Pay survey reveals two thirds of paramedics considering leaving ambulance service

Adobe Spark (5)Two thirds of staff say they will consider leaving the ambulance service if a change to the pay banding of paramedics is not made, according to a survey carried out by the Journal of Paramedic Practice.

An online poll completed by 1084 paramedics has revealed that 67% will consider leaving the ambulance service if the Government continues to fall back on its 2015 promise of reviewing the banding system to recognise the skill set of paramedics. Additionally, 87% felt the Government has misled ambulance service staff over promises for pay.

One respondent said: ‘Increased pressure to use alternative pathways, treat at home, discharge on scene. Increased level of assessment and treatment options, together with increased expectation of qualifications and study, but for no extra pay? Ridiculous.’

Another said: ‘Several of my colleagues and friends are struggling to pay their home bills and have left the job for better paying roles in the Arab states.’

Commenting on the findings, Gerry Egan, chief executive officer for the College of Paramedics, said:

‘Since its establishment, the College of Paramedics has worked hard to develop the paramedic profession in the interests of providing the best possible care to patients and to ensure that paramedics receive due recognition for the service they give to society.

‘This combined with the increased reliance on paramedics by the health system, which has come about for a number of reasons, means that there has been a continuous increase in the expectations of the range and quality of services that paramedics provide. So it comes as no surprise that the results of the Journal of Paramedic Practice’s survey are similar to a survey conducted by the College of Paramedics last year.

In 2014, paramedics were among the thousands of health professionals who took to the picket line in the first NHS strike over pay in 32 years.

The dispute came as ministers in England awarded NHS staff a 1% increase in pay, but only for those without automatic progression-in-the-job rises.

Despite the independent NHS Pay Review Body recommending a 1% rise across all pay scales, ministers claimed this was an ‘unaffordable’ cost.

In a desperate effort to resolve the pay dispute of 2014/15, the Secretary of State for Health, Jeremy Hunt, agreed to a number of commitments to ambulance staff, including a review of the banding system.

Current vacancy rates for the paramedic profession are at 10%. This represents 1 250 vacancies out of a total workforce of 12 500. It is believed that these high vacancy rates are due to changes made to the healthcare system in recent years. This includes a shift in focus to treat patients at home rather than conveying them to A&E, as well as a change in the nature and volume of job opportunities for paramedics.

Almost all respondents (93%) of the survey believed that the current scope of practice of paramedics is changing as a result of increased skills and competencies. Additionally, 94% felt band 6 of the Agenda for Change pay scale was a more appropriate pay band due to the level of responsibility and autonomy practised within the paramedic role, including triage, referrals, and decisions around non conveyance. Overall, 96% believed their pay did not reflect their responsibilities.

However, not all believed that current pay for paramedics has contributed to increasing vacancy rates and the number of people leaving the profession.

‘I disagree that this would be a reason for paramedics leaving,’ said one respondent. ‘With the role having changed so much, I believe that our advanced practice colleagues (paramedic practitioner/emergency care practitioner) are leaving to work in hospitals. There is potential to earn more money, better chance of a break, and better working conditions. I disagree that pay alone is a reason staff are leaving.’

According to Egan, the significance behind the figures for those considering leaving the profession may be unclear:

‘The responses regarding those intending to leave their positions as paramedics may be blurred somewhat between those intending to leave ambulance service employers and those who might leave the profession,’ he said. ‘It is a well-known fact that many paramedics are leaving ambulance services to take up opportunities in walk-in centres, minor injuries units and the like.’

A large number of respondents felt that it was work pressures and stress that have contributed most to the number of paramedics leaving the ambulance service:

One respondent said: ‘I don’t think pay is a factor in staff leaving. Lack of retention [is] more likely due to increased workloads, poor culture and public expectation.’

Another respondent said: ‘There have been some paramedics with MSc or BSc that have left to find better paid jobs. But the majority of paramedics leaving the profession is due to the increasing workload and the undertaking of urgent care alongside emergency work. Demand, stress and pressure are why paramedics are leaving, not money.’

Stress and burnout remain an undeniable issue facing ambulance staff, with paramedics in England taking 41 243 days off in 2014 as a result of stress-related illnesses. This has had an inevitable impact on those choosing to leave the ambulance service. Only a handful of ambulance services have agreed to pay paramedics Agenda for Change band 6 in the hope of recruiting and retaining paramedics .

Another significant finding was that 66% of respondents believed there are no adequate opportunities for career progression.

A common consensus was that progression only came in the form of management positions, with few opportunities for promotion in a clinical capacity.

One respondent said: ‘There are a number of areas within the paramedic profession to progress to, such as critical care roles or minor health roles, or management; however, these areas still do not have the same pay scale as other health sectors, meaning progression, while increasing skills, does not increase pay, therefore [it] is seen as a way to gain skills in order to leave to a sector with increased pay.’

However, this was not felt by all, with one respondent highlighting the work that the College of Paramedics has done to outline career pathways:

‘The College of Paramedics (and South East Coast Ambulance NHS Foundation Trust) has done a lot to develop career pathways. Integration of the out-of-hours providers and the ambulance service would provide even more opportunity for paramedics to progress as well as improving the response times for patients.’

Commenting on the suggestion there are insufficient career progression opportunities within the paramedic profession, Egan said: ‘The College would argue that its career framework sets out the roadmap for career progression and the shortage of opportunities may be a problem to be addressed by the main employers of paramedics.’

