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.

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Ambulance service at creaking point

Adobe SparkRecent figures published by NHS England reveal the ambulance service is continuing to fail to meet Government standards for responding to Category A (Red 1 and Red 2) calls. The figures for March 2016 showed only 66.5% of Red 1 calls were responded to within 8 minutes, while 72.3% of Red 2 calls received a response within the same timeframe (NHS England, 2016). This is compared to 73.4% and 69.6%, respectively for the same period in 2015. It marks 10 months that services in England as a whole have failed to meet the Government target of 75% for Red 1 Calls. The response to Red 2 calls is the lowest proportion recorded since the data collection began in June 2012. However, it must be highlighted that Red 2 data from February 2015 onwards are not completely comparable across England due to the introduction of Dispatch on Disposition, allowing up to two additional minutes for triage to identify the clinical situation and take appropriate action.

It has been a tough year for ambulance services, with London Ambulance Service NHS Trust being placed under special measures by the Care Quality Commission (CQC) in November 2015 and East Midlands Ambulance Service NHS Trust being recently rated inadequate by the CQC for safety due to insufficient staff numbers and a consensus that the skill mix of staff deployed was not always safe (CQC, 2016).

The fact of the matter is that demand for ambulance services continues to rise and services are struggling to keep up. The ambulance service in England received 861 853 phone calls in March 2016, compared to 694 188 in March 2015 (NHS England, 2015; 2016), a rise of 24%. However, Trusts have not been able to increase their numbers of staff to meet this demand. This creates greater work pressures and stress for existing employees, brought on by longer working hours and missed meal breaks. The result? High staff attrition within Trusts. Those that remain will no doubt be questioning whether this is sustainable. With staff currently being balloted by unions over industrial action on pay, the possibility of a crisis within the ambulance service cannot be dismissed as hearsay.

If this is to be avoided, a number of things have to change. Trusts must ensure front-line vacancies are filled and staff do not leave. This can only be done by fostering a work environment in which staff are happy to remain. The over triage of patients must be minimised so that appropriate resources are dispatched. And, where possible, patients’ needs must be addressed at the point of contact and unnecessary transfers to hospital must be avoided. If the ambulance service carries on as it is, it is difficult to see how it will continue to operate in 10 years’ time. By focusing on employee welfare, this crisis may be averted.

References

Care Quality Commission (2015) London Ambulance Service NHS Trust Quality Report, 27 November 2015. http://tinyurl.com/hxdhwpr (accessed 26 May 2016)

Care Quality Commission (2016) East Midlands Ambulance Service NHS Trust Quality Report, 10 May 2016. http://tinyurl.com/h5r4wfv (accessed 26 May 2016)

NHS England (2015) Ambulance Quality Indicators Data 2014–15. http://tinyurl.com/zf2p5jf (accessed 26 May 2016)

NHS England (2016) Ambulance Quality Indicators Data 2015–16. http://tinyurl.com/jyls6rt (accessed 26 May 2016)

Taken from Journal of Paramedic Practice, published 27 May 2016.

Delivering a promise over pay

Project M (2)

The junior doctor dispute over pay has taken up a lot of space in the news in recent months, yet they are not the only health professionals who are displeased with Government plans.

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. 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 to recognise the skill set of paramedics (Hunt, 2015). Roll on 2016 and there is still no suggestion that Mr Hunt will deliver on his promise. Understandably this has angered many ambulance staff.

As a result, the unions UNISON, Unite and GMB have announced they will be balloting their ambulance service members to see if they are willing to take industrial action over the Government’s failure to keep its promise.

The numbers of paramedics leaving the profession has been increasing year-on-year (UNISON et al, 2015). This has resulted in the addition of paramedics to the shortage occupation list (SOL), with vacancy rates running at approximately 10% of the total 12 500 paramedic workforce in England (Migration Advisory Committee, 2015). One of the key reasons people cited leaving, or considering leaving, the ambulance service was pay (UNISON et al, 2015).

The proposal set out in the Urgent and Emergency Care Review (NHS England, 2013) to extend paramedic training and skills, and develop 999 ambulances into mobile treatment centres, emphasises how the current scope of practice of paramedics is changing. As paramedics take on increasing responsibilities, it is only fair their pay is amended to reflect this shift. The short supply and high demand of paramedics means that ambulance services are facing a conceivable recruitment and retention crisis. However, 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.

The Journal of Paramedic Practice would like to find out how its readers feel about their current pay and conditions. I therefore urge you to take 3 minutes to complete our online survey.

References

Hunt J (2015) Letter from the Rt Hon Jeremy Hunt MP, Secretary of State for Health, to Christina McAnea on Agenda for Change Proposal, 27 January 2015. http://tinyurl.com/hcwlk7g (accessed 29 April 2016)

Migration Advisory Committee (2015) Partial review of the Shortage Occupation Lists for the UK and for Scotland. MAC, London. http://tinyurl.com/qdaqbbl (accessed 29 April 2016)

NHS England (2013) High quality care for all, now and for future generations: Transforming urgent and emergency care services in England—Urgent and Emergency Care Review End of Phase 1 Report. NHS England, Leeds

UNISON, Unite, GMB (2015) NHS Pay Review Body Evidence: Recruitment and retention of ambulance staff. http://tinyurl.com/grd59l2 (accessed 29 April 2016)

Taken from Journal of Paramedic Practice, published 6 May 2016.

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.

Report into London’s NHS demands urgent review of emergency ambulance services

A report into the service provided by the NHS in London has demanded an urgent review of emergency ambulance services, including further investment and greater clarity on pathways of care among its key recommendations.

The People’s Inquiry, commissioned by the Unite union, has said that the present trajectory of financial constraint and fragmentation within the NHS in London, if unchanged could lead to increasing strains on frontline services and commissioning budgets, primary care, mental health and community health sectors.

Malcolm Alexander, chair of the Patients’ Forum for the London Ambulance Service NHS Trust (LAS), spoke of the increasingly long delays in responding to calls from category C1 and C2 patients. This seems to suggest that frontline staffing levels and resources of the ambulance service are not keeping pace with the rise in urgent and emergency calls across London.

The report raised concerns over the lack of transparency over the issue, recommending that there should be an obligation on ambulance control to notify callers well in advance in cases where it is clear that delays are inevitable in the dispatch or arrival of an emergency ambulance, so that they know the situation, and in some cases may be able to make other arrangements.

The report also raised concerns over the misleading rhetoric of pathways of care, which conceals the fact that none of these pathways appears to have been clearly established or are viably operating. A recommendation was made for the clarification of pathways of care to ensure local services are viable and clearly understood by all health professionals involved.

Finally, the re-establishing of a reliable and accessible Patient Transport Service (PTS) is discussed, recommending an appraisal of the costs, benefits and viability of the expanded network of PTS that would be required for LAS to provide reliable services that could enable less mobile patients to travel further for outpatient treatment in the event of hospital organisation.

Taken from Journal of Paramedic Practice, published 26 March 2014.