Up to 80 per cent of key ambulance staff could be required to work during a strike or risk being sacked, documents released by the Department of Health and Social Care have revealed.
The government this week announced it is pressing ahead with plans to introduce a minimum service level for ambulances during strikes, despite fewer than one in five of those responding to a consultation supporting the idea.
The MSL – which is expected to be in force by the end of the year – will see all 999 calls answered and triaged as normal, life-threatening cases responded to, and all cases where there is “no reasonable clinical alternative” given help at the scene or transported to a healthcare facility “as it would be if the strike was not taking place on that day”.
In its consultation response, DHSC said providing cover at this level would “generally require around 80 per cent of an ambulance service’s resource on a typical shift”, adding: “We recognise that setting the MSL so that a high number of rostered staff are required to work will have a significant impact on the ability of employees to participate in strike action.”
Most, if not all, ambulances in a fleet would need to be staffed to ensure calls could be responded to, and “a high proportion” of all levels of paramedics, emergency care assistants and other staff in ambulance teams would be needed and could be issued with a “work notice,” meaning they must attend work on a given day or they could be dismissed.
“A high percentage” of emergency call handlers, dispatchers and clinicians working in control rooms would also be needed, along with support staff such as emergency mechanics, on-call IT staff, “make ready” staff who prepare and restock ambulances, and specialist staff such as hazardous area response teams and special operations response teams.
In a foreword to DHSC’s consultation response, health and social care secretary Steve Barclay said there was evidence of “where the locally negotiated and voluntary system of derogations had not worked well… this included derogation agreements being made at the last minute, or services not being manned because of confusion as to what the agreed derogations were.”
However, he added unions had ensured the most serious incidents were responded to in the vast majority of cases during last winter’s strike and suggested voluntary derogations would still have a place as long as employers were confident the MSL would be met by entering into them.
The consultation response also said some patient transport services and inter-facility transfers should continue during strikes. This includes patients needing renal dialysis, oncology and related cancer care patients, palliative care patients and other high-dependency patients, as well as some patients needing transfer to other hospitals.
The consultation drew 150 responses, with the majority being from members of the public – 79 per cent of whom were opposed to MSLs. Some responses said MSLs failed to address underlying problems with recruitment, retention and working conditions in the ambulance service and could damage morale – a point HSJ understands was raised by voices within the ambulance sector as well.
Unison senior national officer Alan Lofthouse said: “The government has some explaining to do about how this legislation is going to work.
“During strike days, the ambulance service operates in a much safer way than on any ordinary day because of the life and limb cover agreed locally.
“These local arrangements are now being thrown into confusion by new laws that are unclear, unhelpful and unnecessary. This will only add to the uncertainty of the public, not help them be reassured in any way.”
Rachel Harrison, GMB national secretary, said: “Official figures show patient safety improved during national ambulance strike days. Thanks to the planning of unions themselves, time spent waiting for an ambulance went down during strikes, not up.
“The stark truth is that public services are not able to deliver safe staffing levels on any day, not because of strikes but because of years of underfunding. While the government continues to scapegoat staff, it is patients and workers who will continue to pay the price for their neglect.”
Updated 11.24am Feb 11 with quote from Unison