> ## Content Index > Fetch the complete content index at: https://www.europeans.today/llms.txt > Use this file to discover other available public pages before exploring further. # Why ambulance workers in England and Wales are going on strike - URL: https://www.europeans.today/2022/12/20/why-ambulance-workers-in-england-and-wales-are-going-on-strike/ - Published: 2022-12-20T03:00:00.000Z - Updated: 2022-12-20T18:13:22.000Z - Description: Ambulance services are facing unfair criticism for a situation which is not of their making. The workforce is in crisis, with system-wide pressures seriously hampering their ability to do their jobs. - Author: Professor Paresh Wankhade - Tags: UK Strikes, Ambulances, NHS, NHS Staff, Hospitals, Paramedics, Social Care, United Kingdom, UK Government, UK Politics ### Ambulance services are facing unfair criticism for a situation which is not of their making. The workforce is in crisis, with system-wide pressures seriously hampering their ability to do their jobs. ###### First published: Dec 2022. --- Emergency service workers are [set to strike](https://www.bbc.co.uk/news/live/uk-63871368?ref=europeans.today) on December 21 2022, to demand better pay. The strike action is happening as the UK is witnessing [the worst ambulance handover delays on record](https://www.telegraph.co.uk/news/2022/11/24/ambulance-handover-delays-worst-record/?ref=europeans.today). Thousands of patients are having to wait outside A&Es up and down the country in the back of ambulances, as backlogs are cleared. A [parliamentary inquiry](https://committees.parliament.uk/committee/430/public-services-committee/news/173229/inquiry-launched-into-access-to-emergency-services/?ref=europeans.today) was launched in September 2022, amid media reports of [“appalling waits”](https://www.theguardian.com/society/2022/apr/10/appalling-waits-for-ambulances-in-england-leaving-lives-at-risk?ref=europeans.today) for ambulances – [up to 40 hours long](https://www.bbc.co.uk/news/health-63808516?ref=europeans.today) – and lives left at [risk](https://www.bbc.co.uk/news/health-63743383?ref=europeans.today) on a daily basis. Adrian Boyle, the head of the Royal College of Emergency Medicine, recently told BBC Radio 4’s Today programme that this is forcing ambulances to be [“wards on wheels”](https://www.theguardian.com/society/2022/dec/01/emergency-care-england-death-waits-ambulances?ref=europeans.today) and could cause excess deaths in England. I have been studying the UK’s emergency and ambulance [services](https://theconversation.com/how-to-reboot-britains-fractured-emergency-services-79528?ref=europeans.today) for over 15 years. My research shows that they are facing unfair criticism for a situation which is not of their making. The workforce is in crisis, with system-wide pressures seriously hampering their ability to do their jobs. Ambulance staff I have [interviewed](https://www.tandfonline.com/doi/full/10.1080/09540962.2021.2003101?ref=europeans.today), describe their experience of the pandemic so far as “traumatic”, stressful, and a “test” of their “resilience”. The sector is [struggling with](http://www.aace.org.uk/wp-content/uploads/2015/09/Ambulance-2020-and-beyond-the-AACE-vision.pdf?ref=europeans.today) staffing shortages and retention and the [highest sickness absence rates](https://bmjopen.bmj.com/content/11/9/e053885?ref=europeans.today) among all NHS organisations. [Research](https://www.nuffieldtrust.org.uk/news-item/feeling-blue-the-experiences-of-ambulance-staff?ref=europeans.today) points to deteriorating job satisfaction among its ranks, with staff increasingly suffering from [burnout](https://theconversation.com/emergency-service-workers-are-already-at-high-risk-of-burnout-coronavirus-will-make-this-worse-136006?ref=europeans.today) and stress. ### **Bed capacity and delayed discharges** When ambulances have to wait outside hospitals to hand patients over, it reduces their capacity to respond to other calls. Since 2013-14, the four-hour A&E waiting time standard [has not been met](https://www.kingsfund.org.uk/projects/urgent-emergency-care/urgent-and-emergency-care-mythbusters?ref=europeans.today), nationally, in England; since July 2015, it has been missed every month. These longer wait times in A&E are largely due to increased emergency admissions, staffing pressures and reduced bed capacity. Between 1987 and 2020, the number of hospital bed places [more than halved](https://www.kingsfund.org.uk/publications/nhs-hospital-bed-numbers?ref=europeans.today) (from about 299,000 to 141,000), while admissions and overnight bed occupancy [have steadily risen](https://www.health.org.uk/publications/reports/how-many-beds-will-the-nhs-need-over-the-coming-decade?ref=europeans.today). England has one of the [lowest