Visiting London Ambulance Service HQ (Part One): Lion's Den or Temple of Enlightenment?

The comments and emails I have been receiving as a result of this blog paint a bleak picture of operational ambulance staff struggling under the increasingly intolerable burden of great responsibility, health-eroding fatigue and an employer that doesn't care about their welfare.

According to reports received from a variety of sources, London Ambulance Service (LAS) in particular is perceived by many to be pushing its staff too hard for too long.

Last week, I visited LAS headquarters in Waterloo in an effort to understand what was going wrong. On my journey, I contemplated what the day might reveal. My itinerary included a short ride-out an emergency vehicle, an hour with Chief Executive Dr Fionna Moore and Director of Operations Jason Killens, and some time in the control centre. As a former front-line paramedic who - like most road staff - rarely saw my own station let alone the nerve centre of the entire organisation, it was an opportunity to see behind the curtain at the machinery and the minds that keeps things moving.

In spite of my attempts at journalistic integrity, it is only fair to say that I harboured prejudices and preconceptions. There were many factors that made it hard for me not to pre-judge. Witnessing a PR-heavy EEAS public board meeting in 2012 had shown me that ambulance executives can operate in a protective bubble of deluded positivity. My opinion was also coloured by years of managerial promises of improvements which never materialised. More recent factors include the apparent continuing nationwide collapse of operational staff morale as evidenced by my ongoing communications with ambulance workers from around the country (as well as plenty of media coverage elsewhere), and my understanding of Jason Killens' handling of the Edmund Daly case felt like an example of misguided and short-sighted decision-making.

So I arrived outside LAS HQ worried that I was walking into an asylum for the powerful, the misguided, the deluded and the corrupt who oversaw the brutal flogging of an inadequate workforce they would sooner replace than support.

But I left conflicted.

The Meet and Greet

As I waited to be collected in the foyer, I noticed a certificate on the wall, awarded by the Department of Health to LAS 'in recognition of the organisation's commitment to improving the working lives of staff.'

I was escorted up from reception by Anna Macarthur, an LAS communications manager and former journalist who had assisted me in the past and had arranged this meeting. With her was Chris Doyle, a 2-pip paramedic staff officer. I was ushered into an office and we got acquainted over coffee. We discussed broadly the purpose of my visit, my concerns and particularly LAS policy regarding staff welfare.

Chris Doyle was very well-informed about the procedures in place to support staff, particularly drawing my attention to Trauma Risk Management (TriM) as a management model implemented by LAS to 'ensure the London Ambulance Service NHS Trust (LAS) comply with the relevant Health and Safety Executive (HSE) legislative and guidance documents to ensure its staff are not exposed to excessive levels of occupational stress that may affect their health.'

Mr Doyle seemed genuinely attentive to my concerns and took seriously my assertions that many staff do not seem to be benefiting from existing support systems. He conceded that if that was indeed the case, then it is something that would need to be addressed. His empathy and candour were apparent and it was evident to me that he was a paramedic who wanted to apply his desire to help to his own colleagues as much as anyone on the other end of a 999 call.

Initial briefing over, I was introduced to Emily, a 26-year-old paramedic team leader (like Eddie Daly, I noted) who had been saddled with the thankless task of taking me out for a 4-hour 'mini-shift' on the fast response car to get a reminder of life in the trenches. I soon learned that she was a bright, enthusiastic university-trained paramedic who enjoyed and took pride in her role.

My First 'Shift' in 4 Years

With barely a chance to get acquainted, we were almost immediately assigned a call to a middle-aged patient with chest pain on one of a nearby train station's many platforms. The road journey was brief, but the sprawling station had many platforms and it was our bad luck that the patient was on the farthest one from our arrival location. With a long walk ahead of us, at this point I imagine Emily was probably grateful to have a pack-horse to assist with carrying the heavy bags and equipment necessary on for an initial assessment.

After several minutes of walking we found our patient sitting hunched against the wall of a passageway as commuters hurried by, left arm clutched across his chest. Emily set about introducing herself and making her initial observations. Her enquiries soon revealed the patient had a history of ill health including cardiac problems. It was hard to be certain as the gentleman's explanations were unclear. His main concern was pain, which he kept referring to (at least to our ears) as 'phlegmatic'.

I hovered like the spare part observers are, trying to resist the temptation to ask clinical questions of my own. Thankfully, Emily soon she gave me something to do - find a member of TfL staff and locate a first aid room to which we could move our patient for some privacy. Concerned that we shouldn't unnecessarily stress a potential cardiac patient, I also arranged for a wheelchair to be sourced.

