UNISON Cymru Wales submission to the Health and Social Care Committee: Inquiry into the performance of the ambulance service in Wales
As the largest trade union in the Welsh Ambulance Service, UNISON is very pleased that the voice of staff across the Trust and across all professions and grades is being listened to by the Health and Social Services Committee. UNISON Cymru Wales represents some 35000 NHS staff across all grades and disciplines, 1200 of whom work for the Welsh Ambulance Services NHS Trust.
For some years UNISON and has absolutely strived, often under very difficult circumstances, to maintain professional and high trust partnership working. This is not just in conventional industrial relations with WAST but also with;
· With Welsh Govt, Health Minister, Deputy Health Minister
· With opposition Health Shadows over UNISONs commitment to improvement in WAST and the requirement for broad cross party support for robust clinical outcome indicators.
· With the media
· By leading the debate, internally and externally, about the need for performance improvement and judging the effectiveness of patient experiences via clinical outcomes not just how fast the ambulance arrived. The debate around demand, clinical outcomes and Choose Well is what UNISON has been very publicly campaigning on for a number of years.
· UNISON has a proud record of being a part of the solution, not the problem in transforming the performance of WAST.
Industrial Relations
There has been a significant improvement in industrial relations since the appointment of Tracy Myhill and Tracy earned the personal respect of colleagues and UNISON very quickly. It would be fair to say that the culture and high standards that Tracy is seeking to implement has challenged the status quo profoundly and that continues to be a challenge to the behaviour of some.
At the same time, UNISON has determined that it had improvements to make in its own structures, some of which did not add value to what we are trying to achieve at WAST. We have dealt with this via the creation of one all Wales UNISON Ambulance Branch that went live on July 1st 2015.
UNISON has long believed that, whilst there has been ‘partnership working’ in name, real partnership working has been anecdotal and not embedded throughout the organisation. For a number of years UNISON committed to move into real partnership working, with shared objectives around the success of the organisation: where high trust, high performance and a commitment to wanting to be the best Ambulance Service in the UK was critical for us.
Since her appointment, Tracy Myhill has been committed to introducing that same true partnership working within WAST and in recent months there has been a cross flow of ideas on what that might be and where we start from. It was Tracy’s initiative to hold three high level seminars across Wales to identify what partnership working could look like.
UNISON added considerable value to this process by inviting WAST and fellow trade unions to consider partnership working case studies from across Wales from world class companies whose partnership working drives them to be globally competitive, high performance leaders. As a result, a case study on how workplace partnership drove high performance at Airbus at Broughton was delivered and we hope to visit Airbus in the near future. We also introduced WAST colleagues and leaders to the exemplar workplace partnership work of United Utilities and Dwr Cymru – Welsh Water which were blueprints for the Airbus experience.
Whilst there have been significant improvements delivered from the top, by Tracy Myhill, Claire Vaughan, Estelle Hitchon and for many years previous, Judith Hardisty, which has challenged the culture of ‘top down management’ throughout the organisation, partnership at a local level is often not where it needs to be. There are still too many occasions where the views of trade union partners are an afterthought or where some meetings go ahead without invited trade unions being in attendance because of resource issues.
The key headlines noted during the last Inquiry still hold true.
· Rota’s
· On time meal breaks
· and over-runs.
UNISON supports in principle the requirement for rota’s to be clinically demand led and for those rota’s to support patients as well as ensure good work life balance. But in many parts of Wales, rota’s are still not right with a feeling that many were introduced in haste not least because many were introduced outside of established partnership working. Our members still report that they are not getting very significant numbers of their meal breaks within their windows. And many staff are routinely carrying out significant shift over-runs. It is important to consider that many shifts are 12 hours long and significant over-runs are clinically dangerous as well as coming at a high personal cost to staff.
So there have been serious improvements, and the new management regime has been key. But our belief is that it is not yet embedded. We would particularly welcome future Health and Social Care Committee encouragement in its recommendations to support real, high trust, partnership working at WAST.
Performance
UNISON is also absolutely committed to getting a world class ambulance service that is fit for purpose in a country that does not always lend itself to vehicles going from A-B in prescribed times. That is why clinically measuring patient outcomes is so important to us.
UNISON has led the debate for some time on the striking evidence that A8 times are not clinically important (apart from the most critically ill and life threatened patients), only measure what the ambulance did before arrival, not what EMS professionals did after and can often divert resources in order to ‘chase the eight’. We implore the Health and Social Care Committee to consider the need to place clinical outcomes (which do matter) above the need to post A8 times (which don’t, other than for around 150 people a day) and to oversee the clinically led response model pilot developed over the summer.