rates](https://www.health.org.uk/publications/reports/how-many-beds-will-the-nhs-need-over-the-coming-decade?ref=europeans.today) of hospital beds per person (just two per 1,000 people), among Organisation for Economic Co-operation and Development countries. Latest projections by the [Health Foundation](https://www.health.org.uk/publications/reports/how-many-beds-will-the-nhs-need-over-the-coming-decade?ref=europeans.today) charity show that, in order to deliver 2018-19-levels of care, up to 39,000 extra hospital beds would be needed by 2030-31. We know that [one in five emergency admissions](https://www.nuffieldtrust.org.uk/files/2018-10/qualitywatch-preventable-admissions.pdf?ref=europeans.today) is avoidable. We also know that [one in three](https://www.theguardian.com/society/2022/nov/13/hospital-beds-england-occupied-patients-fit-discharge?ref=europeans.today) patients across NHS England are staying in hospital for longer than they need. This has, in part, been attributed to [the lack](https://www.nuffieldtrust.org.uk/news-item/hospitals-at-capacity-understanding-delays-in-patient-discharge?ref=europeans.today) of social care provision in the community. However, fears of a [“tripledemic”](https://www.bbc.co.uk/news/health-63307833?ref=europeans.today) of high levels of flu, COVID and respiratory infections this winter could result into up to half of the available beds being occupied by patients – making an already grim situation even worse. ### **Handover delays** Since March 2022, NHS England targets stipulate that handovers from ambulance to A&E should take place within 60 minutes. Notwithstanding [NHS plans](https://www.england.nhs.uk/reducing-ambulance-handover-delays-kloes/?ref=europeans.today) for improvement, a quality indicator for measuring hospital performance in meeting those transfer-time targets has not yet materialised, despite [parliamentary recommendations](https://publications.parliament.uk/pa/cm201012/cmselect/cmpubacc/1353/1353.pdf?ref=europeans.today) made more than a decade ago. The government’s own policy document [has revealed](https://www.gov.uk/government/publications/our-plan-for-patients/our-plan-for-patients?ref=europeans.today) that in the winter of 2021, 45% of ambulance handover delays took place in 15 hospital trusts. Patients are [increasingly being held](https://www.cqc.org.uk/publications/major-reports/soc202021%5F02c%5Fambulance-handovers?ref=europeans.today) in ambulances, either awaiting treatment or until a place is available in A&E wards. This raises serious concerns around [patient safety and harm](https://aace.org.uk/wp-content/uploads/2021/11/AACE-Delayed-hospital-handovers-Impact-assessment-of-patient-harm-FINAL-Nov-2021.pdf?ref=europeans.today), concerns which the most recent data backs up. [According](https://aace.org.uk/wp-content/uploads/2022/11/National-Ambulance-Data-to-October-2022-FINAL.pdf?ref=europeans.today) to the Association of Ambulance Chief Executives, in October 2022, almost 44,000 patients experienced potential harm as a result of long handover delays and nearly 5,000 of these, severe harm. Handovers exceeding three hours reached nearly 15,000 in October; those exceeding 10 hours also grew to reach a series high of 860\. Month on month, wait times have increased by 28%. These delays have a knock-on effect. They lead to emergency call handlers having to respond to distressed patients and families with updates on their wait times. They can also lead to [thousands](https://www.nhsconfed.org/articles/what-latest-data-tell-us-about-ambulance-handover-delays?ref=europeans.today) of additional (duplicate) calls, thereby adding to the pressure on the system. ![](https://storage.ghost.io/c/15/40/1540bec0-7154-4feb-b8e1-97f579155b08/content/images/2022/12/wwww-00048.jpg) ###### A “tripledemic” of flu, COVID and respiratory infections this winter could result into up to half of the available beds being occupied by patients. | [CREDIT: UNSPLASH/IAN TAYLOR](https://unsplash.com/@carrier%5Flost?ref=europeans.today) ### **Emergency call triage** In my research, I have shown how [unsuited](https://www.tandfonline.com/doi/full/10.1080/14719037.2019.1642377?ref=europeans.today) the NHS ambulance model – which is largely predicated on rapid response, patient stabilisation and handover to hospitals – is to the new realities of increased demand, bed shortage and lack of social care capacity. It also does not take into account [the higher clinical skill](https://www.routledge.com/Emergency-Services-Management-A-Research-Overview/Wankhade-Murphy/p/book/9781032055435?ref=europeans.today) sets paramedics now boast. Call volumes have grown exponentially from eight million 999 calls in [2010-11](https://digital.nhs.uk/data-and-information/publications/statistical/ambulance-services/ambulance-services-england-2010-11?ref=europeans.today) to over [12 million in 