Ambulance tea break death
Discussion
There are some very interesting posts on this topic, but note that there are some very genuine, sincere comments from "front-line" staff. However, it would be awful if it turned in to another "Fire-fighters strike on Bonfire Night" debate, especially as a few of the posters are the same.
It is really important to differentiate between what happened in the case in Scotland which is no doubt under investigation, versus the regular day to day life of NHS Ambulance Trust staff. We can all assume and speculate on the original case and make comments, but lets face it, we don't know the full facts.
The meal break situation for NHS staff (not just ambulance staff) has been an ongoing debate and issue since the change of terms & conditions and contracts as part of the implementation of Agenda for Change. Some 6 years on, there still is a lot of variance in its application and particularly with Ambulance Trusts, finding a workable and satisfactory solution for all has been problematic.
There are three main players in the resolution of the issue and it would be exceptionally naive and would show a lack of understanding if you "blamed" one group. It is a triangular relationship:
1) Ambulance staff - facing a constant increase in demand/activity that exceeds 5% per annum (especially 999 responses) and some predictions say that it may actually overtake Police call volume in some areas soon. On top of this, further demands due to increased skill set for clinicians, alterations of the resource profiles (crews versus solo responses - the latter required to achieve a very challenging response target), changing profile of the workforce e.g. introduction of support worker roles as part of crews to improve staff levels and fund Paramedic development, increased daily duties relating to governance responsibilities around infection control, audit, safeguarding (none of which can be viewed as just "H&S gone mad").
The daily workload can vary massively, not just in urban areas but also rural areas. Yes, a rural crew may have periods of time waiting for a call at a station or more often a standby point, but they also can end up dealing with demanding incidents that have a call cycle of many hours. It is also likely that when they transport a patient to a hospital which is more often than not in a large town or city, they will also be allocated an "urban" incident whilst in the area.
Most now work 12 hour shift patterns, have to battle against demand out-stripping capacity (as do the Control Centres who deploy them) and very often get a very late break (because they HAVE to be given one) coupled with late finishes. This may be a break 9 hours in to a busy 12 shift, which actually becomes 13 or even 14 hours.
99.9% of the staff are hard working, dedicated staff who want to care for people and save lives - they cannot do that if they are exhausted, hungry/thirsty or simply not there due to illnesses exacerbated by the demands of their role.
2) Unions - like or loathe them, they have a role to play as they attempt to balance the needs of the employee and employer. Yes, some of them may appear militant, out of touch with reality or oblivious to the views of their membership. However, if you study organisational behaviour and have even a limited level of understanding of this, then these traits can be evident in employees, employers and unions/regulatory bodies.
Unions do work hard to try and get the best deal or arrangements for their members and this can be achieved to varying levels over varying time-scales. Often compromises have to be made on all parts and the case being referred to in the Scotland example "may" be due to such.
3) Managers/management - believe it or not, they often share the same objectives as staff and unions. In the case of Ambulance Trusts and from my own experience, delivering the best level of efficient, effective patient care with the resources made available is the primary objective. Unfortunately, there is not an infinite financial envelope available and more and more of the NHS focus is on becoming efficient, not wasteful with the investment we have had over the last few years. I would suggest that ensuring your staff's health and welfare were considered can reduce illness and absence (e.g. uncovered shifts), reduce clinical incidents that would also dent patient/public confidence and actually be more financially viable than just paying people NOT to have a break. The purpose of the management is to work with both the above parties to achieve this objective to the best of everyone's ability, which should in turn provide the best service possible.
However, there has to be a degree of acceptance by all parties, plus the public, media and forum posters that there is always an absolute limit to what can be realistically achieved.
Again, to try and draw similarities to others isn't always possible. For example, if that hard working maintenance fitter at a fairly critical component manufacturer said to his boss
"Look, I am really sorry but I need to go and get some rest. I was in late last night dealing with a breakdown and to get the factory running, I have already been here for 9 hours today. Fred is still off sick so you won't have any cover for a short period - really sorry but I am beat. I have left a few messages asking for cover and the agency are getting back to me"
If said worker was unavailable and there was another breakdown that couldn't be dealt with in a timely fashion, would we then call him a lazy person who wanted tea and doughnuts? I doubt it! But, you will say that this doesn't cost lives. What if that fitter worked in a factory that provided key medical components - yes directly there may be no loss of life, but who is to say that there wasn't indirectly due to an interruption in the chain?
