‘Constructive’ first ambulance strike agreement revealed

Elderly people who fall may only be sent an ambulance after they have spent four hours on the floor, and some category 2 calls may not be responded to under one of the first agreements with ambulance unions about next week’s strikes.

But the deal between South East Coast Ambulance Service and the GMB union will see many union staff continue to work on ambulances and in control rooms – and others may be asked to come off the picket line if operational pressures escalate.

HSJ has seen the details of the deal – thought to be one of the first agreed before next Wednesday’s strike. Some other trusts are hoping to conclude negotiations shortly, but for several — such as in the North West and London — it is thought no strike “derogations” (exceptions) have so far been agreed, and managers are concerned that unions are resistant. Trusts have been pushing for more cover on strike days – especially around category 2 calls.

In the South East, the GMB is the only union striking – both Unison and Unite failed to get 50 per cent of members voting in their ballots – but GMB has the largest ambulance membership and is particularly strong in the emergency operations centre (which takes and triages calls, and manages responses).

There is a national agreement to staff category one (the most serious) calls but other arrangements are being negotiated locally.

Under the terms of the South East deal with GMB, between 50 per cent and 75 per cent of key emergency operations centre and NHS 111 staff will remain in work – depending on their role —as will 50 per cent of ambulance crews (known as “field” staff). Clinical “navigators” in both NHS 111 and 999 call centres will all work normally.

There is no agreement to respond to all category two calls, but GMB staff on the picket line may be asked to start work to respond to certain categories of calls if others can’t cover them, including:

• Elderly fallers who are outside or have been on the floor for more than four hours;
• All category one calls – these are the most serious and include cardiac arrest;
• Paediatric emergency calls;
• Maternity emergency calls;
• Major incidents;
• Road accidents where people are trapped;
• Category 2 calls for stroke and cardiac incidents where patients present with newly acquired or recent symptoms where treatment is time critical.

However, the agreement says choosing to continue working through the strike or abandoning the picket line is a voluntary decision for individual members. 

GMB branch secretary Jason Dicker said a response after four hours would be an improvement as many elderly fallers currently wait far longer. ”We have put that four hour requirement in to halve the time that our elderly fallers wait,” he said. “We will not tolerate them lying on the floor for any longer.” 

Hazardous area response teams will continue to work but only respond to HART calls and some crucial back office functions – such as IT and medicines packing – will be staffed as normal. But a lot of non-essential work – such as training and vehicle servicing – will halt and some managers will be expected to undertake patient-facing work.

SECAmb interim chief executive Siobhan Melia told its board this morning that the trust had been allocated 100 military personnel who would drive ambulances. But she added that there was a degree of “unpredictability” about the decisions of individual union members on whether to work, and the trust would need to take an “agile” approach to deploy staff to where they are needed most.

She said the negotiations with the GMB had been “constructive” and “felt like a partnership approach”. The trust would be able to request strikers come off the picket line to respond to the agreed list of incidents or if the emergency operations centres had “unmanageable” call levels.

Other trusts — some of which have more unions on strike (see box below) appear to be having a much more difficult time of making agreements, with at least the North West, London and North East still in talks.

There is growing concern about the impact of the strike on both 999 and 111 call answering with one ambulance source pointing out that however many ambulances are kept on the road is irrelevant if incoming calls are not answered in the first place. Another senior source said that despite derogations, response times would be hit hard because of the complex additional coordination of staff from picket lines required. 

Both 999 and 111 services are already under intense pressure: figures released by NHS England today show that nationally nearly half of NHS 111 calls were abandoned last week as the volume of calls soared to over 700,000. Only 15.4 per cent were answered within a minute.

There is also concern that the second planned strike date for GMB only – 28 December – will be more challenging than next week. Ms Melia said: “It starts at the end of two bank holidays which run after the Saturday and Sunday [Christmas Eve and Christmas Day]… four days of limited access to normal NHS services always has a significant impact.”