As a result of the Government not reviewing the banding system for paramedics, the unions UNISON, GMB and Unite conducted consultative ballots of ambulance staff. The responses indicated that ambulance staff in England will take part in industrial action, including strike action, if the Government continues to not deliver in its promises over pay.

Each union is reporting their ballot results to members, before consulting over the next steps.

Results published by Unite show that 66% of members voted yes to taking strike action and action short of strike action, with a turnout of 31%.

Results from the other two unions have not yet been made public.

A joint statement issued by the unions said:

‘We are clear that ambulance staff have waited for 12 months and are not going to wait longer. If possible, we would also like to avoid a dispute, and the disruption that strike action will bring, however we know that ambulance staff are not prepared to wait indefinitely.

‘We will be calling on Government to make real commitments to ambulance staff, within clear timescales. If there is a genuine will to avert a dispute then we will pause the move to a full industrial action ballot while we hold constructive discussions.’

While the National Ambulance Strategic Partnership Forum have made a formal request to the National Job Evaluation Group to look at the National Job Evaluation paramedic profile, only a handful of ambulance services have agreed to pay paramedics Agenda for Change band 6 in the hope of recruiting and retaining paramedics. This includes East of England Ambulance Service NHS Trust, West Midlands Ambulance Service NHS Foundation Trust, Yorkshire Ambulance Service NHS Trust. There is currently no indication that other services will follow suit.

Taken from Journal of Paramedic Practice, published 1 July 2016.

Patients and pay: meeting the demand

Last month thousands of health workers, including paramedics, took part in the first strike over pay in 32 years.

Workers from seven trade unions were involved in the strike, which lasted from 07:00 to 11:00 BST in England on 13 October.

The dispute came as ministers in England chose to ignore a recommendation from the independent NHS Pay Review Body which called for a 1% pay rise for all staff (UNISON, 2014). The Government claimed that an across-the-board 1% increase in pay was an ‘unaffordable cost’, with the NHS Employers organisation estimating the resulting increase in expenditure would amount to approximately £500 million.

Instead it was announced that staff eligible for incremental ‘progression pay’ increases on the Agenda for Change framework, which usually average at 3.4%, would not receive a 1% rise on top of this. However, staff due to receive an incremental rise of less than 1% would have them lifted to 1%. This amounts to approximately 55% of NHS staff and covers almost one million workers.

Speaking on BBC Radio 4’s Today Programme, Health Secretary Jeremy Hunt said that if all NHS staff were given a 1% pay rise, hospitals would have to sack 14 000 nurses and risk creating another Mid Staffs scandal (Riley-Smith, 2014). This would in turn jeopardise patient care as there would be fewer staff able to attend to the needs of patients.

However, UNISON have argued that the cutting of pay does not save jobs. It claims that last year more than 10 000 jobs were lost as a result of unnecessary structuring of the NHS in England, meaning that the Government in reality is making cuts to both pay and jobs (UNISON, 2014).

As demand for health services continues to grow year-on-year, a balance must be struck if the NHS is to continue to survive as a functional entity. While undoubtedly the patient and their needs must be put at the forefront, unrealistic expectations of staff and a corresponding lack of fair pay would mean this is not possible.

As a one-off payment, a 1% increase would not count towards payments for overtime, unsociable hours or pensions. Staff need to know that they are valued and therefore treated well if they are likely to remain in the NHS. By denying a pay rise the Government runs the risk of losing dedicated staff.

A further four-hour strike in England on 24 November has been announced in the hope that the Government will understand that this is a concern that will not disappear. However, as Mr Hunt continues to stand his ground, staff can only wait in hope to see if a resolution will be reached.

References

Riley-Smith B (2014) NHS strikes: 14,000 nurses would be sacked if we agreed to 1% pay rise, says Jeremy Hunt. The Telegraph. http://www.telegraph.co.uk/health/nhs/11158184/NHS-strikes-14000-nurses-would-be-sacked-if-we-agreed-to-1-pay-rise-says-Jeremy-Hunt.html (accessed 3 November 2014)

Unison (2014) NHS Pay 2014. http://www.unison.org.uk/at-work/health-care/key-issues/nhs-pay/what-is-the-issue/#jobs (accessed 31 October 2014)

Taken from Journal of Paramedic Practice, published 7 November 2014.

Ambulance staff strike in dispute over pay

Ambulance staff were among the thousands of health workers who took part in a strike over pay on 13 October.

Workers from seven trade unions took part in the strike, which lasted from 07:00 to 11:00 BST in England.

Unions and managers had met in advance of the strike to ensure essential services were maintained, with military and police personnel helping ambulance services where needed.

Despite ambulance services developing backlogs, priorities were given to life-threatening cases.

The dispute came as ministers in England have awarded NHS staff a 1% increase in pay, but only for those without automatic progression-in-the-job rises.

The independent NHS Pay Review Body recommended a 1% rise across all pay scales, but ministers claimed this was an ‘unaffordable’ cost.

The unions involved in the strike included Unison, Unite, GMB, UCATT, the Royal College of Midwives, the British Association of Occupational Therapists, and Managers in Partnership.

Christina McAnea, head of health at Unison, said the offer in England was a ‘disgrace’.

‘The fact that so many unions representing a range of NHS workers are taking action or preparing to join future actions should send a clear message to the government,’ she said.

Taken from Journal of Paramedic Practice, published 20 October 2014.