Monday, 6 October 2014

The Good, The Bad and the Ugly

"66 year old institution, near collapse."

I don't really know where to start on this one. Usually I am ready to commentate on all things ambulance, especially when we are in the news, being thrown under the bus or maligned. A few months back The Spectator published the first of two articles regarding the current crisis within the ambulance service. It touches upon the amount of frontline staff leaving in their droves, and asks the very simple question, why? Fast forward a month and a second article was published, in what was a hard hitting, painful accurate portrayal of the crisis facing Londoners and all the ambulance services up and down the country. The official line, was that everyone was leaving because of pay and cost of living. Sadly, this couldn't be further from the truth. Whilst the article had some inaccuracies and was biased in some areas, the theme and overall mood of the piece was spot on. 

As I sat doing paperwork after dealing with a total time waster I listened to an urgent request for a vehicle, for a child vs a bus, trapped and screaming. I was a good 10 miles away but offered up all the same. 18 minutes later, I was shocked to discover that I was first on scene, on my own, in a car. To cut a future post short, the injuries were horrific, the child was in a grave situation and there was so much to do in terms of injury management that I needed more than my pair of hands. Unfortunately, more pairs were not forthcoming. It was an hour before backup arrived. An hour with a patient who's injuries still haunt me. An hour with the crying, screaming, panicked family, friends, neighbours and members of the public. If there was ever a situation to highlight the current crisis, it was here and now. With call demand rising week on week, staff leaving day by day and sick levels at an all time high, it certainly feels from where I am sitting that there is no way out. It feels like the ship is sinking, and everyone around me is jumping.

Over years of working with the same people, you forge very close friendships. Friendships which in many ways you rely on as part of your working day. I ended up with a close group of 5-6 friends with whom I could laugh with, confide in and socialise with. Within the last 12 months, all of them have left. Some to other ambulance services, others to other areas of healthcare. None of them cited money as the reason for leaving. The main theme was a lack of respect, lack of career progression, exhaustion and working conditions. The ones who went to other areas of healthcare, who don't necessarily enjoy their new job say 'well at least it's not the ambulance service'. People have quite simply had enough. 

From a personal point of view, I stopped blogging because I had nothing positive to say. Every day at work filled me with more negativity. And negativity breeds negativity. There was nothing I could write, without it sounding miserable and that's not what I'm about. The crisis within the ambulance service is caused by a domino effect of knee-jerk reactions from top to bottom of the NHS. The main issue from where I am standing, is the fact that for too long, the NHS functioned well but propped up by good will. Remove the good will, and everything slowly collapses. 

The Tory government insisted on huge cuts across the board and no matter what comes after, these ill advised, poorly implemented cuts to aid privatisation are the root cause of the problems. They are not the sole reason behind the current crisis though. Ambulance chiefs had to make savings but did so in panic and with what appears to be with little thought or planning. Again, it was a knee-jerk reaction. The problem was, in the panic, they made cuts in the three areas where cuts should never be made. They stopped investing in recruitment, the stopped investing in training and stopped investing in equipment. That left what was essentially a time bomb, and sure enough, 4-5 years on, that bomb has exploded. Richard Branson once said that "you must train your staff well enough so they can leave and treat them well enough that they don't want to". By doing the opposite, a mass exodus was inevitable. Unfortunately, by dangling the carrot of money, the service continued to just about cope with a lack of staff by filling the gaps on overtime. Time and a half, then double time, then triple, then double plus a bonus, then triple plus a bonus. Whilst this happened though, the void behind the good will got bigger and bigger. Eventually, the good will wasn't enough and in many cases stopped altogether. Fed up with being run ragged day after day, on an ancient, poorly kitted vehicle, with no rest break, having had no training for 5 years, and no prospect of career profession people left and on mass. In my service by all accounts it has been 30+ leaving a month, for a long time. And now the exodus won't stop. Day after day, you hear of more good people leaving. And none of them are citing money or cost of living as the reason. At least not to their friends and colleagues. 

