrong location, others who did not know their way to the correct hospital, and many more that arrive ridiculously late, or not at all, often resulting in tragedy. This is regularly blamed on the crews; their lack of knowledge, poor judgement or diagnosis, or issues surrounding training. Some reports rightly delve deeper, looking at the culture of cost-cutting, the lack of funding, and the unworkable size of most Ambulance Trusts.
Is this something new? Well, given my experience, I would have to say no. When I joined the LAS, in 1980, It had fairly recently become part of the NHS, as it was previously administered by the LCC/GLC. It is arguable that the transfer to the NHS brought with it increased proposals regarding medical care, and better development of the role, in the short term. For the Unions and staff however, it was a difficult transition from municipal employment, to a job in the Health Service. With a history of Union militancy, and taking a firm stand in negotiations, it was hardly suitable conditions, for a transfer to a job within a so-called caring profession, where staff were traditionally not militant, and if anything, compliant. The closed shop system was retained, so to join the job, you had to join one of the five Trade Unions involved in representation. For me, this was more than acceptable, as I was convinced that a closed shop system was the answer to correct working conditions, and pay negotiation.
We had a management that had come from Local Government or The Civil Service, and was essentially bureaucratic, without the Health Care ethos. They were predominantly ex-military or Civil Defence, old guard, and proud of it. They wanted to run the service on military lines, with outdated uniforms, saluting, caps, and pay parades. They literally had no idea what constituted a modern Ambulance Service, and did not want to know, if it contradicted their ‘vision’. Pay was low, conditions basic, and as employment was still fluid, there was always someone else, waiting to step into your job. The situation was ripe for confrontation, and that is exactly what they got.
Stopping there for now, I will agree that much of the operational practice was sound. We used terms like ‘swoop and scoop’, and later, ‘the golden hour’. Our training was based on the minimum requirements to maintain life support, prior to a rapid removal to the nearest casualty department. In London at least, there were then so many hospitals, that removal to an A&E Department usually involved a matter of minutes. The emphasis was not on what we did on scene, but on stabilisation, and rapid removal to the proper environment. That is something now discredited, and in my opinion, wrongly so. Too much reliance is placed on the ability of paramedics and ambulance staff to treat patients on scene, and not enough on getting them to a place where proper facilities may aid their recovery, in the long-term. Being on one side of this argument, or the other, defines your faith and belief in the system, as it exists at any given time.
In the later years of my service, I saw this policy swing around completely. The idea was to treat on scene, not to remove where possible, and to involve family doctors, and other agencies, considering all options, before actually going to hospital. Paramedic response units, cycles, motorbikes, anything that could be utilised, all with the primary intention of not taking the person into the nearest hospital for assessment, for treatment by doctors, and other qualified staff. This was a slippery slope, and one that should have been avoided. The legacy of this policy is with us now; with bad decisions, crews under pressure, and response units waiting for interminable times, for a crew to actually remove the patient to hospital. Despite the advances in training, and the increased role of the Paramedic Practitioner, whether they like to admit it, or not, (and they don’t) genuine patients belong in hospital; not in their own homes, or trapped in a car at the roadside, waiting for someone to make a decision that can affect their whole future. The change in role has been disastrous for the public, and the evidence is plain, for all who actually want to see it.
That aside, let us consider the political ramifications of these changes. Once Ambulance services became Trusts, they felt invulnerable. They were masters of their own destinies, and finances, and felt confident in taking on the Unions, and changing staff conditions. It all went to their heads. They got rid of the ‘old guard’ managers, and employed new whizz-kids. They had a different vision, one of fast response units, crews being flexible with attitude to working conditions, and a mission to erode traditional payments for working unsocial hours, and not having meal breaks. Despite the debilitating National Ambulance Strike, of 1989-1990 ( which I cannot possibly cover on this post) no lessons had been learned, and the management came at staff head on, ready for confrontation. Of course, we had essentially ‘lost’ that strike, so we were considered ripe for exploitation. And to a large extent, we were.
The staff had changed considerably since the strike. Many of the experienced people had gone, disillusioned by the dispute, and the future plans of their employers. Their replacements were younger, a generation inspired by unrealistic TV shows, like ‘Casualty’, and ‘Holby City’, believing the job to be something it plainly was not. This led to a divide within the operational staff, between the new and old members, and one which was apparent to anyone who cared to look. At the same time, management began to chip away at existing agreements, and working conditions. They changed the annual leave agreement, the sickness policy, and the unsocial payments. Despite aggressive moves from the Unions, the staff failed to vote in sufficient numbers, to retain the status quo. Alongside this, our traditional allies, the Nurses, and the Fire Brigade, were undergoing similar changes. Educational requirements for all three jobs were changing fast, and new entrants often had degrees, or equivalent professional qualifications. Society as a whole was changing, and our staff along with it. The closed shop was abolished, so new staff rarely bothered to join a Union, ignorant of the fight for conditions over the centuries. By the time I was approaching my 50th birthday, I was considered outdated and regressive by my peers, and I knew that it was time to go. By then, response units were in widespread use, as were motorbikes. We could already see, at least those who cared, that the outcome for patients was altering dangerously. Added to this, the high profile helicopter service was well-used, contrarily depriving people of the chance to be moved to hospital quickly. ( At least in London) It was all going badly wrong, and this time, with the support of most of the staff.
I left in late 2001, feeling like I had left behind a part of myself. After twenty years as a shop steward, deputy convenor, and unashamed political activist in the service, it was no longer the Ambulance Service that I knew, or felt wanted in. Nothing could persuade me that I was wrong, and that they were right.
Twelve years later, and I feel vindicated. Every Ambulance Service, in all parts of the UK, is under pressure; under-performing, vilified by the media, and letting down its staff and patients. Take the East of England Ambulance trust. This is covering an area of unbelievable size. From Watford, to Great Yarmouth, to Southend, and everything in between,; including Bedfordshire, Cambridgeshire, Suffolk, and parts of Buckinghamshire. This is an incredibly large area, unmanageable in reality, yet run as one service, with one aim, and one pool of staff. And it doesn’t work, at any level. It fails all its targets, lets down both staff and patients, and attempts to do the impossible, on a daily basis. But it does not admit defeat. Rather, it blames staff, vehicle breakdowns, and unacceptable patient demand, for all its shortcomings. Anyone is to blame, as long as it is not the intransigent management, unable, and unwilling, to admit that it is all beyond their capabilities. They keep deploying ever more fast response units, basic-trained first responders, de-fibrillators in railway stations, anything to avoid the issue that they are not giving a service to a deserving public. When all excuses fail, they blame the public for having the temerity to call ambulances in the first place, and put out documentaries featuring the worst excesses of public drinking, and drug abuse. As if that is some excuse for not attending a genuine heart attack, or epileptic seizure.
If I was still serving in the Ambulance service, I would be ashamed. Ashamed to work for such managers, ashamed to work with colleagues who firmly believe that the public do not deserve ambulances, and ashamed to be part of a system that refuses to address the shortcomings that are apparent to all. I am glad that I left, and that should tell you something. Something not good.