I haven't written the following,but I could have done......it just about covers all current aspects of the occupation,within an organisation that,imo,is on its arse.
Bloody good staff are leaving a career,that they dreamed of pursuing,because the conditions they are working in are abysmal.
I hope you agree,it's a worry.......
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The decline of the Ambulance service and how it has happened.
On the 28th of September 2009 I embarked on a five year journey with the London Ambulance Service. In a few weeks time it will come to an end.I joined with virtually no medical experience but with a real interest in medicine (I had considered becoming a Doctor at around the same time). As I ploughed through the six months of basic training I thought I might finally have discovered the answer to the question of what job I’d be doing for the rest of my life. The placements came and went and every day I felt I was in the right place.The early days of starting with the Ambulance Service are fraught with different emotions. Every job comes with a certain level of tension. Your first drives come with the tension of driving in an area you don’t know, in heavy traffic with the lights on. This requires a concentration that is undeniably tiring. Every new job you go to you think the worst case is coming at you and although that is rarely the case the excitement gets you through anyway. You rely on your more experienced crew mate and you learn every day.
Over the next three years I would qualify as a Paramedic and this is the point where you should have arrived. Officially this now makes you top of the pile having to take the lead on any job you arrive at first. Again the tension rises but this dissipates as time goes on and life settles down. You get to go and protect life, meet new people, drive round an amazing city and all the while being paid.So what could have gone wrong?
The truth of the matter is that things were going wrong long before I arrived.
The clues were there from the very beginning.
Early indications were there. Talk of missing equipment in training school, the discrepancies in levels of training and help students received. The down right dangerous state of the vehicles on our driving course was embarrassing - they might as well have been held together with tape.My second placement was marred by someone stealing a set of my epaulettes, the equipment on station was there intermittently and we were often stuck with vehicles that were once again sub-standard. This also meant that we had to do more lifting as the older trucks had no tail lifts and were ergonomically poorly designed. Not to mention the fumes that would often fill the compartments.But I persevered. I passed all the exams and practicals and despite the fact that other groups were clearly getting a lot more ‘guidance’ about their examinations than my group.
Once I got to my station I was immediately placed on the relief rota. The deficiencies in kit were immediately noticeable once again. Basics such as blankets, BM kits and Thermometers all conspicuous by their all too regular absence.Management help and guidance was all but non-existent, although I had already been warned to stay away from them as much as possible by many of the staff I had encountered.I worked the most awful, soul destroying rota possible, but still enjoyed my job and so persevered knowing that one day in the next few years I’d be qualified and my life would be easier.Time went on, weeks and weeks of swapping crew mates and stations with no stability at all gradually wearing me down without me knowing it.
As your life developed with the Service in it, it started to become clear that work would take its toll on everything I did. Relationships were started with the caveat that we might not see each other very much, friends gradually stopped inviting me to parties and get togethers as their 9-5 jobs clashed with my working life and vice versa.When I did have time off I was tired and I just needed to rest. The relentless torrent of 12 hour shifts, late finishes, shift changes with short turnarounds (i.e. nights to lates, lates to earlies etc) had taken its toll and I found myself increasingly sitting wanting to do nothing on my days off. My body clock had no time to adjust and I’d find myself with cold sores and minor sniffles or some other ache or pain after every run of shifts.Management targets became part of your life as you went from being new to being just another bum on a seat. I often joked that they may as well stamp a barcode on the back of your head to scan you in and out given how little they really knew about you.While things seemed to tick over nicely with just a few voices of discontent in my first few years, the cracks had started to appear. The sick rate seemed appalling and there were staff members you didn’t see for weeks on end. People seemed to go down with really serious illnesses and anecdotally more so than in other jobs I have had but no one really seemed to be looking at it.You would hear about the occasional suicide or accidental death of a staff member and it would be talked about for a week or so then disappear and again nothing was done about it.
People started seriously talking about getting up and leaving the service for a new career or the same career in a different place. A marked change from a few years previous where people complained but no one ever left.
The Service also got busier. When I started 4000 calls was a busy day, in the past 6 months we have hit 6000-6500 on a number of occasions and this has had an impact on the aforementioned targets.As the demand has risen pressure has been put on crews to work a bit harder, a bit faster, this has lead to a pin system to make sure you are in and out in a shorter time at hospital. Every one of your times gets scrutinised and marked against a complex and service average and at every stage there is pressure to take less time to do the same job.But this pressure has come at a price.
The staff don’t want to do the job under relentless pressure and this lead to people actually doing something about it and leaving the job. For the first time people were looking elsewhere for work and actually going. Some people were just going home after completing their training others were looking for advancement but no one wanted to deal with the barrage of calls that were being thrown at them.As staff numbers fell the pressure increased on those that remained and the good will that had held things together was gone and now things were falling apart.
