Blokes With Bandages

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.

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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.

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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.

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Our Pay

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.

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The Solution?

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.

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Next post will be about our training, and how it does us no favours.

17 thoughts on “Blokes With Bandages”

  1. It's the old 'Treat 'em mean and keep 'em keen' attitude. Though there are some areas of society where this would make life worst for the 'customers' in the long term. As is the case with morale in the NHS.At the college where I ONCE part-time lectured, we were told a few years ago that all the teaching staff had to go on a City & Guilds course otherwise we could no longer do work for the college. This was around the time new management came in and shot the paperwork through the roof.Consequently, I gave up working for the college and so did a few others – especially those with 40+ years teaching experience. We considered the actions of those who know (or believe they do) to be an insult.Now the college recruits mainly straight from Teacher Training, since they have no idea of life before all the new rules came into force. Maybe this will be the same with the ambulance services throughout the country.

  2. This is exactly what is happening in ambulance services. Has been for some time. The message is quite clear. We are very much the frogs in the metaphorical experiment.

  3. Most shifts I get more of these than jobs….(Which is good, because it means that there is some effective filtering going on, but bad because the reason why we are chasing our own tails is because of call connect and the desire to hit that eight minute target)

  4. Sorry – I meant *people*, not governmental or upper tier management NHS creatures.Everyone on the road knew that we were going to get screwed over.

  5. One of the big problems with the LAS is perception.With record numbers being suspended for, what appears to be, political reasons. Running about for jobs that have no information only to be cancelled and received ta similar job in the opposite direction. We find ourselves in opposition to the management position and government policy where targets are god and nothing else matters.I disagree with you about clinical excellence, when we have a real job I don't know of anyone who does not do their very best. We think and work hard for the best clinical outcome for our patient. The problem is that it quite often becomes a long job and that is held against us as it effects our average job cycle time.We are now at the point where we can no longer believe that management care for anything but targets and the government proves that by fining the service if it fails to meet these targets.Where management and staff do not communicate properly you end up with the perception that management do not care. The only defence to that is to show that you do not care either. Those that do care can be seen on every ambulance station, they are the depressed ones. They stay because they know that they do good, occasionally, and are depressed because they know the system is in opposition to everything they believe.I suspect you are a case in point.

  6. “Running about for jobs that have no information only to be cancelled and received ta similar job in the opposite direction”I've had an irate controller at a running road race constantly asking me for an update on my patient, then if I had FOUND my patient.

    “Female, with ankle injury, sitting on the kerb.”

    “The road that the finish line is on”

    It took a while for her to realise that walking from the middle of this 2 mile stretch carrying kit would take a while, and that it's not my fault I can't find the patient!!!

  7. “It's a side effect of 80% of our jobs not needing any emergency medical intervention at all.”I agree with this completely, but the rest of your post seems to steer away from this.

    I would guess that fewer than 1% of calls benefit from an 8 minute response. I think it's fairly safe to say that 99% of patients will be alive and well 30 or 60 minutes after calling.

    We're chasing our tails trying to meet this A8 target… and for what?

    If we took a step back, improved first aid training in schools*, improved OOH GP services**, and improved access to community AEDs***, we could ditch AMPDS and spend a few more minutes triaging calls. Most calls wouldn't need an emergency response.

    Sure, some calls needs a quick response, but you can still make, “Is the patient breathing?” the first question.

    I really think that we need to move away from this idea that an ambulance should be on standby at the end of your road. It's a ridiculously expensive idea. We should all be responsible for early CPR and early AED – not just the ambulance service. It would be a better use of limited funds, and would improve patient outcomes.

    * easy

    ** not so easy

    *** big shops, big offices, care homes, schools, leisure centres, etc

  8. “Running about for jobs that have no information only to be cancelled and received ta similar job in the opposite direction”Something like this? 🙂

    It's 3.01am in the London Ambulance standby point:

    EMERGENCY IN NW1!

