One Year On.

October the 1st, 2004.
We are now one year on from the implementation of Agenda for Change (AfC), and us EMTs still don't know what our new pay and conditions are going to be. The planning for AfC was started a year before this. So AfC has been with us for two years.

I think one of my commenters put it best when someone asked about AfC.

The pay rise announcement for paramedics, whilst being a significant rise, is not the great deal that it's been made out to be, with very little option for improving your pay based on skills and knowledge.

The rise for Technicians which is what you would be to start with if you joined the ambulance service, is still to be decided. The offer from management has been thrown out by the unions as it was utter rubbish, and it's now been referred to a national committee. If the rumours are true, and it seems that's the way it will be, techs will be placed in Band 4 of Agenda for Change, so while our gross annual salary will rise to just over £25k, our basic salary will effectively drop from £21,900 to around £19k, with the rest being made up from enhancements – unsocial hours payments, London allowance etc. We'll get time and a half for overtime, but that'll be based on the £19k basic. Plus band 4 doesn't recognise us doing ECGs, giving drugs and supervising trainees.

To put it into perspective – there are hospital cleaners that are going to be placed in band 4. Enough said?

Sorry to rant on but this A4C stuff, but it really annoys the Hell out of me!

For me, it's not about the money – it's about recognising us for the jobs we do and the skills that we have. We essentially work on our own, have to solve time-critical problems and give drugs that are normally only prescribed by doctors. We are at risk of being beaten up, we have to calm situations down, and maybe even be the first on scene at terrorist bombings.

Yet it seems that we are not recognised for this, instead our basic pay will drop, and the only way that we will make up the shortfall will be the new idea (for the ambulance service at least) that working rotating shifts should earn you a bit more money. The drop in basic pay will imply that our day to day work is not worthy of financial recognition.

Of course, this is all supposition, as no-one seems to know anything.

Morale at the moment is, to put it bluntly, crap, and it wouldn't surprise me if there were some form of 'action' in the near future. (Nothing that would affect patient care though).

It isn't helped by the misinformation in the media that is claiming that we will be earning a 30% pay rise, as this is purely for our (top trained) Emergency Care Paramedics, who are taking on the role of out-of-hours GPs. ECPs are in band 7, EMTs are likely to be put in band 4. So I won't be seeing a 30% increase…

At least we haven't got a job description that tells us to expect to be beaten up by patients and their relatives.

16 thoughts on “One Year On.”

  1. Hear hear! Once again, the huge importance of spending time with the other professionals in the team comes into focus. I've mentioned this before and I think I'll go on mentioning it forever…more can be learned in a day doing this than almost anything else on the course.By the way, I can't help thinking that anyone who has to scrape people up off a dark motorway and try to ensure they have all the necessary bits has to be worth a lot of money. How many of us could handle that time after time?

  2. It is always frustrating when some bright 'Managment' comes up with these bright ideas and don't think about the 'foot soldiers' who are the people who get things done.I hope things do work out, and many people can only do things for the love of the job for so long, money does have its role to play as well.

    The Driving Instructor

  3. Frontline staff will rarely get the deal they deserve. Often because they are too busy actually Doing Their Jobs (and indeed recovering from the physical and mental stresses of that) to be on committees and steering groups.My guess would be that you write this blog in your time because you enjoy it and it helps you. Whereas management will only pay attention to structured input on Form E582FH submitted before the second Tuesday of the month when countersigned by…

  4. Firstly I have been reading your excellent Blog for a while now but never felt moved to comment.I am very sorry but you appear to mistake the governement and policy makers who control the organisation you work for as people who give a shit about their workforce. You should have learn't long ago that the only reason the NHS functions at all is because of the goodwill of the staff, overstaying shifts, extra shifts at short notice, going the extra mile to make a decrepit system work at all. Oh, and don't expect to be paid your worth. They know they have you every way, why do managers get car allowances etc…and a 1/60th pension and clinicians get nothing and a 1/80th pension ? Do managers work harder and produce the results therefore being owed a higher return ????

    Sorry, feeling a bit bitter. All my respect for going in day after day and grinding it out.


  5. All public servants get crapped on in some manner when it comes to money, until you get to a certain level of management – New entrants to the Directorate where I work earn the same as I do. I've been there for three years and every year they raise the minimum. It doesn't make you feel as though the work you put in is actually important to the bosses . ..

  6. (Whilst I understand that *you* actually do hold a professional Qualification) lets remember that in order to become an ambulance tech you only need a few GCSE's, you dont spend years training at degree/HE level, (maybe all ambulance staff should?)Is it fair to pay Ambulance staff the same as highly qualified Hospital staff. Ambulance crews will have a patient ratio of 1:1 whereas nurses can have 1:30! -I can see the logic behind banding techs into 4, My personal feelings is that we all have a crap deal. – LN

  7. Ah LN, but I disagree…You must know that 90% of what they teach you in nurse training is 'fluff', most of it is concerned with being a 'reflective practitioner' and other beanbag sciences. At least it was when I trained to be a nurse.

    But that aside, we are supposed to be judged on what job we do. And in my experience, nursing was much easier than ambulance work. For example, on the wards, my daily routine was…

    Wash patients, feed patients, give patients drugs, get a set of obs from each patient, evaluate and update care plan, sort out social care, more paperwork, lather, rinse repeat until end of shift.

    This is physically tough work (Heaven knows it was too much like hard work for me), but you can do most of it with your brain in 'neutral'. If there was ever a problem the patient could be handed off to a doctor.