The management are trying to solve the problem, they really are, but there is only so much that they can do. The problem is though, they made widespread, wholesale changes to the working lives and practices of staff with little consultation. In fairness, the changes had to be made. Again, it was the lack of change in a previous regime that led to it, but it's one thing to change practices during the working day, another to effect peoples family life. As much as this has had a negative effect on staff, this didn't cause the crisis, it was more a result of the crisis. Morale is at such a low ebb now, every promise of new staff, new vehicles and more training is met with cynicism, sarcasm and more resignations, and in many ways, rightly so. There is no trust any more. Unfortunately, the actions of previous management teams will continue to make the current ones efforts to solve it, near impossible.

This is the point at which I am getting frustrated though. It is all very well moaning about what is wrong, but personally, if you're going to moan, you have to be willing to work to help fix it. Sadly, you're left with half a workforce who are willing to help change things, willing to make positive suggestions and act upon them, and other half who won't, who block positive change, dig heels in and who spread a feeling of bad will throughout the work force. And it is THIS makes any positive change very slow to appear. Too slow in fact, to stop the rot. I also think the unions should be bearing the brunt of the blame when it comes to this. For too long they didn't represent the interests of the staff. The reps looked after themselves and saw their role as a great opportunity for time off the road, ignoring the wishes and concerns of large chunks of new staff and relief staff all because they were not considered  'core staff'. This fragmentation has led to the divide in working relations and is the cause of many newly qualified paramedics leaving the service after just a few months service.

The problems have been caused not only by lack of funding and lack of management but also poor working practice on behalf of some front line staff, throughout the NHS. It would be unfair to lay all the blame on the doorstep of managers. We as a work force should be taking responsibility for some of the issues we are faced. Call volume is at an all time high, the consequences of which we all face,  and various initiatives are being brought in to combat this. Hear and Treat, alternative care pathways, various streaming techniques and patient ring backs are all being used to try and lessen the impact on hospitals and the service. Not all staff are willing to help though. There are those who will take everyone to hospital because 'that's my job'. It is all well coming up with a solution but if everyone doesn't pull in the same direction you're left with a stalemate. 

There are some FRU's who cancel most ambulances, discharge and refer and try to save resources. There are others who won't cancel an ambulance and deal with the patient themselves because it means more paperwork or they are too risk adverse. There are ambulance crews who use as many alternative care pathways as possible and will offer up for calls being held. There are others who will sit there and not offer up for even a cardiac arrest being broadcasted because they are fed up being off late or haven't finished their tea. There are staff who drag their heels with everything they do from activation to at hospital times, just because they have had enough. There are some team leaders who are proactive and look after their staff, keep them current with their development and lead by example clinically. There are others who do literally nothing for their team and just come to work, take everyone to hospital and go home. There are good managers who manage staff well, and bad managers who don't. All positive dealings with any job role, any department and any service is always superceeded by the bad experiences. And here for me is where the problem lies. There are the good and the bad in every level, throughout the ambulance service and naturally, it is the bad that stalls progress. For too long the NHS has allowed bag eggs to stay in their jobs, preventing good people from progessing. There is a culture of blame and no cohesion within the ambulance service and people quickly become disillusoned. The camaraderie that once was, is diminished. The good will that held the service up is gone. The pride in the job we once had, is non-existent and you're left with a self destructive, miserable, tired workforce. 

And who suffers because of all of this infighting, poor working practice, bad management, budget cuts, staff resignations? The patients. The boy lying in front of me, screaming, his parents crying, his friends terrified. They don't care about all the crap. They don't care if we are recruiting from abroad. They don't care in our training course was cancelled. They don't care if it's the fault of the government or the fault of the previous management team. They don't care if the ambulance is old or if our rotas are changing. They care about why there is no ambulance in the here and now. We all have issues, but we have one fundamental responsibility, and that is to provide care to the people who need it, when they need it, in a professional and timely fashion. Anything short of that is a critical failure. 