Finally management started to make some small attempts to try and rectify the situation. Personal issue kit was brought in meaning we could do our job properly. An attempt to organise staff so we can get the right response to every patient has been made, a clinical hub has started cancelling ambulances where possible - all good initiatives - but all too late.Our triage system allows too many unwarranted calls to get through to us with a high priority category and as such we are swamped. The public know they can call us at any time and we will come to them. We are terrible at saying no to people.
All this has lead to our current situation.
We are now underfunded, understaffed, overworked, poorly treated, target driven, not patient focused and dealing with every little problem that members of the public can come up with.I can’t remember the last time I broke into a Paramedic drug pack to actually give some vital medication.
So what is the end result?Well as I sit here typing this I am 2 weeks away from my last shift with the ambulance service and here are the reasons why: -
My Health
After reading many articles about life expectancy in the Service and the high rates of heart disease and cancer it is impossible to ignore the way I feel after a run of shifts. Worn down, tired, as though I’m hungover without a drink. My body clock has no time to recover and I feel generally awful. The bought of Bell’s Palsy last year was a particular concern.
The future of a Paramedic is possibly to work until 68. I have no intention of doing that and have to find an alternative work direction. I do not want to die on the job because I have worn myself down to nothing trying to do it.
Mental health. There seems to be a real lack of regard for the mental health of Paramedics and others who deal with this front line work. I don’t think I feel it right now, but I don’t want to be in a position where I do start to. The suicides in the service are a real concern.
My home life
For a while this year I worked back on the B-relief, this meant that I barely saw my girlfriend (who I live with) for two months. It put an unnecessary strain on our relationship. We got through it, but no job is worth that. When I have a family I don’t want to not see them grow up due to work and not be able to do things with them because I am too tired.
My Friends
I am fed up of never seeing any of my friends and losing contact with people simply because I am too tired or unavailable. I need to have a better work life balance.
Work pressure
There is too much emphasis on targets and not enough on patient care. I didn’t join to reach a patient in 8 minutes and to turn around jobs at hospital in under 14 all of which we do without breaks.
The work load has become unbearable. While I used to say ‘you can only do one job at a time’ I have not been able to live by that mantra in recent months. Hearing 20+ calls broadcast over the radio all day is soul destroying.
We aren’t fixing the main problem - we are going to too much rubbish. People call for all sorts of nonsense and we just get sent. Until there is a serious review of the triage system this will never be fixed.
Recognition
I’m not looking for a pat on the back or a thank you from my managers, but none of them really know who I am. I am fed up of being a bum on a seat with no identity. I come in and work hard, I teach staff more inexperienced than me and I get on with the job. I am good at what I do and despite my annoyance at them I usually hit those targets and yet no one knows how good I am at my job, so when it comes to a possible promotion I am locked out by number of years service.
Career progression
Linked to the above point, there is little opportunity for genuine career progression in the London Ambulance Service. It takes far too long for good people to move up to the next level whether that be in management or on the clinical side. The new band 6 Senior Paramedic role is a pay off to get people to not go to the East of England who are doing the same thing and to have the clinical hub manned. It isn’t progression in my eyes because there is no real clinical advancement.
The Advanced Paramedic role is the golden carrot that is being dangled almost permanently out of reach to many. Once all the places have been filled opportunities will come up once in a blue moon and even then the requirements are far too lengthy and restrictive. You are talking about a band 7 role, the equivalent of which I could apply for in another year or so elsewhere, it would take me 5-10 years in the LAS to reach the AP job description.
Management
As a first point I will say there are some decent managers around in the LAS and it should be noted that many of them are being hamstrung by the pressure we are under. But a lot of the management style of the LAS is too old fashioned, too autocratic. No one seems to know how to inspire staff how to get them to own the targets to make them want to hit them.
The support when things go wrong is seen to be non-existent. Whether this is a perception or the truth is hard to say but either way it is equally as damaging. Until there is a clear statement of intent to back staff and then some action behind that I feel there will always be a them and us attitude there.
Colleagues
Again I start with a caveat - most people in the ambulance service are great people. Many will stand by your side whatever the horrible situation you are in and make sure you come to no harm. However there is still an undercurrent that is unpleasant in the service.I have described it as being on the playground again and with minor thefts, poor attitudes towards other staff and patients around it is not always a pleasant place to work.
Some staff just seem to want to be a road block to everything that is put forward as a way of improving things. If you support a change you are an arse kisser, if you don’t you are a whinger. This makes it impossible to move forward at any pace. There needs to be a pulling together of staff and management to work for a better ambulance service where everyone sees the bigger picture otherwise there is absolutely no hope at all.Without an honest frank, open dialogue nothing can be achieved.
So there you have it, my time in the London Ambulance Service will come to an end soon. I have some of the best memories I have ever had in my life from this job and I will miss it, but I can’t risk my life, my health and everything else on a job that is fundamentally broken and an organisation that I no longer feel proud to be part of.
Good bye
Onwards and upwards!
