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Trusts press for more ‘life and limb’ cover during ambulance strike

Published on: 14 Dec 2022

Ambulance trusts are pressing unions to confirm that crews will cover at least some ‘category two’ calls — which include suspected heart attacks and strokes — during next week’s strike, amid growing fears for patients’ safety.

HSJ understands at least one of the major ambulance unions has so far stated that all category two calls will not be covered by national exemptions (known as “derogations”), and that no ambulance trusts have so far secured local exemptions. 

Negotiations are now taking place in each ambulance trust area, with the national agreement only covering the most serious calls, category one, which includes cardiac arrests.

Category two covers a very wide range of conditions with over well 300,000 incidents a month, close to half of all ambulance incidents. These range from suspected heart attacks and strokes – where treatment is time-critical – to less serious or less time-dependent cases such as some falls patients. Not all are conveyed to hospital.

GMC, Unite and Unison are all planning strikes in ambulance trusts on Wednesday 21 December, and GMB is also planning action for 28 December (see table below for the dates and trusts covered).

The unions have said their members will continue to cover “life and limb” care on these days, but this has been left undefined.

One senior employer source said that since excluding category two did not amount to “life and limb cover”, because some very serious cases are included, all trusts were rejecting this position from the unions, and seeking exemptions for at least some of this work.

Another senior ambulance director said that as of Wednesday ambulance unions were “sticking to their category two definition”.

HSJ has also been told that at least one ambulance trust has argued to unions that all category two incidents should be covered. There is no expectation lower priority calls – categories three and four — will be covered by striking workers.

Taxis may be sent for some patients who need to come into hospital, while military staff are being trained to drive ambulances, and primary care clinicians have been called in to assist.

Hospital leaders have told HSJ of major concerns about the knock-on effects of next week’s ambulance strike, which covers all but one of the 10 ambulance trusts, at a time when all are already under huge operational pressure.

Where ambulances are not staffed by paramedics, nearly all patients are likely to be taken to hospital rather than treated at the scene, and once they arrive may be simply ‘dropped off’ rather than overseen by ambulance crews.

Patients may also take themselves to inappropriate services. Hospital chiefs also fear a surge in demand in the days following the strike, at a time — just before Christmas — when they are normally seeking to significantly reduce bed occupancy before the Christmas holiday.

Health and social care secretary Steve Barclay said last week that unions had indicated suspected heart attacks would be covered and that discussions last Thursday would include what cases crews would still attend.

However, today NHS England said that emergencies would be covered but discussions were continuing on other calls. It has not specified whether “emergencies” includes some category 2 calls as well as category 1.

It is also unclear how ambulance call centres will be affected.

Unison said that negotiations were continuing locally but it was the employer’s responsibility to provide cover. ”Unison is committed to working constructively with the employers ahead of the strike action. It will encourage ambulance staff to work under the exemptions when they’re in place,” it said. The GMB had not responded to a request for comment by the time of publication.

In a letter last month, NHSE said that the National Ambulance Service Partnership Forum and a steering group set up by the Association of Ambulance Chief Executives would agree derogations covering 999, 111 and patient transport services with trade union leads.

HSJ understands that some private ambulance firms have been asked to provide extra help during the strike but have said they do not have the staff to respond. The St John Ambulance – which has a national contract to provide extra capacity to the NHS when needed – will not be providing more support outside its planned and contracted activity and will not ask its staff to provide additional capacity, it said.

The Independent Ambulance Association has said its members will continue to provide contracted 999 and non-emergency patient transport services to the NHS but it was not able to facilitate ambulance services directly to the public.