The ambulance service is broken, there is no hiding from that, but if we want to fix it, everyone has to work for it. There is no switch, no quick fix. There are some people who need to take a long hard look at themselves and decide if this is the job for them. In the last few months I have been disgusted with the attitudes of some and the behaviour of others. It's disruptive and doesn't help the problem. There is so much to be proud of within the NHS, but if we continue to act to the detriment of the patients, it will only pave the way for full privatisation, and that would be a grave grave day. If you are not part of the solution, you are part of the problem. 








41 comments:

  1. Wow I've missed this blog! As someone who is soon to be starting their career within the ambulance service, I hope the fact that at my assessment centre, there was 30 or so cpearly motivated, able and intelligent candidates all with their heart set on a career with yourself provides a slither of silver lining

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  2. Yep, spot on. Sharing as wide as I can.

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  3. Very powerful Ella - glad you are back. A couple of questions - firstly where are the paramedics going? You say 'The main theme was a lack of respect, lack of career progression, exhaustion and working conditions. The ones who went to other areas of healthcare, who don't necessarily enjoy their new job say 'well at least it's not the ambulance service'. People have quite simply had enough' - I can absolutely see that but what areas of healthcare do they go? and if not other areas of healthcare - where do they go? Paramedicine, at present, is vocational so I'm wondering what transferable skills are used? Also I've been in the ambulance service nearly 20 years and didn't join until late in life but ever since I joined all I've ever heard is 'its never been so bad' - in your opinion are things really worse now or is perception? As you progress through your career people will leave and things will change but can it really be worse than being hammered everyday? The job you describe sounds horrendous by the way and I feel for you. Thanks Ella - I genuinely enjoy your blogs and admire your work - John

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    1. Abu Dhabi- But it's no better there where crews are forced to work as much as 72 hours a week without overtime.

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  4. With limited internal progression, paramedics have been picked off by other parts of the health economy. Round here we have lost a lot to Disability Assessment. More money, Mon-Fri, 9 to 5. A work-life balance. 999 emergency services now have to compete to retain paramedic skills and this needs to be recognised in pay and conditions. I still love being a paramedic, but they're making it harder for me!!

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  5. Hear hear. Well said.

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  6. Very well written and balanced assessment. I hope AR reads this to give her a proper insight into her service.

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  7. LS no matter how motivated you are or how intelligent, the ambulance service will suck the life out of you. There is nothing you can do to change it, you will become one if us, demotivated, fighting a losing battle, frustrated and eventually bitter.
    Run while you can to somewhere where you motivation and intelligence with be appreciated. It's certainly not the ambulance service!

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  8. Wow. I work in the police and if you replace the word "ambulance" with "police", and "paramedic" with "Cop" it's exactly the same. Hit the nail on the head with what's wrong in the public sector at the moment.

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  9. I personally was not aware of your blog, Ella. However, having read this as i see it's doing the rounds on facebook sharing, i can only applaud your awareness of what are the real reasons for the mass exodus from the Service. Those of us 'old school' Paramedics with long service truly have never seen a workforce feeling so under-valued as they appear to be at the present time. The sad fact is the reality of a 'hidden in plain sight' agenda of Government(?) Service Management(?), to downsize and allow privatisation to occur. The NHS costs money: Privatisation makes money.
    Maybe i am being over-simplistic in my belief of this very real agenda, but cannot see any other reason to allow so many staff to leave without any attempt to retain them. Those that do stay will find that improvement in staff welfare is highly unlikely.
    I feel i have very much summarised my thoughts mainly because i did not want this to turn in to another blog on your site.
    That just leaves me to say keep it up....the operational staff need a 'voice of the people' and yours is a voice worth listening to.

