# Ambulance Departure [[Articles]] #ambulance 'So long, and thanks for all the fish'. [Douglas Adams] --- - [[#Retention Policy|Retention Policy]] - [[#A Job Too Far|A Job Too Far]] - [[#Communication|Communication]] - [[#Time to Leave|Time to Leave]] - [[#The Departure|The Departure]] --- ## Retention Policy _"We don't need one"._ It was during one of those deeply meaningful annual reviews, the ones that no one looks forward to. Management hate them, staff hate them, but the boxes have to be ticked. The only people who look forward to them are the ones who will climb the greasy pole, oblivious to their own shortcomings; the ones who have no intention of staying at the coalface, the inexperienced policy-setters of the future. I digress. I'd reached the point where I was 'playing the game', nodding in all the right places and avoiding management as much as possible. As far as I was concerned they were all culpable in the demise of rural ambulance cover. We'd reached the end of the meeting and along came the usual question: "Is there anything you want to ask?". What the hell, what's to lose - "What's the service's retention policy for keeping staff?" "We don't need one!", came the reply with a look suggesting that I would never rise above the ranks. The reply summed up the state of the NHS and why I wanted out. I guess they were right, to a point, as long as there was a steady stream of university students why bother trying to keep more expensive 'experience'? As the NHS implodes, staff leaving in their droves, record numbers of vacancies and the promise of a desperate, government-driven (Conservative party), workforce plan - it wasn't such a stupid question. It may not be NHS policy to not have a retention policy, but it was certainly conspicuous by its absence that day. --- ## A Job Too Far _Forgotten communities._ One 'job' in particular stuck with me that epitomised the state of patient service, or lack of it. We'd had a call to an elderly patient who had fallen in the street in a small market town 'up in the hills'. No other information had been passed. We pulled into the street where a small crowd had gathered, we parked and I got out. I was immediately met with abuse from the crowd, unhappy with the time it had taken for us to get there. I was a little taken aback - we'd responded in about 12 minutes - not brilliant but not bad considering the distance. A Police Community Support Officer (PCSO) was in attendance, he spoke up to quieten the crowd and explain that any delay wasn't our fault. The story unfolded, if anything I was more disgusted than the crowd. The elderly patient had tripped and fallen injuring her hip, unable to stand she had been lying on the pavement in the middle of the town for **five hours.** The PCSO had witnessed the fall and waited with her, doing his best to provide comfort - full credit for that. Despite the horrendous pain she was in good spirits and apologised for the inconvenience she'd caused, as old folk tend to. We could only think of how she, and the rest of the rural communities, had been cast aside by an uncaring service in favour of urban response times. **Disgusted. Angry. Disillusioned.** --- ## Communication _Churchill visits the crewroom._ It was the early days of the pandemic. Standing in the crew room where everyone was socially distanced, sitting in two-meter isolation eating their cold breakfasts. The microwaves had been removed lest they be a source of infection. No hot food provided, not so much as a single free coffee - Thanks! The station manager walked through the crew room and glanced toward the troops. For a moment my expectations were raised that perhaps, just perhaps, we were about to get a morale-boosting pep-talk or some key update - it would be the first . Early days of the pandemic - not much information had trickling down. The rolling 24-hour news via the crew-room TV was about as good as it got along with the daily science briefing; I was surprised how many of my colleagues showed no interest. In-service procedural updates started filtering through, but they soon became too numerous to keep track of, changing almost daily trying to keep pace with shifting government policy. The manager stopped and turned to the now expectant audience. A rousing Churchillian monologue it was not, instead a chastisement was delivered to an unwitting sole for wearing a wristwatch, in breach of a 'bare below the elbow' policy. Then out he walked, without another word. **The troops felt suitably demotivated.** **The victim felt publicly humiliated.** _(Bare below the elbow - NHS policy at the time exempted ambulance staff from this ruling, acknowledging the need for wristwatches)._ --- ## Time to Leave _End of the line._ For many in healthcare the pandemic was the first and last straw that broke everything. For me, the rot had set in long before the world had heard of the wet markets of Wuhan. I'd been more than happy working on a rural response vehicle. My career ambition rested there. I didn't want to climb any ladders. Been there, done that. I'd passed all the courses to work on the car. I'd even signed up for a degree course hoping, naively, to secure my future at the rural post. It was not to be. Someone in the Ivory Tower had decided that the rural posts and the response cars were to be axed. Of course the box-ticking 'consultations' with staff and the public were conducted; varying degrees of "tough, it's happening". Local CCGs[^1] and worried locals be damned. At least there was some consolation, knowing that the outlying areas were still covered by volunteer Community First Responders (CFRs). Not for long. The CFRs were still there but they were soon to be deskilled in what appeared to be an exercise in risk and cost management. Many good people, who had been serving their communities for years as volunteers, quit. The rural response cars and CFRs were being devalued. The local town council was becoming a bit of a thorn in the side of the plan to close the rural response post, rightly questioning the closure, so the closure was brought forward. Welcome to the city - empty promises of a locker and a regular crew mate. The one perk - I swapped nights for late shifts, but they may as well have been nights with all the