Ambulance chief: 'I'm sorry.... things will get worse before they get better'
- Credit: East of England Ambulance Service
Ambulance response times and handover delays have hit record lows over the last month and more than ten per cent of the East of England Ambulance Service workforce is off sick. Joel Adams sat down with new EEAST CEO Tom Abell to ask what is being done to provide adequate care this winter.
JA: You’ve been in post just over three months, how is it going?
TA: We’ve got lots to do. We’re making a start on the cultural change we need to see and we’re putting in steps on how we respond better to demands.
Clearly one of the things that nobody in the NHS nationally expected was the significant and sustained increase in pressure on the emergency care system that we’ve seen in the last four or five months or so.
We started researching our “NHS On The Brink” series in June because we could see winter 2021 would represent a perfect storm with flu, Covid and people who’d delayed seeing a doctor. If we could see that coming, why couldn’t you?
I think the service saw it coming, the difficulty with it is how it is presenting - it’s more 999 calls, more attendances at A&E, more people being admitted for longer into hospital which means hospitals can’t admit people into bed as fast as they would like, which results in ambulance delays. And there are difficulties within the care market in terms of not being able to discharge people from hospitals.
How many staff do you have, and how many are off sick?
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About 4,000 staff, of whom about 3,000 are ambulance clinicians which includes paramedics and emergency medical technicians, and 10 to 12pc are off sick on any given day.
How does that compare historically?
It’s elevated, so the norm a couple of years ago is about seven per cent. So it’s five per cent higher.
No it’s five percentage points higher, it’s about 80% higher. So on any given day 350 ambulance drivers and paramedics are off sick?
Yes - technicians and paramedics
What is being done to fill the gaps?
We’re recruiting 100 more call handlers into the control centres, at the moment we’ve got about 40 recruited and inducted.
We’re working with private ambulance services who support us at the moment to see what they can do to support us.
We’re offering overtime and overtime incentives for people who do want to do more hours to help increase the numbers and we’re also in the process of recruiting non-clinical drivers - so being able to buddy up a clinician with a non-clinical driver, which is something that we did during Covid.
Those drivers are coming from blue light services, so police, fire. Or they may be recently retired members of the ambulance service who don’t want to work clinically any more but who have the right experience and qualifications to drive on blue lights and to drive a C Class vehicle.
How would you characterise the scale of the current crisis? Is crisis a reasonable word?
I wouldn’t use the word crisis. I would say, it’s high demand, it’s high pressure that we’re seeing placed on the service and people within the service at this given point in time.
I think “crisis” leads you to unnecessarily worrying people - the service hasn’t collapsed, the service is still there for people who have got the most life threatening needs.
If you call an ambulance because you’re having a heart attack, and it comes and it gets you to the hospital and you can’t get inside for treatment, that’s a crisis isn’t it?
It’s unacceptable. And that’s why we’re working with the hospitals.
Can you tell our readers that nobody else will die in the back of an ambulance in a hospital car park this winter?
No I can’t do that, because that isn’t within my control as the chief executive of the ambulance service.
But surely an event like that rings the loudest possible alarm bell?
It does, and that’s why we’re taking action. We’re bringing cohorting teams in each of the hospitals to support the offload of patients into hospitals so they get better care faster, that’s going to be in place across all the trusts in the region over the course of the next fortnight.
Clinical staff, healthcare assistants supported by our paramedics who may not be able to work on a vehicle - they’ve got a back injury or something - but who can provide clinical care, working across the three hospitals in Norfolk to help look after patients, so an ambulance isn’t stuck with a patient in the back.
Where will the patient be - are we putting up tents?
No there’ll be a designated location in each of the hospitals where we’ll be doing clinically appropriate cohorting.
Last week the trust had to redirect from NNUH to West Suffolk, was that a blanket instruction?
Not that I’m aware of, but what we’ll routinely do is dynamically move routes to hospitals which aren’t struggling. That’s a routine part of our business, clearly we’re doing it more in the last few months than we have done historically.
The latest response times are pretty terrible, how and when will they get better?
