Clowns to the left of them, jokers to the right. Paramedics stuck in the middle with you…

South Western Ambulance WA07RYP 612We get the inside track from a paramedic about the ambulance strike…

I was glad to have the opportunity on Friday to re-post my article from last November where I described some of the difficulties currently faced by Paramedics in Northern Ireland. I felt it important to provide some context of the proposed Ambulance Service strike on Friday as the verbal jousting between NIAS managers and union spokespeople that day left me bemused to say the least.

After NIAS cynically broke the strike at the 11th hour by declaring a major incident, it was revealing to see that union leaders seemed to be more worried about industrial relations than those between staff and patients. I am not a member of a union and as such have no particular axe to grind. I am opposed to industrial action by members of our profession for the simple reason that even a strike with the most noble of intentions could irrevocably damage the public’s perception of the service.

I feel that the unions have exploited ambulance staff’s genuine fears over how their service is being run and involved us in strike action that had little hope of solving our particular problems in order to give the government a bloody nose over austerity. Any success would have been a Pyrrhic victory, destroying public confidence and tarnishing an impeccable reputation. Critically, losing a patient’s trust and respect would mean that in the future even the most able clinician could struggle to create a relationship that fosters recovery, potentially worsening patient outcomes.

However contrary to media reports, most staff were not proposing to strike against pay cuts and job losses but rather at how we see the service we love being run into the ground by managers who seem to give little consideration for staff or patients. Problems between workers and managers are common in all organisations, but when we are in the business of caring for members of the public, chronic mismanagement and a poisonous atmosphere between staff and managers will inevitably impact on patient care. As advocates for our patients we have a duty to speak up.

Strike action was a desperation tactic. Issues that continually arise without redress are the chronic lack of ambulance cover, going without meal breaks until 8+ hours into a 12 hour shift, missed and disturbed meal breaks, enforced overtime at the end of many shifts and cancelled leave. The last point is particularly exasperating, with staff booking leave months in advance only to have it cancelled at short notice and forcing them to miss important events such as family weddings, anniversary weekends and holidays.

The ill-feeling is exacerbated by the perceived indifference of managers to tackling these problems. It seems that as long as calls are answered nothing else matters. Every manager is aware of these contentious issues but they have generally demonstrated a complete lack of engagement with staff. Any approach other than that employed now would be better. I say come and talk to us, empathise! Tell us that you recognise the problems, give us the reasons why it has to be this way and what you are doing to remedy the situation. Ask for our input and ideas. Communicate!

Alas this is not the case. I wouldn’t know many NIAS managers to see but I would definitely know their voices although I only hear them on Nolan whenever the service is under the spotlight. Then we get lingual gymnastics of the highest order and the spouting of half-truths that would make the slipperiest politician blush, along with insinuation that the problem is with the staff (instead of addressing the root causes) and assurances that everything is actually fine! It’s been them and us for a long time now but it has recently escalated into open warfare. On one side we have faceless suits who have never treated a patient in their life (apart from a couple of ex-paramedics who have went over to the dark side), and on the other we have the ambulance crews whose task is to provide a consistent service in the face of mounting pressures.

The big question is why should you, a member of the public care?

Austerity seems to be here to stay and the reduced funds available need be channelled to where they are needed most. But it is YOUR money, why would you not want it spent wisely? Are you happy that NIAS can’t find money to fund enough ambulances to take patients to hospital but can employ two medical directors (one earning £100k/year) while other larger ambulance services in the UK make do with one? That a new station and divisional HQ in Ballymena is to be built at a cost of £5.6 million? That they continue to allow many officers to drive fully equipped ambulance cars to get to and from home and work while not compelling them to attend emergency calls during periods of high pressure? That they have spent hundreds of thousands of pounds in the last four years training Paramedics but have forced many of them into lower-skilled positions or to join other services?

I am well aware of my own relatively privileged position – £21-27k per year is a good wage although still not commensurate with the demands of many aspects of the job. Add in pension, sick pay etc. and most people would probably think that we should just get on with it and count ourselves lucky. The reality is that the stress of the job is aggravated immensely by perpetual mismanagement. We are human, not an army of care-giving automatons and when normal people are stressed, tired and undervalued mistakes are made, injuries and sickness increase and the quality of service delivery drops. It impacts the public, ambulance crews and all their families.