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  10. I am one of those that left the service for the same reasons you have mentioned. I found that due to late finishes, meal breaks that were well out of banding and the general way we are run ragged, my health was starting to suffer and I was mentally drained by the end of every shift. I ran on adrenaline till my days off and then they were used as recovery. I would have classed myself as a positive person when I first joined but this was gradually worn down by so much negativity from others. I loved the job, or should I say I loved what the job should have been. The fault lies in training, management, public perception (and abuse of the service), GP's abusing the system, a triage system that can't cope, 111, government and members of staff who basically stand around drinking tea while other people are trying to respond to extra calls. This to me can't be fixed. You can't correct one area without looking at another. The truth is, if members of the public were educated on what an emergency is they would think twice about calling 999. Unfortunately they'd call 111 instead and still would get an ambulance. No right answer to this but I hope it gets better as there are a lot of good men and women out there trying their best

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  11. Well said. Where I work you'd get no thanks (or support) for your hour spent with the child ... but I do get an email pat on the back for using the right colour mop and bucket to clean the toilets, kitchen, corridor or vehicle.

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  12. I was speaking about this today. I asked 5 Paramedics if they were happy with their job, they all said no. It's so wrong that we feel like this.

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  13. Fair and true but the service seems to have no direction from managment at the highest level to the bottom grade (what ever that is these days) as road crew sort us out a set of standerds and remits that mean somthing and reinvest properly in the excelent staff that are in place and use them wisley instead of letting them walk unopposed or is that what they want????

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  14. Respect to all of the ambulance service. My father had cause for your service a year back when he was a cancer patient. Thanks to one of your colleagues who suggested he might be on too many tablets that were contradicting each other the hospital manage to solve his blackouts. You are the unsung heroes if I could wave a magic wand and give you the wages and working hours you deserve trust me I would I take my hat off to you guys .

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  15. Unfortunately it's the same story in A&E too...

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  16. I have had a couple of trips in ambulances and also worked as an ECA for a couple of years, so I have seen both sides of the service.
    I worked for SJA, and wearing those bright greens just meant you were a doormat for most triage nurses and some paramedics.
    Some paras really had a passion for the job but some were just so rude and ignorant. Is this lack of morale or people in the wrong job? I was so disappointed when I was turned down for an EMT1 role, and now work in medical engineering.
    I must admit my current job is less stressful, with better pay and conditions. I used to hate coming home for dinner at nearly midnight, never seeing friends or family. But I loved helping patients.
    I have been to some bad trauma jobs, and seen some distressed relatives.
    Privatisation of the ambulance service would mean worse vehicles, less training, more hours and less support. Unfortunately the people who love the job stay on the road, and the ones who CBA look for office days, and this poor attitude has its affect on the service.
    I thought I could one day make a great paramedic. But you need to think about yourself. I really hope that if I ever need an ambulance again I get someone who is selfless and passionate, instead of some that I have had the displeasure of working alongside.
    Sometimes you think patients are wasting time, but put yourself in their position. How would you feel?
    The service needs shorter shifts, with longer breaks and FFS moved up to Band 6! There are some people who are rinsing the NHS with no intension of working and managers need better power to sack tge idle and reward the faithful.

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  17. Nowhere is the reality of this collapse clearer to see than in the seat of the Ambulance Diapatcher. The pain of every patient, the agony of the lengthy waits and the understandable fatigue/dispair of the once-dedicated road staff.

    It's going to take true team effort, innovation and goodwill to survive... So "If you're not part of the solution, you're part of....."

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  18. Where is Sir Francis when you need him !!!

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  19. Excellent post Ella, and a very accurate picture you've painted of conditions and problems faced by ambulance staff across the UK. It's so refreshing to hear someone speak out about some of the home truths that don't normally come to light too.