Within another minute or so, as Emily administered the appropriate medication to her patient, a motorcycle response paramedic arrived followed by another TfL employee with the requested wheelchair. Just as we were about to relocate, the ambulance crew back-up appeared. Moving to a first aid room was no longer necessary and instead the small crowd of us began the trek back through the station to the ambulance. Emily left to bring our car to the ambulance's location and the motorcycle paramedic quickly departed in a different direction.

I walked with the ambulance crew and the patient, now in the wheelchair pushed by our TfL conscript. It transpired that the patient's 'phlegmatic' problem was actually 'thalamic' and a quick bit of smartphone-assisted research revealed thalamic pain syndrome as hypersensitivity of nerves affected by a previous stroke of the thalamus region of the brain. A useful differential diagnosis, but still didn't rule out an acute cardiac event.

I took the opportunity to ask the ambulance paramedic how his shift was going. He was 7 hours into his third successive 12-hour day shift an no, he hadn't had a break yet today. He smiled mirthlessly at the very idea and walked wearily, shoulders slumped, in the manner of a man conserving his energy. He had that resigned 'one job at a time' fatalism written all over him.

Once aboard his vehicle, I watched him and his EMT crewmate patiently assess the patient, who was proving to be a truculent 'service user' with lots of opinions, 'journalists' like me can't be trusted, the attending Emergency Medical Technician was 'just a driver' and so on. It gave me a timely reminder of the reality of the demands of the daily ambulance routine and provided a stark contrast to the effervescence of my assigned 'crewmate'. I recollected one of my old mantras, 'sympathy is a finite resource'.

Emily soon arrived in the car and, after a quick 12-ECG showed no acute heart problems and the ambulance departed to hospital, we returned to our vehicle to finish up paperwork and book clear for another call.

But before we had the chance, a 'running' call found us: a patient collapsed in the main station concourse. Back into the station we went, to find the patient laying supine being attended by a passerby and a TfL staff member. As the woman recovered from what appeared to have been a faint, we helped move them to a nearby first aid room and Emily soon diagnosed low blood sugar to be the cause of the her continuing light-headedness. She was encouraged to eat a snack and, after further assessment, Emily stood down the inbound ambulance and waited for the lady to make a full recovery before sending her on her way.

The Yin and the Yang

As we mobilised once again, Emily and I had the opportunity for further discussion. We stood by for a brief time outside the local A&E and chatted before heading back to HQ for the next part of my day. Our conversation was enlightening. She described her positive approach to her clinical work and the challenges of being a team leader for approximately 200 staff. We talked about managing pressure and stress and how she could identify signs of it in her colleagues.

Memorably, she hit upon something which struck a chord with me. The idea that how endurable a busy shift was (and these days, they're all busy) was hugely influenced by the attitudes of your colleagues, particularly your crewmate's. If you work alongside someone who is enthusiastic even under pressure, who can deflect the worst of the challenges emergency ambulance work has to offer, it can help fortify you against the worst of the job. That camaraderie and self-sufficiency is vital. Equally, someone who is downtrodden, negative or bitter can undermine your ability to cope.

My career experiences have found me on every side of this equation and my thoughts turned to the demeanour of the paramedic I had encountered earlier and his EMT crewmate. They were both professional and competent, but that unavoidable, resigned weariness of the veteran had been evident.

Sitting in the passenger seat beside Emily as we pulled up to HQ made me realise the contrast between us. She represented the positive, pro-active, fresh young blood that the service so desperately needs. After only a relatively short career, she was clearly on an upward trajectory. I, on the other hand, represented the bitter, disenfranchised veterans whose careers plateau into an endless repetition of soul-sapping shifts until something (in my case a back injury) brings that to an end.

I was mindful not to try too hard to dispossess Emily of her ideals. For as long as they lasted, they are a credit to her and a shield for both her and those people she influences. It would be wrong of me to hasten their inevitable erosion. Besides, I may be someone already broken by the ambulance experience, but that doesn't mean everyone will end up that way. Maybe Emily is tougher than I was. Maybe she'll be better looked after.

But I couldn't help wondering which of us represented the majority. And why?

Perhaps my impending parley with the senior execs might shed some light.


[NEXT: An audience with the Chief Executive and Operations Director to discuss staff welfare and the case of Edmund Daly]


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