ensuing late finishes. No regular crew-mate, the station manager wanted flexibility and didn't like the idea of regular crews. In the early days students used to 'third man' to gain experience, but then the pandemic and 'exceptional times' arrived. Students were now being crewed up with paramedics, with many of them not qualified to drive. Management had little interest in the additional pressure being placed on crews; driving for 12 hours whilst working with clinically inexperienced and unqualified staff. It wasn't much fun for the students either, in at the deep end and occasionally getting crewed with unsympathetic 'mentors'. The rest of the old rural team all had regular crew mates, I was still waiting. It got to the point at one stage where pretty much all my shifts were with unqualified students. Whilst I had nothing against students, the pressure was beginning to get to me. I wasn't unique, the pressure was getting to everyone. We were in the middle of a pandemic. I used to be proud of the service. The workload was now badly outpacing resources. Patients waiting for four, five, or six hours for an ambulance. The controllers came in for a lot of flak from the road crews. I could never work in the control room, 'despatching by algorithm', hoping and praying that nothing serious dropped through the gaps in the system. Not the controllers' fault. I guess it was all part of the modern need for litigation limitation, 'the computer got it wrong'. But some of the crap that was coming through beggared belief. The crew room cynics attributed this to hitting 'easy response times' and a belief that the service was being paid 'by the job', irrespective of the calibre of the job. This logic appeared to fit the feeling that rural locations were slipping down the priority list: send crews on a target-missing round trip into the hills or a couple of good response times in the city? A manager once said that the response times could be missed on every single rural job, the volume of jobs being so small, it wouldn't affect the overall response figures one bit. Great attitude for an organisation that supposedly served all of the community. Needless to say, I didn't share their viewpoint. I had served a remote rural community for over half my career, I lived in that rural community, friends and family lived there, why should rural patients wait in line behind target-chasing city jobs? Management didn't appear to give a shit. I guess, like many organisations, they weren't allowed to think for themselves: as the politicians are keen to say these days 'collective responsibility' - stick to the script. I got sick of spending the first few minutes of patient contact apologising for the crap service, this wasn't how it should be. A steady degradation of standards and withdrawal of services. Getting flak from the public, and privately agreeing with them. They say that stress is caused by things outside of our control; this was well and truly out of my control. Each day was becoming a struggle and I couldn't wait to leave. **I never did get a locker.** --- ## The Departure _Thanks, and no "Thanks"._ I was on my way out, working my four-week notice period and keeping my head down. I'd not broadcast my intended departure beyond a couple of close friends. I emailed my resignation to management and received the stock reply: 'Thanks for your service. Don't forget to return all uniform items, or you'll be billed...'. Of the dozen or so managers, acting managers, and wannabes, two showed passing interest in my departure: one asked why I was leaving, with a tone of disbelief, and the other wanted to form an escape committee. My penultimate shift, crewed by chance with a union rep., someone I'd known since I joined the service; dependable with the sense of humour of a survivor. We grabbed a coffee from the crew-room vending machine whilst my crew-mate commented to a mutual friend, "It's his last day tomorrow" whilst gesturing towards me. "Four off?" "Er.. no". Not wishing to draw attention to my impending departure. "Eighteen off then?" "No". "Oh. What then?" My partner filled in the gaps, "He's quitting, leaving". "Christ, that's more experience gone", shaking his head as he wandered off. The rest of the shift was uneventful, most of the time queuing outside A&E which was becoming the new normal. My last day finally arrived - I parked my car and walked into the station; strange feeling like a weight had been lifted. I just needed to get through the day without any drama, a nice steady shift. I had been blessed with an excellent crew mate, who had no idea that it was my last shift and took some convincing. Another shift of prolonged queuing at the hospital, which gave some of my colleagues chance to seek me out, the word had spread. Every one of them understood why I was leaving and genuinely wished me well. During the shift the station manager was in situ, along with two other operations managers one of whom I actually spoke to during the shift. Not a single word from any of them - 17 years of service and not one word on my last day. The end of the shift arrived and we headed back to the station. I'd ticked the box requesting an exit interview which, according to the form, would be conducted by whichever operational manager was on duty. Walking into the garage I noticed that the management car was missing, early hours of the morning and the car was out - that usually pointed to a 'bad job' somewhere. According to the support staff there was no 'bad job', the manager had left the station about twenty minutes before my return. No exit interview then, just as well. I changed into civvies and left my kit with the support staff. They couldn't believe I was leaving, I couldn't believe that 17 years of service was condensed into the contents of two bin bags. I drove out of the gates, never to return. It felt odd leaving like that. All the people I had helped over the years, all the training, all the long hours, all behind me now. Sadly, I'm not alone in not hearing a word from management on my last day. A friend retired after 27 years leaving the station mid-afternoon on his last day, without a word from management. **Just another number to be deleted from the payroll.** --- [^1]: Clinical Commissioning Group