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Revealed: why paramedics are fleeing the NHS

28 August 2014

I can’t blame bigwigs in the NHS for the meltdown of our 999 service. It’s fundamentally our own fault that the service we depend on to save our lives is breaking down. We call 999 at the slightest sniffle, which means paramedics and ambulance drivers find it impossible to keep up. They’re run ragged trying both to respond to every call and hit the government’s response time targets.

What I can blame the bigwigs for (by which I mean senior management in the NHS London Ambulance Services) and do in this week’s Spectator cover story, is that they have responded to the crisis in a catastrophically counterproductive way, with the result that their paramedics are fleeing the service. So many staff are leaving the London Ambulance Service (LAS) for example that it predicts a shortfall of 600 paramedics — that’s a third down — by the end of the year. They’re so desperate for staff, they’re trying to recruit from Australia.

LAS management claim to be baffled by the exodus, but I’ve spent a month speaking to whistle-blowers and former LAS paramedics and during the course of my little investigation I’ve concluded that the LAS (and perhaps this applies to other services nationwide too) have made three terrible mistakes:

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Mistake 1: Rather than admit to being beyond breaking point, the LAS management has begun to use protocol designed for terrorist attacks as a routine way of dealing with call volumes. There are seven colour-coded levels in the ‘Surge plan’ designed to manage crises. Surge Red indicates a crisis, it is the third most serious call. Surge Purple is the second most serious call after Surge Black. There has never been a Surge Black called on record. So consider:

  • Surge Red was enacted ‘almost every day in June’
  • On 23 June t​he service received up to 350 calls per hour and had up to 200 people at a time on hold​. It couldn’t cope,​ the surge plan was escalated to purple and a major internal incident declared. ​Surge Purple is the level of incident that was declared on the day of the 7/7 bombings
  • It isn’t an isolated incident — it happened twice in June, and again in July

Mistake 2: Rather than take care of their hard-working, badly paid and experienced staff, ambulance service managers (and again, I think this is true nationwide) have allowed an awful culture of fear and bullying to take hold. Paramedics are regularly threatened and disciplined by their management for making the sort of tiny errors that would be normal in any job, let alone one as chaotic as emergency care. To a man, the paramedics I spoke to said that the attitude of their immediate managers was the biggest problem at work, and more stressful than treating and transporting patients, however critically ill.

Some comments made by anonymous paramedics:

‘We love our work and try hard, but everyone’s paranoid now, and we all think management is out to get us.’

‘There is a dominant culture of fear and paranoia. If you complain, management will strike you off the register.’

‘They send ambulances to any old call, even if it’s not urgent, just in case someone complains. There’s no thought for frontline staff.’

‘The scary thing is that the LAS is driving hard-working staff to suicide.’

I have heard more than once that the management of the LAS have a list of ‘suicide risk’ paramedics that they keep en eye on for fear of bad PR. I have no way of corroborating this, but the fact that it’s widely believed to be true is in itself worrying.

Mistake 3: Though listening to paramedics was worrying, perhaps most alarming was reading the minutes of the London Ambulance Service Trust’s monthly board meetings which make it clear that the very top brass — in particular the Chief Executive and the NEDS — are either ignorant about the crisis in their own service, out of their depth, or unconcerned. The minutes of the London Ambulance Service’s most recent board meeting (on Tuesday 29 July 2014) make surreal reading. These people are often paid 4 or 5 times a paramedic’s salary, and this is what they have to contribute by way of solutions to the crisis:

  • The Trust’s Chief Exec Ann Radmore begins the meeting by wondering ‘whether there was anything that could be done to make it easier for people who were deaf or hard of hearing to apply for jobs at the LAS.’
  • The London Ambulance Service has gone to Australia to recruit – but even that might not be enough. ‘Nick Martin asked whether the recruitment campaign should focus on other countries such as China and Philippines. David responded that this had been considered.’
  • ‘Theo de Pencier suggested that the 2015 Rugby World Cup might also attract people to work in London.’
  • Theo de Pencier, a Non-Executive Director, also makes the helpful suggestion that the quality of London’s air may be of concern to paramedics.

My own suggestion to the board would be that if Theo de Pencier is being paid to offer this sort of advice, then the cash-strapped LAS might quite easily do without him.

