No amount of PR from NHS England and the DHSC can hide the fact that the industrial disputes hitting the health service are about more than just pay. New research focusing on the ambulance sector – set to be hit by strike action early next month – offers up damning evidence of workforce planning and capital investment failures that directly impact on patient safety every day.

This week’s Observer carried an analysis based on FoI requests which revealed that ambulance trusts across England were experiencing high levels of staff turnover, particularly in the south, as paramedics and others increasingly leave for less stressful and better paid jobs.

The newspaper found that turnover rates at South Central Ambulance Service were particularly bad – 20 per cent for advanced paramedics, more than 40 per cent for dispatchers, 55 per cent for assistant dispatchers, and as high as 80 per cent for emergency call-takers and NHS 111 healthcare advisers – and that sickness absence rates were higher than before the pandemic.

Trust board papers for the South Coast East Ambulance Service, meanwhile, showed turnover was high enough – up to 40 per cent in some roles – to undermine attempts to employ enough staff in 999 frontline positions. And the South Western Ambulance Service admitted that staff turnover over the previous 12 months, for those performing some of the most pressured roles, was up to 30 per cent for clinical support desk staff and more than 50 per cent among emergency medical dispatchers.

The Observer’s report echoed the results of the most recent NHS Staff Survey, which showed that almost 25 per cent of ambulance staff are planning to quit, and a growing proportion have become disillusioned with the standard of care offered by their workplace – a situation they ultimately have no control over.

Research commissioned by the Liberal Democrats, unveiled in January, hints at the full extent of falling staff numbers across the entire ambulance sector, with one service – in the North West – down by more than 650 full-time, clinically registered staff, compared to 2015. This month the opposition party followed up on its staffing research with new data showing that delays in ambulance response times resulted in hospitals declaring almost 4,500 people ‘dead on arrival’ in December alone – a year-on-year  rise of nearly 20 per cent.

Labour has produced its own research too. Last week it went down the FoI route to discover that one patient waited more than two days (65 hours, 38 minutes and 13 seconds to be exact) for an ambulance last December, and another spent 40 hours in the back of an ambulance outside a hospital until A&E staff could find a bed for them. 

And this week both opposition parties reported how ambulance staff are now regularly called on to help patients suffering from severe mental health issues, as overburdened NHS community services increasingly struggle to cope with more than a million people waiting to receive care and treatment.

However, all these indicators of workplace stress in the ambulance service and the corollary threat to patient safety rarely generate more than a scant response from the government. The Observer’s reporter, for example, was only able to solicit from the DHSC this tired assertion, often repeated but never delivered on: “To ease the pressures on healthcare staff, the NHS will soon publish a long-term workforce plan to support and grow the workforce.” Yes, but when?

That policy of promising but rarely delivering was on show earlier this month too, when the BBC – again having to resort to FoI requests – shot holes in a joint NHSE/DHSC two-year, £1bn investment ‘blueprint’ launched at the beginning of the year allegedly to support the emergency care network. As part of the plan, it was originally claimed, the size of the national ambulance fleet was to be increased by 10 per cent, with an influx of 800 new vehicles. 

The planned increase turned out to be mostly illusory, though, as the BBC discovered. Figures from the eight ambulance trusts that responded to the corporation’s FoI requests revealed that most of the ambulances being bought are replacements for existing vehicles, not additions to the national fleet, and purchases are often dependent on ‘match funding’ from NHSE, after that body imposed a pause on replacement programmes four years ago. 

And with no accompanying details of how the extra vehicles would be staffed, the King’s Fund thinktank understandably questioned what impact they could possibly have, given that handover delays at A&E departments – not vehicle shortages or breakdowns – were the major factor in driving poor ambulance response times, Only last week the BBC reported response times by the Welsh Ambulance Service were the second worst on record, but at the same time handover delays at major A&E units across the principality were up 51 per cent on the previous month

Another initiative aimed at improving response times came in February this year, when NHSE asked ambulance trusts to ‘grade’ emergency calls and divert those not involving threats to life and limb elsewhere – potentially to GP surgeries or even pharmacists. But with both those sectors already under pressure it’s not clear how much potential this initiative really has to ease ambulance waiting times and handover delays. 

But the problems ambulance staff have to deal with are, of course, part of a wider picture. As Sir Julian Hartley – chief executive of the ambulance trusts’ representative body NHS Providers – warned when the ‘grading’ initiative was unveiled, “Pressures in the ambulance service are linked to pressures across the whole system. We need to focus on reducing high bed occupancy, increasing bed capacity and tackling delayed discharges through increased investment in social care and community services.”

The impact on patient safety of the government’s failure to properly resource the ambulance service with adequate staffing levels and investment has been well documented in the past – see The Lowdown’s own investigation two years ago – and this, alongside pay, remains a core issue for those ambulance staff still set to strike next month, striving to get a better deal for patients as well as themselves.

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