Apologies for the very long post, but it was needed to provide a balance. Perhaps reading it a couple of times before replying may help? I am not saying the person involved in Scotland is right or wrong as there is always more to it than is reported - more than all of us will probably ever know.
It is really important to differentiate between what happened in the case in Scotland which is no doubt under investigation, versus the regular day to day life of NHS Ambulance Trust staff. We can all assume and speculate on the original case and make comments, but lets face it, we don't know the full facts.
The meal break situation for NHS staff (not just ambulance staff) has been an ongoing debate and issue since the change of terms & conditions and contracts as part of the implementation of Agenda for Change. Some 6 years on, there still is a lot of variance in its application and particularly with Ambulance Trusts, finding a workable and satisfactory solution for all has been problematic.
There are three main players in the resolution of the issue and it would be exceptionally naive and would show a lack of understanding if you "blamed" one group. It is a triangular relationship:
1) Ambulance staff - facing a constant increase in demand/activity that exceeds 5% per annum (especially 999 responses) and some predictions say that it may actually overtake Police call volume in some areas soon. On top of this, further demands due to increased skill set for clinicians, alterations of the resource profiles (crews versus solo responses - the latter required to achieve a very challenging response target), changing profile of the workforce e.g. introduction of support worker roles as part of crews to improve staff levels and fund Paramedic development, increased daily duties relating to governance responsibilities around infection control, audit, safeguarding (none of which can be viewed as just "H&S gone mad").
The daily workload can vary massively, not just in urban areas but also rural areas. Yes, a rural crew may have periods of time waiting for a call at a station or more often a standby point, but they also can end up dealing with demanding incidents that have a call cycle of many hours. It is also likely that when they transport a patient to a hospital which is more often than not in a large town or city, they will also be allocated an "urban" incident whilst in the area.
Most now work 12 hour shift patterns, have to battle against demand out-stripping capacity (as do the Control Centres who deploy them) and very often get a very late break (because they HAVE to be given one) coupled with late finishes. This may be a break 9 hours in to a busy 12 shift, which actually becomes 13 or even 14 hours.
99.9% of the staff are hard working, dedicated staff who want to care for people and save lives - they cannot do that if they are exhausted, hungry/thirsty or simply not there due to illnesses exacerbated by the demands of their role.
2) Unions - like or loathe them, they have a role to play as they attempt to balance the needs of the employee and employer. Yes, some of them may appear militant, out of touch with reality or oblivious to the views of their membership. However, if you study organisational behaviour and have even a limited level of understanding of this, then these traits can be evident in employees, employers and unions/regulatory bodies.
Unions do work hard to try and get the best deal or arrangements for their members and this can be achieved to varying levels over varying time-scales. Often compromises have to be made on all parts and the case being referred to in the Scotland example "may" be due to such.
3) Managers/management - believe it or not, they often share the same objectives as staff and unions. In the case of Ambulance Trusts and from my own experience, delivering the best level of efficient, effective patient care with the resources made available is the primary objective. Unfortunately, there is not an infinite financial envelope available and more and more of the NHS focus is on becoming efficient, not wasteful with the investment we have had over the last few years. I would suggest that ensuring your staff's health and welfare were considered can reduce illness and absence (e.g. uncovered shifts), reduce clinical incidents that would also dent patient/public confidence and actually be more financially viable than just paying people NOT to have a break. The purpose of the management is to work with both the above parties to achieve this objective to the best of everyone's ability, which should in turn provide the best service possible.
However, there has to be a degree of acceptance by all parties, plus the public, media and forum posters that there is always an absolute limit to what can be realistically achieved.
Again, to try and draw similarities to others isn't always possible. For example, if that hard working maintenance fitter at a fairly critical component manufacturer said to his boss
"Look, I am really sorry but I need to go and get some rest. I was in late last night dealing with a breakdown and to get the factory running, I have already been here for 9 hours today. Fred is still off sick so you won't have any cover for a short period - really sorry but I am beat. I have left a few messages asking for cover and the agency are getting back to me"
If said worker was unavailable and there was another breakdown that couldn't be dealt with in a timely fashion, would we then call him a lazy person who wanted tea and doughnuts? I doubt it! But, you will say that this doesn't cost lives. What if that fitter worked in a factory that provided key medical components - yes directly there may be no loss of life, but who is to say that there wasn't indirectly due to an interruption in the chain?