My enquiries focussed on the London Ambulance Service, which is the largest and most over-stretched trust. But there’s every indication that services in the rest of the country are suffering in the same way. Here’s a roundup of local news stories which suggest this is a national problem:

  • 12 December 2013 – The Worcester News runs claims from a paramedic whistleblower that West Midlands Ambulance Service staff feel ‘downtrodden and bullied’
  • 19 March 2014 – the NHS staff survey showed almost half that staff in the East of England Ambulance Service had witnessed harmful errors or near misses in the last month. A paramedic told the Eastern Daily Press: ‘For the last two to three years there has been a steady decline in the staff survey results and it is pretty bad. There is nothing more demoralising than turning up to a job where patients have been waiting ages for an ambulance to show up.’
  • 19 April 2014 – Bedfordshire News — Dr Anthony Marsh, head of the East of England Ambulance Service Trust said that staff are ‘tired, overworked and frustrated’
  • 8 May 2014 – The number of frontline ambulance service workers in the East Midlands Ambulance Service taking time off with stress has more than trebled over the last five years, from 61 to 217, the Nottingham Post reported. 48,000 working days were lost due to staff sickness. Bosses said the figures were partly down to increased strain in the job. And a former paramedic told the paper:

‘It’s more stressful than working in the police or the fire service. Someone will go to a child death, which is awful, and from there they can immediately go to another. But anyone would go to pieces after that job. That’s made irrelevant if the targets need to be hit…. The morale of the staff can be measured by sickness levels. It is low. The volume of calls has gone up, as has the pressure.’

  • 30 July 2014 – A paramedic from the East of England Ambulance Service NHS Trust told the Watford Observer:

As much as the service says they are recruiting, a substantial number of staff are still leaving due to moral being so low. There are staff shortages in the Watford area and management are trying to paper over the cracks by offering extra shifts on overtime.

  • 5 August 2014 – A source tells Jack FM, an Oxfordshire radio station, that ‘there has been a huge exodus of staff… they don’t value us. It’s us versus them between the front line crews and management’
  • Even at the South West Ambulance Service Trust, one of the better-performing in the country, staff sickness rates are running at 5.9 per cent (the target is 4 per cent). That’s 7,660 calendar days in June alone
  • In the North East Ambulance Service Trust the proportion of staff who reported suffering from workplace stress in 2013 increased to 55 per cent from 41 per cent
  • The North West Ambulance Service NHS trust has seen 11 per cent more 999 calls, and 14 per cent more high-priority ‘red incidents’ in May and June 2014 than the same period the previous year. The board says:

‘The increase in high priority incidents is stretching the available ambulance resource to a point where at certain times patients who are less critical are getting an attendance that is much longer than they expect. This is generating a circular problem with rising sickness rates amongst staff which means even less resources to meet the continually high demand.’

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Show comments
  • Anon

    Does Dr Anthony Marsh have an email account ?

  • Anon


  • Joe Taylor

    wonderful article, congratulations. Would you be able to investigate why the voulme on hashtage #cameronmustgo is being kept out of the mainstream media?

    • Gen d’Eau

      at least Ed doesn’t need a tag, it’s so completely obvious why he has to go. How about #IncompetentsMustGo ? Covers all three.

  • lailahaillallah

    One wonders whether this will be the winter where the whole NHS system collapses? At least in some areas? That will mean people dying for want of a space in hospital or an ambulance to get them there. It has come close before.
    Using the risk-averse software will not help the service either. It is, of course, brought in to “save money” but when you look at all the knock-on effects, it does the opposite.
    And of course, no one is ever held to account.

  • s.p

    I wish I could stress to you the thanks my colleagues and I feel towards you for making this so public. You have no idea the conversations that are taking place in hushed whispers between us all about it. We can’t speak loudly because we are too scared of the reprucussions.
    We feel so alone it’s frightening. Nobody seems to care as we watch the job we love being dismantled and our health being slowly stripped. I wish the media would focus on it rather than waits in e.d. I have never known a job that is run so poorly whilst the staff suffer as we do. We are undergoing a Rota change at the moment that promises to make it so we have even less time with our families. All for a poor wage that the government are threatening to make worse all the while making out it will help the service push forward.
    Please focus on service as a whole across the u.k as the problems are EXACTLY the same for us all.


