Counterfire spoke to a paramedic in the London Ambulance Service, who asked to remain anonymous, about the crisis in the ambulance service and hospitals

The stories I have heard suggest the ambulance service is at breaking point. What is your experience?

It is at breaking point. We are getting to the stage that we are unable to unload patients. At Whipp’s Cross the other day, for example, there was a three-hour waiting time before we could get patients out of the ambulance. This has massive repercussions. You have to look after the patients, they get understandably upset, it is dreadful for them, and deeply stressful for us.

We had an eighty-year-old in an ambulance for two hours the other day, for example, and earlier an eight-year-old with chronic chest pains. Both were desperate for help and panicking that they weren’t getting it.

Queen’s Romford is in meltdown. Virtually every day it’s an hour or more wait. At Queen’s they are getting staff to go in on overtime to wait with patients in the corridor, which can take hours. The corridor is not the place to be treated.

In so far as there is one, management’s response is to shuffle people to different hospitals. This takes up even more ambulance time. The result is at certain points they will literally not have ambulances to send out to anyone. 

Another thing that happens is that they put massive pressure on us to ‘go green’, to become available. The main method is to push ‘seeking alternative care pathways’ when you get to see patients. We have to tell them to go and see their GP, if they have chronic abdominal pain for example, or just give them a stronger pain killer. Old people who have falls, leave them at home. All this leads to complications for the patients. And it, of course, creates real friction.

It is putting people into real danger. They nominate one vehicle to what is called ‘sweep ups’. You have to go around to see people who haven’t been picked up five hours or twelve hours after they have called in. Of course, they are angry and sometimes very ill. We have heard that 250 people have died because of delays in the early days of the pandemic.

How is this affecting staff?

Ambulance workers are at rock bottom, burnt out and fed up. It was about six years ago that things started to become difficult, but now it is worse. We rarely, if ever, have a break. The last lunch break I had was five months ago.

It makes you tetchy and it makes you lose empathy for the patients. Much of what we normally do is to give reassurance. We call it ‘GP work’; convincing someone it is normal to feel tired or lose your sense of taste when you have Covid and so on. Given our stress levels, it’s a big struggle to be empathetic.

On top of this, we are in an impossible situation because management want us to persuade patients not to go to hospital, but they won’t back us up if we make a mistake.

We are massively monitored. We have to ask the station to have a break, sometimes people are called out by the bosses for going to the toilet too often. Our ‘throughput’ is monitored, we are told that we are taking too many people to hospital, or that we are taking the vehicle off the road for repairs too much. There is a constant pressure to increase productivity; they don’t understand that people need a break after being bombarded with people’s problems. 

There is no one who has worked on the ambulances for more than a few years who doesn’t have a back problem. There’s no one who doesn’t have some kind of stress, anxiety, insomnia, or depression. There is a very high level of suicide. People are voting with their feet. They are looking to work in other areas of the NHS after three of four years.

The GMB union has done a survey, and the word of mouth is that the vast majority have voted to go on strike. Our sense of being used has been deepened by the pay issue. Frankly we feel betrayed. We were given a 3% pay rise earlier this year, and then two weeks later they increased national insurance, so the rise just disappeared. If there is a proper strike ballot in the ambulance service we will definitely end up going out.

Why is this happening now?

Similar things have happened every winter for the last five or six years. But what is different now, I guess, is that the staff have got to the point where we can’t cope. 

They normally put extra ambulances on by offering double time; 25% of the shifts in the past have often been covered by overtime. But people have had enough now, they are too tired, they just aren’t doing the overtime anymore. 

More generally, it is happening because there are shortages across the board. The hospitals don’t have enough staff, beds, or cubicles. We are short of at least 60,000 nurses, 10,000 doctors, and at least 2,000 paramedics across the UK. This in turn is a product of long-term underfunding, made worse because we are doing two things at one time. We are trying to run the NHS as normal, and deal with the worst pandemic in memory. 

Ten years of underfunding and understaffing are bound to have an impact. The NHS is in fact a very efficient way of organising a health service, much more efficient than commercial models, it is just underfunded. Everyone in the service knows what the problem is; it is obvious. There are hundreds of Australian paramedics working for us because they haven’t trained up staff here. They are sending management to Africa and Eastern Europe to try to recruit paramedics.

There is virtually no training here, very few bursaries, and the pay is ridiculous. Why would you want to do this work if you only get £34,000?

First, we need more social precautions. We ended lockdown too early, and now we are paying the price. Second, we need more nurses and paramedics urgently, and a massive injection of emergency funds to deal with what is a really serious humanitarian crisis in our health service.