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 firstname.lastname@example.org Anonymity assured.