    Many colleagues I speak to are still under the impression that Trusts need more vehicles to do the job currently required of us. Whilst I feel like I'm the only person saying we should invest in urgent care, hear and treat, and more pathways for low acuity patients whilst increasing non-conveyance rates,

    If I'm totally honest though I think it is the demoralised, and bitter, staff that don't want to do anything other than take people to hospital because it's what's always been done and is most risk averse, these are the same people that complain about 12 hour shifts, but won't work anything else offered because off the potential loss in unsocial shift enhancement or whole days off, the same people who complain about not getting meals on time whilst hanging out at hospital to make sure an out of window payment is earnt, regardless of how many cars are sat on scene screaming for back up... These are the people in the wrong job, yet have no intention of leaving until they've made sure everyone else is as demotivated and miserable as themselves!

    Keep up the good work :-)

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  20. Wow. I couldn't have put that better myself. I left the ambulance service for all of the reasons you have put. I was simply feed up with being left to deal with dying patients and no back up. I am happy now, working elsewhere in health care. And I think that working for the ambulance service as it is now is a terrible job. Hand on heart I wouldn't recommend it to anyone, and that really saddens me.

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  21. As the wife of a paramedic I agree with most of what you say, but sorry, standing around drinking tea??? not on my husbands shift love, he doesn't ever get the chance!!! now doing 12 hours straight with never a break and once every 12 weeks he has to do 7 twelve hour shifts in 8 days!! The staff are run ragged. When they have a genuine need to return to station, (soiled uniforms, ambulances awash with blood!!!) they are treated with disdain by the controllers who seem to permanently assume they are looking for a chance to skive. They are exhausted and treated very poorly, management believe the best way to deal with the staff shortages is to just beat the staff more with sticks, push them ever harder to make up the shortfall. No wonder the service is losing staff at an ever increasing rate. Perhaps management could go back to treating the staff as human beings, it might help. But yes, things will certainly get worse before there is any improvement.

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    1. Look, I know the game. We all do. Yes, we are run ragged to the point of breaking, but anyone who says they don't have the chance for a cuppa is telling a fib! I drink far to much of the stuff, mainly to get me through the horrendous runs of shifts you mention. But there are people, clearly not your husband, who will sit in their cab sat at hospital and ignore broadcasts for cardiac arrests. Only two nights ago I heard a crew say 'Fuck em' when it was broadcast. It's these people I refer to and it's these people that are the cancer of the service. 90% are dedicated hard working people, but it's the 10% who can't be bothered, have lost compassion, persistently negative and obstructive with progress that are crippling the service!

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    2. So true especially the management bit

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  22. A&E is just the same its sapping the life out of me and thats sad as I love my job but the pressure is enormous and 60% of patients shouldnt even be there

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  23. Good post! A while back at a station meeting our chief executive was asked what he was going to do to prevent experienced staff from leaving... His response staggered us; "Nothing", he said... "Staff have ALWAYS left for one reason or another, and new staff have ALWAYS come in to replace them. I don't need to alter that cycle". That is the mentality we are up against.
    I've been in for 20 years now and things really are bad. However we have a massive body of very young and newly qualified staff who have never known anything different. For them they are doing a job they want to do and let's face it, as a 20 year old fresh out of Uni going into a first job the money isn't bad. So what have they got to complain about? It's only us Dinosaurs that moan about being expected to drive at 100 miles an hour everywhere, not getting breaks, refusing to carry people you know damned well can walk, etc...
    Keep up the good work
    Diagnosis? LOL!

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  24. Thank you for a well balanced and informative article.while I have no direct involvement in LAS I did work in a neighbouring service as a paramedic and some of the experiences you highlight reflect my own. 5 years ago I resigned and left for Australia to work as a paramedic and things are so different here, I now have a career in which I am genuinely valued as a professional person by my employer and the community at large. It saddens me greatly that the nhs is broken probably beyond repair despite the very best efforts of the majority of staff and from an outsiders view may reflect british society in general. I digress. Interesting to note that LAS director of ops has been here recently on a recruitment drive does he seriously think paramedics here would willingly swap the lifestyle here for the lifestyle there.let really don't think so.

