On this blog I've often moaned about things that the government does that makes our job more difficult, less effective and worse for patients. A large part of this being the clinically irrelevant Orcon target of reaching a large number of our patients within eight minutes.
This target chasing has led to what I consider to be a number of very bad decisions from our upper management which has resulted in low staff morale.
However, I've endlessly banged on about these problems and I'm yet to see any change.
What I haven't done is look at the role that us road staff have to play in this situation.
Our own personal morale is crucial in our own development, without some 'get up and go' we are happy to remain where we are. Turning up at the start of the shift, doing twelve hours work, and then at the end of it going home with no thought to the larger picture or how we can change things for the better.
A large part of our problems are, I think, brought on us by ourselves.
For a fair number of the road staff workforce our job is essentially 'blokes with bandages', and that includes the women. They see themselves as largely taxi-drivers with a few other skills. On occasion I'm certainly guilty of thinking the same way myself.
It's a side effect of 80% of our jobs not needing any emergency medical intervention at all.
There is almost a 'reverse snobbery', where it is culturally desirable to not be clinically well trained. Where knowledge of medical issues outside of the 'pick them up and take them to hospital' is seen as being a swot or a boffin.
We hamstring ourselves by reducing clinical knowledge to a 'nice to know' rather than a 'need to know' basis, and by almost being proud of our lack of knowledge.
What has led us to this? Why does such a large section of road staff have this attitude?
I can see four immediate causes for this, and a lot of it isn't our fault.
- Our pay.
- Our initial training.
- Our continuing training and lack of clinical governance.
- A lack of development opportunities.
- A lack of role models.
A vast number of road staff, myself included are on the 'Band 4' payscale. That is the same sort of level as a care assistant in a hospital. A starting nurse is Band 5. My salary is £21,798 and it's not going to get any higher as that is the top of my banding.
Actually that is not strictly true, I could move up a band by training to be a paramedic, but then I would lose my crewmate and probably my station – and some things are worth more than money. If I became a paramedic my pay after six years of paramedic practice would be £27,534.
I'm not complaining about the pay particularly, because the median wage is £23,472, meanwhile the median 'Health Professional' wage is £49,488. (Numbers from that link, multiplying a weekly rate by 52. The median wage is the wage where half the people in the country are being paid more than you).
So, at the moment I'm earning a bit less than the median wage.
In that case, is it at all surprising that we don't see ourselves as healthcare professionals when we are getting similar wages to medical secretaries or HCAs?
One of the comments that I regularly hear is 'I'll do that when I'm paid to do it' – referencing that our pay is supposed to be related to our job role, and yet the role keeps expanding but our pay doesn't. For example – we now recognise and treat appropriately heart attacks, yet our pay hasn't changed. We now give morphine as an analgesia, yet our pay hasn't changed. We are being encouraged to leave people at home, yet our pay hasn't changed.
As an aside, 'leaving people at home' is an almost perfect example of this blokes with bandages attitude, and one on which I'll return later.
One of the fears that I've heard both on station and online is that the removal of intubation from the Paramedic training is to keep them in Band 5, thus keeping pay down.
If you believe that you are only worth the same wages as a 'man and van', then you are probably going to content yourself with doing a 'man and van' job. Pick up the patient, do the mandated checks and take them to hospital.
So the problem is, we aren't paid enough to care about the big picture.
I'd love to say that the solution is as simple as throwing money at us, perhaps even just enough to make our worthwhile job seem worthwhile. But it's not going to happen – there is no way that the public is going to swallow the idea that the NHS pays it's staff more for a better service when the NHS is already having trouble paying for cancer drugs or even for beds.
It's not even that we can improve our initial training for an increased wage. A newly qualified nurse with a diploma is earning the same as a degree level paramedic. Because apparently we on the road, on our own, have the same supervision as a nurse in a ward.
No-one ever said that the Agenda for Change banding would be fair, just or right. And the ambulance service is the proof of that.
So, we aren't going to get more money, especially with the government constantly talking about big, huge, and painful cuts – what is it possible for us to get?
A bit of respect.
Respect isn't given, it's earned. We need to start demanding respect for our profession, and start proving that we are worth that respect.
We need better representation in the media, we need more innovative practice and we need for our concerns to be discussed on a national level.
We need to promote ourselves as professionals. We need to stop putting ourselves down. We need to have our trusts stop bending over backwards to apologise when we have done nothing wrong. We need people who assault us to be put into prison, not let out because 'apart from beating up a paramedic they are actually a lovely person'. We need our PR departments to be more proactive and upfront about what we do.
More importantly, we need to have respect for ourselves and see ourselves as professionals.
Next post will be about our training, and how it does us no favours.