Apologies for the very long post, but it was needed to provide a balance. Perhaps reading it a couple of times before replying may help? I am not saying the person involved in Scotland is right or wrong as there is always more to it than is reported - more than all of us will probably ever know.
Edited by slimtater on Saturday 6th November 14:29
Engineer1 said:
FFS I will lay this out for the hard of thinking.
1. Ambulance staff are people.
2. Ambulance staff are entitled to contractual breaks.
3. Most NHS staff are on pay freezes.
4. A lot of sections of the NHS are understaffed meaning that even when not at work staff are getting calls to see if they can come in to cover shifts.
The guy in the story just made a s
tty decision, but sometimes these decisions need making or your 12hr shift becomes 13hrs with no breaks. Without knowing the full sequence of events, and any contributing situations we can't comment.
What's the relevance of point 3? 1. Ambulance staff are people.
2. Ambulance staff are entitled to contractual breaks.
3. Most NHS staff are on pay freezes.
4. A lot of sections of the NHS are understaffed meaning that even when not at work staff are getting calls to see if they can come in to cover shifts.
The guy in the story just made a s
tty decision, but sometimes these decisions need making or your 12hr shift becomes 13hrs with no breaks. Without knowing the full sequence of events, and any contributing situations we can't comment. JumboBeef said:
Not so often in The Highlands and Islands, which this story is all about. Yes, it can be a very long drive to the hospital but most (nearly all) days you have plenty of time to sit around on station outside of your meal break.
Is the area in question typical of the Highlands and Islands though? It is a popular tourist area with plenty of outdoor sports and thewhisky trail. The A9 isn't far away either. Potentially one of the busier rural areas I would have thought.
ninja-lewis said:
JumboBeef said:
Not so often in The Highlands and Islands, which this story is all about. Yes, it can be a very long drive to the hospital but most (nearly all) days you have plenty of time to sit around on station outside of your meal break.
Is the area in question typical of the Highlands and Islands though? It is a popular tourist area with plenty of outdoor sports and thewhisky trail. The A9 isn't far away either. Potentially one of the busier rural areas I would have thought.No, it would be quiet up there. Half a dozen jobs a week I would have thought.
JumboBeef said:
ninja-lewis said:
JumboBeef said:
Not so often in The Highlands and Islands, which this story is all about. Yes, it can be a very long drive to the hospital but most (nearly all) days you have plenty of time to sit around on station outside of your meal break.
Is the area in question typical of the Highlands and Islands though? It is a popular tourist area with plenty of outdoor sports and thewhisky trail. The A9 isn't far away either. Potentially one of the busier rural areas I would have thought.No, it would be quiet up there. Half a dozen jobs a week I would have thought.
Johnnytheboy said:
Engineer1 said:
3. Most NHS staff are on pay freezes.
What's the relevance of point 3? The other issue that no one has covered yet is that with changes to hospital services ambulances are having to move more people further. So when the new hpspital at Pembury comes on stream ladies im Maidstine and that area who need urgent obstetrics will need an ambulance from Maidstone to Pembury, whereas currently they can go to Maidstone.
The outcome of changes like this at all hospitals is that the ambukances are going further, but of course the number of them is not being increased. In many areas its also made worse by the ambulance being region based so of course at the end of shift it can be a long way from its base and hence need a long drive home.
Yes in the ideal world this guy would have taken the call but can I remind you that there appears to be no criticism of the other person who was also on duty but was on a break at home. She should be coming in for equal criticism if he did wrong.
The outcome of changes like this at all hospitals is that the ambukances are going further, but of course the number of them is not being increased. In many areas its also made worse by the ambulance being region based so of course at the end of shift it can be a long way from its base and hence need a long drive home.
Yes in the ideal world this guy would have taken the call but can I remind you that there appears to be no criticism of the other person who was also on duty but was on a break at home. She should be coming in for equal criticism if he did wrong.
Chrisgr31 said:
The other issue that no one has covered yet is that with changes to hospital services ambulances are having to move more people further. So when the new hpspital at Pembury comes on stream ladies im Maidstine and that area who need urgent obstetrics will need an ambulance from Maidstone to Pembury, whereas currently they can go to Maidstone.