    (Yes, I know that there is more to nursing than this, and they may have added more since I left, but you get the gist).

    Notwithstanding the incredible denseness of ambulance training – I doubt if I could have done it without my nursing background (neurons and neurogilia in an afternoon, better learn it well, because you are getting tested on it later). We also have to work essentially alone, being autonomous practitioners, and having to make split second decisions about patent care rather than having a ward meeting.

    Let me put it another way – I could nurse, even in A&E, while *ahem* hungover. I could never do that in ambulance work.

    Nursing is fairly repetitive physical work, while ambulance work is more mental, with bursts of incredibly back-breaking physical labour.

    I've find myself using all my nursing skills, plus ambulance skills every day. My collegues, who don't have nurse training also use nursing skills that they have picked up from the old hands.

    All the above is meant with the greatest respect to you and the nursing profession – I think you guys should get paid more than when I was nursing, but it doesn't mean that we shouldn't also get a comparable amount as well.

    You should try to get a rideout with an ambulance crew – most places are happy to arrange it, and it'll give you a better idea of what we get up to, and why we are worth more than hospital cleaners…

    With Respect – Tom

  8. As a “customer”, the main difference I've noticed between Ambulance staff as opposed to Hospital staff, is that Hospital staff are on their own territory and have their own way of doing things, whereas Ambulance staff have to go into alien territory and take control of whatever situation they find.That's not to say that one job is harder than the other, just that they're different, require different skills, but may be worth the same pay for different criteria.

  9. LearningNursing – I fully respect ALL nurses – some of my best friends are nurses, so I want to make that clear from the start.All of them also agree that nursing in hospital is completely different from attending an accident scene. Let me give you some examples from my shift today alone:

    Call to an 84 year old male, Cardiac Arrest. Sadly, there was nothing we could do for him, so we spent the next hour looking after is wife, helping her notify relatives, arranging the GP to call and certify death, making her a cup of tea and some breakfast. We can autonomously do recognition of life extinct.

    Call to young girl in Labour – full term, birth imminent. She'd had no ante-natal care as she hadn't told anyone she was pregnant as she was scared how her family would react. She didn't want to keep the baby. Persuaded her to give personal details, and coached her through the labour until reaching the labour ward. Had it been necessary we could have delivered the baby, cut the cord, and delivered the placenta.

    Unconscious diabetic – gave injection of glucagon, patient recovered and declined A&E. Ensured patient had eaten and was safe to leave.

    Severe Asthma attack – gave salbutamol nebuliser, chest became quiet (a sign that the condition is becoming life-threatening), so gave injection of adrenaline before transport under a priority call to hospital.

    The point is, all of these procedures were carried out by a technician with just “a few GCSEs” – me. And that's not including doing ECGs and interpreting to confirm a heart attack before directly admitting them to a catheter lab for an immediate heart operation, extricating people from crashed cars, dealing with volatile situations where people have been stabbed, assaults, groups of drunks etc. as well as carrying sometimes quite heavy people (18 stone +) up and down stairs

    In hospital you have security to call on – we have the police, who rarely have units available to send to help us (even for urgent calls). If it goes bent in hospital, you call for a doctor. If it goes bent for us, we have ourselves and that's it.

    Again, I'm not knocking nurses, and fully believe they should be getting more money than they do already, but please don't ask technicians to accept a pay band that doesn't recognise the skills we use.

    The two jobs really are quite different, and I hope I've gone some way to help point out where some of the differences are. I agree with Tom – arrange a rideout with your local ambulance station and see what we really do.

  10. I think it is only fair to point out to LearningNursing that technicians and paramedics can now do their training through the diploma and degree system. However, Which ever approach to learning the “accademic” stuff you still end up doing the same job. several of my colleagues have already got degree qualifications but they do the same job and earn the same money. My sister is also a Nurse and came out observing with the ambulance service. She was shocked at the variation in our work and just how many times we put ourselves at risk for our patients. She didn't realise or fully understand the full job that ambulance staff do and after just one day on the road her perception of ambulance staff has changed. I have heard some nursing staff refer to ambulance staff as being “thick” because – at the moment- a degree is not a requirement. is this really a fair opinion?!We have been told in our service that Technicians on band 4 are not aloud to work unsupervised, lift patients or give drugs which basically only leaves the driving left. The whole a4c banding system for the ambulance service needs to be reveiwed so that people are getting paid for the jobs they do and the skills they use but as yet this is taking far too long

  11. please, for the love of all that is sacred, do not get me started on people who think that having a degree makes them better or worth more than people who “just” have work-based training, experience and so on.*wanders off in search of the calm and happy place*

  12. I think you'll find that it's the civil service that get 1/60th. Us NHS managers are on the same 1/80th deal as you are. As for car allowances……. I use my own car for work and get paid a mileage allowance if I use it for work.And before you start, some managers work very hard and long hours without any overtime payments. There are some idiots around but that's true of all jobs!


  13. It's not just medical staff who can't get their head around the whole A4C thing. I work in mental health, have spent 10 years getting qualified and thought that now I would get the same pay as someone doing the same job as me in the next county – surprise, surprise I'm still getting paid less (bitter, moi?). The whole thing sounded like a decent idea but pay scales have been sorted out by people who don't necessarily understand what job you do, what your training is etc. Nurses are easier to band cos everyone knows (roughly) what they do; doctors opted out of the whole thing (apparently the pay scales didn't go high enough!). The rest of us try to explain to well-meaning people that no we don't have a typical day, yes sometimes our patients kill themselves, and is it really more important to know how much an assessment/equipment weighs than what I actually do?

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