  • Mr Shamen

    I’m an AEMT in YAS and our service is almost at breaking point. We have dozens of core rota Paramedic lines unmanned whilst there is an abundance of ECAs on duty. RRvs are taken off the cars to crew up with the ECAs most every shift. Overtime is being offered at double rate across each weekend. DCA crews are inevitably late off shift making most of their shifts 13 or 14 hours long, sometimes even longer. Morale in YAS is at an all time low these days but management do not care at all. We are supposed to be family friendly…………but if you happen to be off for illness or the like, you receive a letter telling you that you are letting your colleagues down by causing them more work. As with most management teams, ours is vastly overpaid for doing next to nothing for us. All they are concerned with is getting us into a ‘Foundation Trust.’ We are doomed.

  • flippit

    Last couple of years I’ve had quite a lot to do with ambulance service as my parents are very aged. The ambulance workers have a lot of form filling and risk assessment, called Mom ‘sweetheart’ and ‘what’s ‘er name again?’ and me “Darlin’, spent hours getting Mom to the hospital and didn’t seem quite sure whether she should go or not. The women seem to do the job much better than men, they’re less patronising, that’s in my own small straw poll anyway. They always seem to be experiencing a mixture of boredom and fear, I suppose fear of making a mistake.

    • Green Echo

      Thank you for illustrating another of the difficulties we have on the front line ambulances so well. As a Paramedic who recently left London Ambulance Service, I can assure you that despite the label ‘Accident & Emergency’, we rarely get called for either. Currently, I have a regular caller ‘patient’ who calls an Ambulance every few days for ‘Chest Pain’. He’s usually quite excited when we arrive and clearly enjoys the social aspect of our visits. We have limited resources to assess ‘Chest Pains’ as a Cardiac/Time-critical or not. We can only prioritise the urgency of the POSSIBLE patient’s condition. The definitive test for being sure of a cardiac incident is a blood test at the hospital. This regular caller has attended hospital by ambulance 63 times so far this year (2014). Every time he calls, we KNOW it’s not likely to be a time-critical cardiac Chest Pain no-one can leave a patient with Chest pain at home when there’s the tiniest chance it could be cardiac-related. So to refuse to send an ambulance exposes the Service to some risk. To minimise that risk, an ambulance is dispatched. If the attending crew then decide to leave that ‘patient’ at home and something happens or a family member complains, the crew could be subject to disciplinary procedures and the Paramedic could possibly struck off. Game & career over. Then what do we do? We’re already broken and not expected to live long past retirement (because of the job demands).So we remove him to hospital. Every time. Just in case. And yes, on our 64th visit I might be a bit unbothered or ‘patronising’. In fact, I’d be quite happy to put this ‘patient’ off calling an ambulance. When I have a patient, I’m a paramedic. When I have fools & drunks, I’m a cabbie who wishes the end of this 12hr+ shift, with no break, would come sooner. The service the public demands has a finite cost and it’s not all financial.

  • Kevin Mcallister

    An anti-NHS propaganda piece?? In the Spectator? Surely some mistake!

    • post_x_it

      There are better ways to disagree with an article than to write it off as propaganda.

      • s.p

        This isn’t propaganda. This is the truth. We live it. This is the first article to actually try and bring it to the attention of people.

  • Diego Martinez

    Atlas shrugged

  • Steve Sampford

    Everybody tries to cure all the symptoms; no one looks for the cause of the illness. To do so, one would have to go back decades and review all that has occurred and examine the true motives behind decision that were taken. That won’t happen because contrary to what has been suggested in this article successive Governments – of all colours – are wholly to blame, and as far as I can determine, entirely unrepentant given the mess they have led everybody to. To find those responsible follow the money and it will lead you to many of those that robbed this country of, not only a fine Ambulance Service but of its entire NHS as well.

    Another point worth making is the media and entertainment industries unhelpful obsession with the word ‘Paramedic’ which has been ceaselessly ‘sexed up’. An ambulance service is about a great deal more than one protected job title. It was brought in as a means on control and as a divide and rule stratagem. It brought with it, a cancerous elitism that has contributed, in no small part, to tearing a noble workforce apart following the Ambulance strike of 1989. I believe this was a deliberate act of revenge against workers in the NHS who dared to stand up against Government at that time, with unprecedented public support for industrial action. They have done exactly the same to the Nursing profession with a very similar result.