The outcome of changes like this at all hospitals is that the ambukances are going further, but of course the number of them is not being increased. In many areas its also made worse by the ambulance being region based so of course at the end of shift it can be a long way from its base and hence need a long drive home.
Yes in the ideal world this guy would have taken the call but can I remind you that there appears to be no criticism of the other person who was also on duty but was on a break at home. She should be coming in for equal criticism if he did wrong.
The implementation of the Next Stage Review is quite watered down by the time it reaches Ambulance Trusts, yet the impact will be noticeable.The outcome of changes like this at all hospitals is that the ambukances are going further, but of course the number of them is not being increased. In many areas its also made worse by the ambulance being region based so of course at the end of shift it can be a long way from its base and hence need a long drive home.
Yes in the ideal world this guy would have taken the call but can I remind you that there appears to be no criticism of the other person who was also on duty but was on a break at home. She should be coming in for equal criticism if he did wrong.
Ruskie said:
Asterix said:
I completely understand the need for enforced breaks if it is constantly busy, as I would imagine it would be in a populated area - but this guy 'probably' had done bugger all that day yet still said that he was on an enforced break.
My view is that it was a massive judgement call by the single individual and does not reflect the service as a whole.
Well said, unfortunately incidents like this shine a light on all ambulance staff and dent public confidence.My view is that it was a massive judgement call by the single individual and does not reflect the service as a whole.
Many times it's a minimum 30 minute wait for an ambo to turn up for injured people @ rtc's.
I suppose public misuse & abuse of ambo's is why they ambo control try and filter calls more.
Engineer1 said:
Simple Monday morning your boss tells you you aren't going to get a payrise irrespective of how hard you work, I bet all the little extras you do like turning up 15mins early working a little late etc. suddenly stop.
Try the private sector. Monday morning your boss tells you it's a 20% pay cut or ps off. Two years running!maddog993 said:
JumboBeef said:
ninja-lewis said:
JumboBeef said:
Not so often in The Highlands and Islands, which this story is all about. Yes, it can be a very long drive to the hospital but most (nearly all) days you have plenty of time to sit around on station outside of your meal break.
Is the area in question typical of the Highlands and Islands though? It is a popular tourist area with plenty of outdoor sports and thewhisky trail. The A9 isn't far away either. Potentially one of the busier rural areas I would have thought.No, it would be quiet up there. Half a dozen jobs a week I would have thought.
http://www.pressandjournal.co.uk/Article.aspx/1996...
"When a vacancy occurs we take the opportunity to review the skills mix, clinical case load and the external environment, to ensure that we have flexibility to meet patient need. This is currently under way with regard to the position in Tomintoul, with a view to recruiting a replacement in the coming weeks.”
Would you really want to work 7 days on, 7 days off?
Nah, I was only joking about the vacancies, mind you, I did used to work 7 on, 7 off (and be on Standby on the night during the 7 on) & the week off was nice....... but I certainly wouldn't contemplate go back to it nowChrisgr31 said:
The other issue that no one has covered yet is that with changes to hospital services ambulances are having to move more people further. So when the new hpspital at Pembury comes on stream ladies im Maidstine and that area who need urgent obstetrics will need an ambulance from Maidstone to Pembury, whereas currently they can go to Maidstone.
The outcome of changes like this at all hospitals is that the ambukances are going further, but of course the number of them is not being increased. In many areas its also made worse by the ambulance being region based so of course at the end of shift it can be a long way from its base and hence need a long drive home.
That is a very good point - the DMAs (double manned ambulances) around here are often tied up- nearly for a whole 12 hour shift on some occasions- with the conveyor belt of 3+hour 'emergency' transfers from the local hospital (that is being progessively wound down) to another with the requisite facilities. This creates a void of ambulance cover for the area with the net result crews are dragged in from elsewhere compounding the shortage of regional cover, (It also pisses all over the terms under which the Ambulance Trust contract with these hospitals were originally negotiated.) The outcome of changes like this at all hospitals is that the ambukances are going further, but of course the number of them is not being increased. In many areas its also made worse by the ambulance being region based so of course at the end of shift it can be a long way from its base and hence need a long drive home.
maddog993 said:
;) Nah, I was only joking about the vacancies, mind you, I did used to work 7 on, 7 off (and be on Standby on the night during the 7 on) & the week off was nice....... but I certainly wouldn't contemplate go back to it now
We have Urgent Tier ambulances just for this job. They are like PTS ambulances but with blues/twos and at least one Technician on board, so they can transfer emergency p/ts (and respond to 999 if required). Because of this, I very rarely get tied up with transfers and 99% of my work load are 999 calls.Chrisgr31 said:
The other issue that no one has covered yet is that with changes to hospital services ambulances are having to move more people further. So when the new hpspital at Pembury comes on stream ladies im Maidstine and that area who need urgent obstetrics will need an ambulance from Maidstone to Pembury, whereas currently they can go to Maidstone.