    3.07am:

    STAND DOWN: DETAIL HAS GONE CAT C

    It's now 3.13am at the standby point:

    EMERGENCY! MOBILE PHONE TRIANGULATION DATA ONLY

    3.14am:

    EMERGENCY UPDATE: LOCATION IS NW1

    3.19am:

    STAND DOWN: DETAIL HAS GONE CAT C

    It's 3.41am, and most of the housemates are sleeping:

    EMERGENCY! MOBILE PHONE TRIANGULATION DATA ONLY

    3.42am:

    EMERGENCY UPDATE: LOCATION IS NW1

    3.44am:

    STAND DOWN: IT'S THE SAME CAT C CALLER, HE STATES HE DOESN'T NEED AN AMBULANCE ANY MORE

    In the alternative ending to this drama, the caller still wants an ambulance and gets put through to the telephone advice desk, who requests an emergency ambulance on an 8 minute response for a blown lightbulb in the kitchen (“?TIA – CALLER LOST HIS VISION. CALLER STATEMENT: I CAN'T SEE ANYTHING”)

  9. I was thinking of the “go to 459541 155783” mobile mast.cancelled.

    Go to 789515 456655 mobile mast (not related to the first job)

    cancelled

    ad infinitum.

    Some shifts you get more of these than jobs.

  10. If you replaced 'EMT' with 'police officer' and 'medical knowledge' with 'legal knowledge', you could say exactly the same about the police, except that we get no legal update training! Having good legal knowledge is seen as 'weird'. Our pay is better, but the culture is the same.

  11. “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.”Personally, I've always wondered how the hell they can justify Paramedics being in Band 5 as it is.

    However, go through the Agenda for Change job evaluation system, and the above theory seems to work…

    If you apply Level 5 in the all-important 'Knowledge, Training & Experience' category (as College of Paramedics and LAS publications state is the case), then give the other categories the lowest possible rating unless a key part of the job or even the job title itself is cited as a direct example for a higher level; you find that the job falls very near the border between Bands 5 & 6.

    The difference between having the skill of intubation or not makes a significant difference to the category 'Physical Skills', which lists ambulance driving as a 'developed skill' that ranks at level 3, and intubation as a 'highly developed skill' ranking at level 4.

    Evaluating the job with the Physical Skills category rated at level 3 (without intubation) gives a Job Weight score of 385 (top end of Band 5). With tubes in the skill set, this category goes up to level 4 and boosts the score to 400 (just inside Band 6).

    Of course, this shouldn't even be an issue for existing medics already using the skill. All should be Band 6 already. Techs are getting just as shafted. Give them one level less in the training and skills based categories mentioned above and they still come out with a Job Weight score well within Band 5.

    I'd love to see a full breakdown of the job evaluations that the powers that be have gotten away with applying. I doubt it would stand up to any kind of independent scrutiny!

  12. “No-one ever said that the Agenda for Change banding would be fair, just or right.”Er, yes, loads of people did actually. It's just that they were wrong.

  13. I think your representation of “median” although technically accurate is a little misleading. Experts in pay would say that 10% either side of median is broadly competitive – though you have to be sure that you are comparing like with like. Comparing the median pay of one job with the median pay of another is only relevant if you are sure they are similar in complexity.This is what I suspect is at the heart of the issue.

  14. Blantantly trying to squash us people who do all the hard work! Thoug you can't lay all the blame for bad triaging on the control rooms, if people in the big wide world would atually be honest about their medical condition I wouldn't have had to wait 40 minutes for an ambulance last week when my kidney was swelling to twice its size at a party. I was supposed to be the designated driver so I was the only one sober and I told this to control, being honest about 1) not being able to make my own way to A&E and 2) that even though I was in a fair bit of pain, I could wait if red call came in before me.One ambulance crew got my call and were on their way when they got called to a “non-breather” who was actally an asthmatic who couldn't be bothered to reach across the table to their inhaler. The same ambulance crew then had to transport a “suspected heart attack” which turned out to be indigestion (who's wife had a car to drive him to A&E herself) and then they got to me just in time to watch me pass out from the pain. If these previous calls hadn't been made or had called to say they just need someone in a car to get their inhaler, I would have been at hospital before I passed out.

    We cannot lay all blame on the poor people in control who have to figure out the fact from the exaggeration. I've worked in a small event control and I tell you now, it's hard work!

    We need to teach the public what needs an ambulance, what doesn't and what they can take ten minutes down the road to A&E themselves.

  15. i think your pay is shockingly low. i'm admin in probation and i earn more than you. i think that is wrong. you should earn way more. especially considering that you're in London.

  16. Whilst staff nurses are band 5, yes, I'm not sure where you get HCAs on band 4 – when I worked as an HCA (up to two months ago) I was, like most HCAs, at band 2, with a small number of more experienced and more fully trained band 3 HCAs also being employed by my Trust (in Cambridgeshire). Band 4 would after all have been a bit much to ask for a job that takes a week to train for!I don't disagree at all with the post, but felt this needed pointing out.

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