Ask yourself how you would feel if a Paramedic gave your relative the wrong dose of a drug and you subsequently found out that they had been attending calls for 8 hours that shift without a break. I do not want to have sleepless nights after harming a patient because I did not have the courage to speak up about dangerous working practices for fear of being shouted down and portrayed as a self-interested public sector worker.

The most important principle in medicine is primum non nocere – first, do no harm. Decision makers need to do their utmost to create an environment for front-line staff that enables them to adhere to this principle. Above all the adversarial approach and lack of engagement needs to be left in the past, then maybe they can begin to properly look after those who look after you.

What do you think? Let us know your views in the comments below. We are keen to hear from other insiders. Got a view on your profession? feel free to contact us with your story Anonymity assured. 


  • Makhno

    It’s interesting to get the insight of someone on the front line. I don’t believe that you are anything like well paid for the job you do – I can remember a Tory minister calling paramedics ‘glorified taxi drivers’. I’m not sure how you can improve things outside of using union structures to the full. I can appreciate that you are subject to declarations of emergencies etc even while on strike, but what about working to contract, extending to working to rule, i.e not doing those things not specified in the contract? In too many jobs, workers continually give extra while simultaneously negating their own arguments that the system isn’t coping. This arguably creates unemployment – if the job can be covered with 8 people, what manager would employ 10?

    I acknowledge and value your concern about relations with the public, but perhaps we (the grateful public) need to decide whether we want properly funded services or are going to swallow the austerity line with its attendant public sector bashing. Nurses got nowhere for years given that many of them would not strike, and it was only a looming recruitment crisis which saw any sort of improvement in their terms and conditions. Sometimes the values which draw people to caring roles like your own can be the very things used against us by unscrupulous managers.

  • puffen

    The inaction of the Health Service Committee, has enabled vanity projects like one in Ballymena to proceed, at the same time as the threatened closure of the Dalriada Hospital in Ballycastle. Edwin Poots was the man on watch at the time, and it is to him that any questions should be directed, Management of NIAS cannot be blamed as they will try and get away with spending as much public money on building their corporate empire, as they can get away with. The post is factually correct, though there are longstanding issues of pay, Which management are fully aware of, And of which it would be fair to say, they have not acted in good faith.

  • hugh mccloy

    The gov are definitely more in favor of bringing in more private clinics / health hubs, this is what we will be faced with next. Ballymena and 2 others over in the SEHSCT

  • chrisjones2

    Look get used to it. We have too many small hospitals and cannot afford enough money to support this nonsense structure in NI. Parts of the NHS are excellent. Other bits are run for the benefit of staff – try getting an xray at the weekend when you are off work. We need a radical overhaul but the sectarian mess on the Hill cant deliver one.

    Eventually the service will just be eroded by salami slicing until they wise up or we stop electing them

  • puffen

    The London Ambulance Service has one Medical Director, the Northern Ireland Ambulance Service has two, go figure!

  • puffen

    It would appear that our CEO , has wound his neck back in, but he still has to explain why Agenda For Change has still not been resolved after ten years, This might be easier to take, but for the fact that The Medical Director, the lead Director in negotiations has been found with his snout in the trough,. Having taken 4 star break in the states at the public expense

  • puffen


  • puffen

    It is about time the the Assembly Health Committee had a look at NIAS, and not give them such a soft touch, I am a taxpayer too, and I have issues how this public body is being run.

  • blinkers

    Missed that one

  • puffen

    Irish News Dr Mc Manus

  • blinkers

    Hundreds of people unemployed would thankfully do your job,

  • blinkers

    Too big egos they have think they are special, the vast majority just courier patients and lime them up in a and e, hang about putting in time to avoid calls
    Then go and book suck for summer months. Shouldn’t be allowed to travel while on sick. They would be quickly back for the overtime.

  • puffen

    Think you have literacy problems

  • puffen

    The Health Committee in the Assembly has been falling down on a myriad of issues, it would be surely be better if it took direct responsibility, for all four Health Boards, and was answerable to the electorate|

  • blinkers

    Is that ur only moan, could probably do lot better, only u lot get paid more per hour for ur moaning and god knows u r well rehearsed in it,