The outcome of changes like this at all hospitals is that the ambukances are going further, but of course the number of them is not being increased. In many areas its also made worse by the ambulance being region based so of course at the end of shift it can be a long way from its base and hence need a long drive home.
That is a very good point - the DMAs (double manned ambulances) around here are often tied up- nearly for a whole 12 hour shift on some occasions- with the conveyor belt of 3+hour 'emergency' transfers from the local hospital (that is being progessively wound down) to another with the requisite facilities. This creates a void of ambulance cover for the area with the net result crews are dragged in from elsewhere compounding the shortage of regional cover, (It also pisses all over the terms under which the Ambulance Trust contract with these hospitals were originally negotiated.) The outcome of changes like this at all hospitals is that the ambukances are going further, but of course the number of them is not being increased. In many areas its also made worse by the ambulance being region based so of course at the end of shift it can be a long way from its base and hence need a long drive home.
Edited by JumboBeef on Sunday 7th November 11:16
The NHS is being seriously schizophrenic at the moment with patient choice being offered and at the same time centres of excellence/regional units being developed. The problem becomes a woman wants to have her child in Solihull hospital but clinical and medical needs mean she would be better in Heartlands of course if Heartlands is full then you might get Shrewsbury, or you might get Newcastle.
speedyguy said:
Ruskie said:
Asterix said:
I completely understand the need for enforced breaks if it is constantly busy, as I would imagine it would be in a populated area - but this guy 'probably' had done bugger all that day yet still said that he was on an enforced break.
My view is that it was a massive judgement call by the single individual and does not reflect the service as a whole.
Well said, unfortunately incidents like this shine a light on all ambulance staff and dent public confidence.My view is that it was a massive judgement call by the single individual and does not reflect the service as a whole.
Many times it's a minimum 30 minute wait for an ambo to turn up for injured people @ rtc's.
I suppose public misuse & abuse of ambo's is why they ambo control try and filter calls more.
Example elderly person falls out of bed, no injuries just unable to get up, takes 30 seconds to sort then 20 mins paperwork!
JumboBeef said:
maddog993 said:
JumboBeef said:
ninja-lewis said:
JumboBeef said:
Not so often in The Highlands and Islands, which this story is all about. Yes, it can be a very long drive to the hospital but most (nearly all) days you have plenty of time to sit around on station outside of your meal break.
Is the area in question typical of the Highlands and Islands though? It is a popular tourist area with plenty of outdoor sports and thewhisky trail. The A9 isn't far away either. Potentially one of the busier rural areas I would have thought.No, it would be quiet up there. Half a dozen jobs a week I would have thought.
http://www.pressandjournal.co.uk/Article.aspx/1996...
"When a vacancy occurs we take the opportunity to review the skills mix, clinical case load and the external environment, to ensure that we have flexibility to meet patient need. This is currently under way with regard to the position in Tomintoul, with a view to recruiting a replacement in the coming weeks.”
Would you really want to work 7 days on, 7 days off?
Engineer1 said:
Johnnytheboy said:
Engineer1 said:
3. Most NHS staff are on pay freezes.
What's the relevance of point 3? I certainly wouldn't sit drinking tea & let people die over a pay rise.
Johnnytheboy][snip said:
I certainly wouldn't sit drinking tea & let people die over a pay rise.
That depends on the call they received. If it was something like:Caller said:
She's in her early 30s, has chest pains and feels rough.[quote]
then she will have been an extremely low priority. He could have said that he was part way through his tea and the controller will have gone on to someone else. The way a lot of posters have been reacting you'd think that he stepped over someone bleeding to death to get an extra doughnut.
then she will have been an extremely low priority. He could have said that he was part way through his tea and the controller will have gone on to someone else. The way a lot of posters have been reacting you'd think that he stepped over someone bleeding to death to get an extra doughnut.
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