Politicians of all colours never feel the heat as much as frontline EMS staff who are upset and appalled at the monthly assault that they get over response times, notwithstanding that it is not intentionally directed at them. All official and unofficial staff surveys/interviews support this feeling from staff. They are not interested in the fact that there was a general election looming or a National Assembly election next year. They are interested in the fact that they are saving lives every day, often in the most difficult and extreme of circumstances, and then suffer the devastating blow of getting the now regular monthly attack on their response times.
UNISON is not opposed in principle to clinical outcome indicators being comparable across home country borders if this could assist in the provision of cross party support in the Senedd for a clinically led set of performance indicators.
UNISON also believes that we need more volunteer community first responders (CFRs) in Wales as a key to cardiac arrest survival and recovery. Irrespective of one’s views on the clinical outcome model it is a mainstream view that for the most urgent cardiac arrests, an eight minute response can be too long in any case. Therefore a package of care with CFRs attending within minutes and EMS responses just after, should be promoted by the active recruitment of more volunteer CFRs. We have also called for a substantial increase in publicly available automated external defibrillators. During the McClelland review we noted that Seattle has one of the world’s highest survival rates for cardiac arrest at around 20%, with King County in Seattle having a 62% survival rate. Seattle has one of the highest number proportionally of volunteer community first responders and a significantly high number of publicly available automated external defibrillators. The average survival rate is around 10% in Wales and across the UK.
Demand
UNISON has consistently been arguing in Wales that demand for emergency ambulances is increasing by over 5% a year, every year and has done so for over a decade, which is unsustainable. This has had a profound effect on the ambulance service as well as the capacity of Emergency Department’s. It is also a desperately dispiriting experience for those patients who could have achieved earlier clinical advice instead of sitting in an Emergency Department.
We have consistently talked about the need for alternative pathways that are ‘always on’. It was important for UNISON therefore to see what we could do practically to support the Choose Well campaign.
So UNISON, as the largest public service trade union determined to use its reach, reputation and relationships with public service employer’s right across Wales to encourage them to formally sign up to the Choose Well campaign. This was so that we could encourage employers we had a relationship with to deliver key messages to both their staff and their services users such as students, tenants, clients and the general public. Our inaugural #ChooseWellChampion was Hafal, the charity supporting those with a serious mental illness who will deliver choose well messages to their 200 staff and 3000 service users across all 22 counties in Wales. After this autumn’s campaign, we hope to talk to the Wales TUC to see whether cross union networks could be used which could open up key messages to Wales’ 500,000 trade union members and their employers.
In helping to reduce demand on 999 and Emergency Departments, UNISON has continually called on the Minister, Deputy Minister, WAST and the wider NHS estate in Wales to look at the innovative examples that some English Ambulance Services use to educate the general public on the appropriate use of 999 and ambulance services.
For example, ambulances in East Midlands have vibrant and informative Choose Well messaging on ambulances. There really seems to be a barrier somewhere in the system to putting out these messages on NHS assets in Wales. We have also called for a schools and colleges education campaign that could include an art competition that will result in an on-ambulance poster for the winner/s. We have also called on the Welsh Government and Visit Wales to work together on an ‘enjoy Wales, stay safe in Wales’ campaign to deliver Choose Well messages to the hundreds of thousands of visitors that we attract in Wales.
Patient Care Service
It is UNISONs firm belief that the ‘non-emergency patient transport’ that the Committee Inquiry discussed in its last outcome in March 2015 is in fact a Patient Care Service (PCS). For example, each PCS ambulance carries a defibrillator and staff who are trained to use them. It would be wrong to conclude that WAST is somehow distracted from its central role of providing EMS services by its provision of PCS services. In fact in terms of resilience, finance and robust support at major incidents, a strategically managed PCS is absolutely critical to the EMS function of WAST. We have some reason to believe that the appetite for Health Boards to take on PCS has slipped away since the McClelland review and that a reformed PCS would be best placed within a clinically led WAST.
Concluding comments
UNISON completely accepts that the performance of WAST has to improve on many levels. We believe that we now have in place a Chief Executive who can make this happen by engaging with trade unions (and staff more widely). Equally, UNISON is supporting the demand for high standards from both staff side unions as well as WAST leaders.
UNISON can evidence that it has long been a part of the WAST solution, not part of the WAST problem. Our combined contribution towards real partnership working, supporting world class clinical outcomes and reducing demand by highlighting alternative pathways is unsurpassed.
Our personal commitment to improving WAST performance is that we will not change our strategic approach which we believe will contribute to an ambulance service that we all, the people of Wales, want to be proud of.
Darron Dupre
Ambulance Lead
UNISON Cymru Wales
14th October 2015