2019-20](https://aace.org.uk/wp-content/uploads/2020/10/AACE-ANNUAL-REPORT-2019-2020-FINAL.pdf?ref=europeans.today). The pandemic has increased [mental health calls](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415211/?ref=europeans.today) as well as unplanned primary care calls, due to people [not being able to access](https://www.instituteforgovernment.org.uk/blog/therese-coffey-nhs-social-care?ref=europeans.today) a GP. In July 2017, [new national standards](https://www.england.nhs.uk/urgent-emergency-care/improving-ambulance-services/arp/?ref=europeans.today) were formalised for assessing emergency response performance: life-threatening injuries (response within 7 minutes); urgent (within 18 minutes); urgent but not immediately life-threatening (90% of calls within 120 minutes); and non-urgent (90% of calls within 180 minutes). This system has given handlers more time to determine the best response to any given call. However, it remains predicated on [targets and response times](https://www.england.nhs.uk/wp-content/uploads/2017/07/new-ambulance-standards-easy-read.pdf?ref=europeans.today), rather than on clinical outcomes and quality of patient care. Also, it’s [not working](https://www.nuffieldtrust.org.uk/resource/ambulance-response-times?ref=europeans.today#background). In [October 2022](https://researchbriefings.files.parliament.uk/documents/CBP-7281/CBP-7281.pdf?ref=europeans.today), the average response time for a category-1 call was nine minutes 56 seconds – almost three minutes longer than the seven-minute target. Category-2 calls are taking up to two hours and 16 minutes, as compared with a target of 40 minutes. This continued focus by commissioners, regulators and providers on [“meeting response times”](https://www.nao.org.uk/wp-content/uploads/2017/01/NHS-Ambulance-Services.pdf?ref=europeans.today), despite the [weak correlation](https://www.emerald.com/insight/content/doi/10.1108/09513551111147132/full/html?ref=europeans.today) with clinician outcomes, is worrying. Research shows how risk-averse the [NHS 111](https://www.telegraph.co.uk/news/2021/06/19/exclusive-risk-averse-nhs-111-algorithm-piling-pressure-ambulances/?ref=europeans.today) system (including the 999 system) has become, resulting in improper triage. [More ambulances](https://www.theguardian.com/society/2017/feb/22/risk-averse-nhs-111-sends-more-callers-to-ae-than-previous-service?ref=europeans.today) are being deployed, with highly clinically skilled crews sent out to non-serious calls. Paramedics are [pleading for help](https://www.mirror.co.uk/news/politics/ambulance-service-crippled-demand-leaving-28727630?ref=europeans.today) and, as GMB national officer Rachel Harrison [recently put it](https://www.theguardian.com/society/2022/jun/12/paramedics-are-leaving-in-droves-as-ambulance-callouts-almost-double?ref=europeans.today), “leaving in droves”. Unless bold [system-wide reforms](https://www.nhsconfed.org/publications/re-envisioning-urgent-and-emergency-care?ref=europeans.today) are implemented, emergency response services will continue to be frustrated in their efforts to save lives. ![PMP Magazine](https://storage.ghost.io/c/15/40/1540bec0-7154-4feb-b8e1-97f579155b08/content/images/2021/09/end-flat-1.png "PMP Magazine") --- | [![](https://storage.ghost.io/c/15/40/1540bec0-7154-4feb-b8e1-97f579155b08/content/images/2022/08/feeback1-small-flatten-1.png)](https://forms.gle/tRe7igVtMPaiAPtJ8?ref=europeans.today "Leave some feedback") | [![](https://storage.ghost.io/c/15/40/1540bec0-7154-4feb-b8e1-97f579155b08/content/images/2022/08/share-1-small-flatten.png)](#share "Share this article") | [![](https://storage.ghost.io/c/15/40/1540bec0-7154-4feb-b8e1-97f579155b08/content/images/2022/08/comment4-small-flatten-2.png)](#comments "Leave a comment") | | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------- | --- ### **— AUTHOR —** | ![](https://storage.ghost.io/c/15/40/1540bec0-7154-4feb-b8e1-97f579155b08/content/images/2022/12/paresh-wankhade-2.jpg) | ▫ **[Professor Paresh Wankhade](https://www.europeans.today/author/paresh-wankhade)*, Professor of Leadership and Management & Director of Research, Edge Hill University.* | | ----------------------------------------------------------------------------------------------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --- ##### Sources **Text:** This piece was originally published in [The Conversation](https://theconversation.com/why-ambulance-workers-in-england-and-wales-are-going-on-strike-196434?ref=europeans.today) and re-published in PMP Magazine on 20 December 2022\. | The author writes in a personal capacity. - **Cover:** Adobe Stock/[jane](https://stock.adobe.com/uk/contributor/5744/jane?load%5Ftype=author&prev%5Furl=detail&ref=europeans.today). ![The Conversation](https://counter.theconversation.com/content/196434/count.gif?distributor=republish-lightbox-basic)