Feeling blue: the experiences of ambulance staff

How ambulance staff feel about their work has long been a concern, but the results of the latest staff survey show that their job satisfaction has deteriorated further. Cyril Lobont takes a closer look at the findings and describes the importance of improving the situation.

Blog post

Published: 09/11/2022

The flashing blue lights and fluorescent bodywork of an ambulance tearing past are one of the most regular reminders of the NHS’s integral role in our society. It has been no secret during recent months that ambulance services have found themselves in a very concerning situation, resulting in growing numbers of sobering stories of lives lost because ambulances failed to respond to critical situations in time.

Rises in A&E handover times threaten to make this indispensable emergency service fail to fulfil its intended function, driving response times up at an unprecedented rate. The people who make up the ambulance service, and those who depend on them, are bearing the brunt of these mounting pressures.

In this blog, I unpick some of the challenges facing the ambulance service workforce and face up to the reality that, without adequately targeting the crisis faced by staff, there is considerable risk of the situation escalating further.

Staffing trends

There has generally been year-on-year growth in the number of ambulance staff, with the number of registered ambulance staff growing by just over 50% in 11 years, to a total of 17,847 in June 2022, working alongside 24,979 support staff. However, the rate at which ambulance staff are leaving has also gone up. Between June 2010 and June 2011, 4.8% of ambulance staff in England left their roles, but between June 2021 and June 2022 that figure was 10.3% (or 1,761 people).

This also constitutes a greater rise in leaver rates than the average for all NHS staff, which went from 10.6% to 12.5% over the same 11 years. Even if these leavers are being replaced, training and integrating new staff is a costly and time-consuming exercise for employers.

Working experiences

The working experiences of ambulance staff have been a longstanding concern compared to other staff groups, with consistently lower levels of satisfaction, stemming from poor working conditions. However, the results of the 2021 NHS staff survey show that satisfaction has suddenly deteriorated further. Compared to 2020, staff in ambulance trusts were 10 percentage points less likely to look forward to going to work or be enthusiastic about their job. This trend is apparent across most relevant measures in the survey.

The selected survey measures in the chart below also do not paint a positive picture. They specifically look at paramedics, and compare 2021 scores to 2019 (where data is available) as well as to survey results from nurses who care for adults – a reasonably comparable staff group.

As shown, paramedics are less likely to have positive key relationships within the workplace, and are more likely to experience violence, than they reported two years before. Compared with nurses, on these metrics their experiences are also less positive. Such factors can only serve to drive people away from continuing, or embarking upon, a career as a paramedic.

Paramedics, like nurses, start at Band 5 in the NHS pay scale. Unsurprisingly therefore, nurses and paramedics had similar levels of satisfaction with pay. However, nurses were almost 10% more likely than paramedics to agree that there are opportunities for them to develop their career in their organisation. The gap is even larger regarding feeling supported to develop one’s potential; over half of nurses felt they were supported, while only one in three paramedics did.

Given these results, it is hardly surprising that in 2021, the proportion of ambulance trust staff wanting to leave their organisation as soon as they could find another job increased by 5 percentage points compared to 2019.

Over a quarter of paramedics signalled this intention in the most recent survey. It is worth noting that this survey data was collected prior to the most dramatic rates of deterioration in waiting and handover times, which have occurred in recent months. This creates considerable concern that, without targeted efforts to help alleviate the stress that ambulance staff are under, their working experiences are likely to deteriorate further.

Our recent explainer on nurse leaver rates brings attention to how high the turnover is in a part of the NHS where staff are, generally, happier than ambulance workers. Even though not all staff who say they intend to leave their job soon will in fact do so, the fact that paramedics were 9% more likely than nurses who care for adults to want to leave their organisation as soon as they could find another job should not be taken lightly, particularly when staff turnover has already been climbing.

The importance of improving the situation

While some of these issues are longstanding, or even sometimes unavoidable on the front line of the ambulance service (such as occasional encounters with violent patients), recent developments may exacerbate the problem of dissatisfaction among staff. Ambulance crews find themselves in the frustrating situation of being unable to provide an adequate service as standards fall, largely driven by delayed discharges and the lack of available beds.

Of the issues affecting the ambulance workforce already mentioned, some are undoubtedly more difficult to address in isolation (especially if dependent on the performance of other NHS services). However, some others depend less on NHS-wide issues. For example, the NHS Long Term Plan recognises violence against ambulance crews as an issue and mentions initiatives such as the use of body-worn cameras to reduce the number of incidents. On the other hand, there is less evidence of concerted efforts to address organisational culture.

Delivering on these could, to an extent, counteract the negative trajectory of the desirability of roles in the service, and the implications that further dips in retention could have upon operations. After all, an ambulance service that gets the right care to everyone who needs it, as soon as they need it, is a key pillar in restoring a nation’s confidence in its health service.