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  25. The NHS is not being ruined by politicians cuts its frozen)! its being ruined by its top heavy structure! with overpaid upper and middle management as well as support services, consulting groups, trust boards etc All with a fetish for targets yet are lavishly spunking public money on artworks for there headquarters and private finance initiatives. ( which will turn out very costly in the long run!).
    So what is my answer !!!! Take the axe to the top and trim it down!!!!!!! Wait we carnt , agenda for change!
    The money is in the pot but is squandered, fleeced and mismanaged. So why throw good money after bad!
    All clinical staff know the problems and many have ideas on how to improve the service , yet these people do not have a voice due to the size, scale and fear of the organisation above them.
    The ambulance service is being hammered at the moment but what are the causes,is it cuts ? I'm not sure im seeing more ambulances and staff appear on the road than ever before.!!
    Id say its demand but is this due to more ill people or just miss management!
    Take 111 if the public required an ambulance, would they not ring 999 ?? Or in this litigation conscious culture is it not right to suggest the public has common sense!
    Also the massive investment in the lucrative care home sector !!! Which i basically a B&B service, extortionately charged to elderly people by fat cats for maximum profits! Whilst paying there staff pittance an understaffing very often. (medical covers free any problems ring the ambulance service they have to come and it doesn't affect profit margins, like training would.!!!!!
    Anyway sorry for the rant.coopizlcocc

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  26. I'm just starting out as a student, it's been my ambition to be a para for a long time. However, having worked in and around the service for a while I know exactly what the situation is like at the moment. My worry is that it'll get worse before it gets better, due to the change in degree for paramedics, being brought in next year, there will be no influx of graduates in 2017, will the service be changed enough by then that graduates will be more inclined to stay? Because if it isn't and the rate of attrition carries on the way it's going, the shortage is about to get a lot worse.
    I for one am proud of what I do and I I want to help protect the NHS but I'm not blind enough to know that paramedicing isn't a life long career anymore, paramedics tend to burn out and move on (be that elsewhere or into clinical support roles in control) within about 5-10 years tops, without injury.
    Are we fighting a losing battle?

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  27. spot on - I moved into another area 9 years ago and the feeling are similar but a little behind the ambulance service. the phase 2 of the keogh report is the way ahead for staff and the service but the money for staff, traning and equipment needs to be there to. Yes staff want a fair wage for the job they do and the responsibilities they take - A fair wage, thats all
    Keep writing and we will keep spearding it - it might just fall on the ight, rather than deaf, ears

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  28. 7 years as relief...no fixed station, no fixed crew mate, no locker, no set shift pattern. When I raise a comment, its shot down with "your opinion doesn't count....you're not core staff". And they wonder why I'm reluctant to help.

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  29. Absolutely fantastic that someone has finally put into words exactly what has been happening for over the past 30 years. It needs a total prune from top to bottom...get rid of the dead, negative wood.

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  30. You are right when you mention this government's policy to denegrate and demoralise the ambulance service.
    (And indeed the whole of the nhs).
    It will then be perceived to be a failure and be ripe for picking off by private companies, owned or share - held, by Cameron and Osborne's millionaire buddies, none of whom need the public sector.
    wake up and 'smell the coffee' when it comes to voting...