They’ll get better when we see a resolution to the handover delays, when we make an impact on sickness so we can increase numbers - which we’re hoping to do over the next couple of months.
We’ve taken the caps off the mental health support and physiotherapy support that we offer staff. Managers are being asked to proactively support people into those services, to prevent people going off work and get them back to work.
What do we need in this region - another hospital? More care homes? More ambulances, more drivers? How do we free up the system?
If there was silver bullet someone would have found it and somebody would have already done this.
We’re changing the way we triage people and putting more senior clinicians into control centres, so people who need an ambulance get one and those who don’t are properly directed and supported to access alternative services.
We’re changing our front line delivery model, so we’ve introduced the Norfolk Mental Health Car in the last couple of weeks. That’s resulted in 80pc of the 25 people they’ve seen since they started not going to hospital. It’s a joint initiative between us and the Norfolk and Suffolk Mental Health Trust. That’s a paramedic and a mental health nurse, who get dispatched to support people with mental health needs. Historically those people would go to hospital in an ambulance and that’s not always necessary.
We’ve made changes in the number of cars we have on the road and the locations of where they’re being staffed, so we’re better able to respond to the most life threatening calls, especially in rural communities.
We’ve also got to support our people better. People have been working so hard they’ve missed meal breaks and so on. We have a trial going on changing the way the service works, and for November, we had the lowest average late shift finish since June.
So there is movement and improvement happening but clearly we have to do more and there’s more to be done.
What are your recruitment targets?
We want over 100 more call handlers by end of January, and we’re looking to recruit another 50 to 60 clinicians or non-clinical drivers over the next two months as well.
I’m working with the colleges and HE establishments on a training plan for next year - because we clearly need a longer term sustainable plan. The principal route into the service is through apprenticeships and graduates, but we haven’t historically had a long term recruitment plan for, eg, bringing in 500 members of staff over the next three years.
Hopefully that plan will be agreed in January and I’ll be able to talk more about it then.
Is there a larger solution needed in terms of capacity?
My observation is the wisest place that we would invest in expanding capacity is the care sector. If we can expand capacity in the care sector we get people into the right setting - a setting that’s right for the and their needs - it helps free up hospital beds and it helps us in terms of handovers.
And if we improve care, it will probably reduce healthcare needs in the longer term. So if I had my magic wand that would be where I was planning to focus energy.
How are race relations within the team?
We have had some issues with racism within the workplace which are well-documented. We are working through tackling those.
Is there institution-wide prejudice?
That isn’t my belief. There is a need for organisation-wide training which we’re putting in place, around equality and diversity, because we have issues with race within the workplace, we have issues of misogyny, homophobia, people with disabilities and how they’re treated, so it’s multifaceted.
From what I’ve seen is those issues exist in some form across the entire organisation but to different extents.
So there’s a two-pronged attack, there’s organisation training, and legacy of employee relations cases which were not handled well. We’re about half way through clearing that legacy backlog.
How many such cases are there?
I don’t know how many are discrimination cases, but the total employee relations backlog is 173 cases dating from pre July this year. We’ve closed 102 and want to deal with the rest by the end of March,
So yes, we’ve got a problem, I put my hands up, I don’t think it’s a blanket thing I think there’s specific issues within certain areas that we’ve got to tackle.
A problem with discrimination?
Yes. But you can look at our CQC report or undertaking to the EHRC it is quite clear that we have a problem. We need to tackle it and be open and honest about that.
What would be your message to families who have lost someone in an ambulance, or to those who feel this is not the care they should be getting?
In terms of the individual cases I’m incredibly sorry for what’s happened and I’m sorry that we are not able, at the moment in time, to provide the level of service that I would like us to be able to provide to everybody across the east of England.
I think my broader message would be, please recognise we are working hard to try and improve the situation, there’s multiple things we’re doing to try to do that, and I believe we will get through this and we’ll see an improved service.
And finally, make sure you do your best to make the most appropriate use of service.
Will things get worse this winter before they get better?
My assessment is it will get a little bit worse before it gets better, yes.
The nature of the actions we’re taking is that they always have a lead time, and the complexity of the situation also means there’s going to be a lag time, so that would be my expectation yes.