    I served on frontline Ambulances as an Ambulance crew in London for the best part of twenty years, doing pretty much anything a Paramedic did until December 2012 and I was happy not to take their empty titles.

  • medifix

    This has been going on for few years and doctors are also retiring and leaving the country in drones.

    • post_x_it

      Aren’t they usually unmanned?

    • Kevin Mcallister

      Doctors retiring? Blimey!

  • Dominic Colella

    I am so pleased to se that we paramedics are being recognised by the press. I am recovering from a breakdown and during this I was harassed by the management of the LAS and was forced to resign under ill health. They are still chasing me fo£166 for pay owed when I had to bring the resignation date forward 2days as the decided to have a hearing without a fare interview. Unison did nothing to help!

  • Mrs Josephine Hyde-Hartley

    We’re going to have to reiterate and reclaim the total dedication of our front-line public ( or otherwise) service workers, in my view as an ordinary member of the public.

    So-called management and other back-office work is a very important job..but it should and must be subservient and led by what’s really happening at ground reality ie that sacred space between ordinary people and dedicated workers who are actually employed to provide ordinary people, of any particular kind, with a service.

  • Mark B


    Please do not moderate my post out of sight. Freedom of speech !!!

  • Mr Grumpy

    “We call 999 at the slightest sniffle”
    Speak for yourself, Mary. The call stats suggest to me that “we” are those raised in the all-about-me post-60s culture.

    • post_x_it

      Not helped by the incessant celebrity-endorsed public health advertising campaigns that actively encourage people to worry themselves senseless about the slightest hint of any symptom.

  • pointlesswasteoftime

    It’s not just paramedics… I know someone who started training to answer emergency calls… it was so inept and ignorant of caller needs (or lack of them) she, and two others, resigned in disgust.

  • zaq

    Brilliant article, please carry on with this investigation!

  • vircantium

    “The Trust’s Chief Exec Ann Radmore begins the meeting by wondering
    ‘whether there was anything that could be done to make it easier for
    people who were deaf or hard of hearing to apply for jobs at the LAS.”

    Typical. More concerned with equality than quality of service. As long as the right boxes get ticked, they can collect this month’s pay packet.

    Now in which other area of public services, say in Yorkshire to pick a random patch, have we seen the results of this culture?

  • Martin Adamson

    In short, the London Ambulance Service is stuffed to the gills with the same kind of corruptly appointed overpaid useless box-ticking PC-approved Common Purpose mediocrities as Rotherham Borough Council. Fancy that.

    • Inverted Meniscus

      Yes and even better, they are impossible to sack. And better still, we get to pay for them.

      • bobfellows

        All employees of the ambulance service are stackable…. It’s politicians that are untouchable

      • No Man’s Land

        NHS and affiliated services middle and upper management can be sacked but have a nasty habit of shifting sideways into the same or similar roles in other trusts. It’s like whack-a-mole.

    • bobfellows

      Totally not true, call rates are climbing through the roof and money gets less every year. It’s broken and needs fixing but it’s not rape of innocent children…. Big difference.

      • post_x_it

        Yes, big difference, but there are clear parallels as well. Going by the board meeting minutes quoted in the article, we find exactly the same refusal to acknowledge the elephants in the room and focus on fluffy, irrelevant topics instead.

  • Frank

    Mary, a good article. I think that it would have helped us understand the beast if you had been able to reproduce the CVs of the members of the Board of the London Ambulance Trust. Dire and it is concerning that head hunting firms keep populating these quangos with people who have the leadership ability of a wet sponge (they may mean well, but….).

    • Martin Adamson

      Actually, I doubt that they even mean well.

  • bobby_r

    When will the British public realise that the NHS is rotten to the core, as any large publicly funded organisation will eventually become, and it is time to introduce reforms to make it more competitive and responsive.

    Paying for your own health insurance would be a start. The poor can get help with the insurance costs, but making people aware that is it a service that you need to pay for, like any other, might help educate and motivate the public to seek redress when they get bad service from the NHS, which in turn will improve it.

    • styants64

      We should get tax relief on paying for medical insurance, also we should pay for decent food while in Hospital we have to feed ourselves at home, the insurance could pay for the Ambulance and food ect while taxation pays for the bulk of the medical treatment.

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