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  31. Absolutely amazing and truthful article. I left the Service in 2013, not due to the reasons stated (even though there are totally true), but to move to another country.
    I have seen the type of people we have all mentioned, the (lets face it) LAZY ones, the ones who don't give a rats ass about cars waiting for crews.
    There are some very very good paramedics out there, alas they are all being dragged down by mis-management, too many chiefs and not enough Indians, over paid chiefs to-boot.
    Keep up the good work
    L

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  32. Hi there I have been in the service now for almost two years(one year probation). Everything you said in your blog I can relate to and have experienced myself. I have worked in many areas of front line care and its the same all over. Morale is at an all time low. I spent the first year of my career as a student so eager wanting to make a difference in any situation. 10 months post qualifying I am looking at my prospects and 're assessing my future. I have came into an unfortunate area and progression to para course is looking further and further away. Every day I am feeling more negative about this career choice that I sacrificed so much for to be treated like the weakest part of the chain by other professionals and ruined by management. So much could be done to improve but your absoloutely right the job is full of people who just take the easy route and have been worn down after years of bad treatment. Unfortunately what staff forget is inevitably it's the people who genuinely do need us that suffer in the end. The public. Is that not why we started on this path to help people? Written by a worn out technician

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  33. i would just like to say that i do agree that the nhs needs improving but for all the times i called for an ambulance when my baby was having seizures the ambulance crews were amazing from the people on the phone trying to keep me calm to the first responder that came to help & the paramedics that got us to the hospital! i think you guys do an absolutely amazing job n i for one would have been clueless without your help! Your doing a fab job guys please don't give up

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  34. You should be very proud of what you have written here, accurate and to the point and obviously heartfelt. For the reasons you have pointed out, I strongly believe that it will never change for the better, it has progressively got worse over the 20 years that I suffered it - yes, I am one of those who has given up, and it feels great! If I may, I would like to add one aspect to your piece that I believe is the core reason that things will never improve - PERSONALITY. If you treat people without respect (and this is the main issue), they will respond as is their personality, and although it is best not to make this problem seem all about money, to most, Band 5 is a sign of disrespect. Not so just because of what they give, but also because they know what the job takes from them. Revenge (due to lack of respect given), is the key personality trait that will prevent any real progression, to many the only satisfaction they have is knowing that things will never improve until they are treated appropriately and so in the meantime they just sit back and watch it implode. Important to add though, these people never became like this overnight, they are not 'bad' people. If 10 new Paramedics are reading this today, firstly my advice would be to pack it in and go use your degree where you and it will be valued, secondly, at least 5 of you will become the above and you won't realise it until it's too late to change! The best thing that has happened over recent years is that the Paramedic qualification is recognised outside of the Ambulance Service, so finally we can vote with our feet.

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  35. My daughter is a paramedic and I could not be more proud of her. She works hard, long hours and from my heart I know she gives a wonderful and caring response in all situations. Sadly what Ella says is true. What to do as a member of the public? I can but promote the Paramedic profession and hope beyond hope some sense prevails over future governments to act in a more long term responsive way! Let's hope they do....

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  36. I hope you will accept this from a recently retired paramedic-42 years service. These attitudes have always been there to a greater or lesser degree-its not a new manifestation believe me. I finished my time on the road but have been up the slippery pole-no I didn't slide down I retired. Colleagues I have spoken to since retiring, without exception, say that they are at their very lowest ebb for all the reasons listed -run ragged, constant change of rosters, your always wrong until you prove your innocent etc. Even the very best motivated are creaking. Is this repairable in the short-medium term? I doubt it the fractures are too deep. I think a fundamental review of what the Ambulance Service should be would be a start. Why is the Service the "catch all" for everything else that no one wants to deal with? Why is there an expectation that you will always get an ambulance? Give the staff time to draw breath sometimes and we may, just may, start to see an uplift in goodwill again. Because as sure as eggs is eggs, it cant run without it. Just look at the loss of core shifts in Shropshire because staff do not want any more overtime for the above reasons. Getting out was the best move I ever made. What a sad indictment after 42 years.

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  37. Cracking read & welcome back Ella. Scary thing is its not just the sharp end of the NHS feeling that way, its the whole thing! Far too many penpushing types with fanciful,impractical ideas that miss out on the basics. Rebuild from the bottom up, if they keep pruning the roots the tree will fall over in the next gust of wind.

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