Changing Identities of Emergency Services Workers: The Need for a New Thinking

The recent tragic events in London and Manchester have highlighted the difficult and challenging role played by the emergency services. Their swift and professional response has drawn universal praise but has also raised issues around reduced funding levels and job-cuts to match heightened security threat. I argue that ‘transformational’ reforms are needed to improve our emergency services in the time of austerity.

Several barriers hamper better coordination between the emergency services. There is a fundamental shift in the nature of the work and staff deployment. Ambulance demand is growing at an annual rate of about 10%. The police services is witnessing a reduction in recorded crime and dealing increasingly with cases relating to cybercrime, child and sexual exploitation and mental illness. Fire Services have seen a massive reduction in incidence of fire. But these organisations continue to be performance managed and target driven and current models of service delivery do not reflect these changes.

The government policy towards blue light integration is quite vague and unclear. The Policing and Crime Act, 2017 places a duty on police, fire and ambulance services to work together but hasn’t been specified. The Police and Crime Commissioners (PCCs) can make a business case to run the police and fire & recues services jointly but ambulance services remain outside the purview of these provisions. These proposals are likely to help drive collaboration only if attendant issues surrounding differences in organisational and professional cultures, differences in career spines and joint training programmes at all levels in the two organisations are responded to.

Workforce support remains a neglected management priority given the operational focus of these services. Staff input and knowledge doesn’t necessarily get reflected in the design of organisational systems and often leads to frustration, lack of motivation and non-engagement. In my research, I have highlighted that staff sickness is highest amongst ambulance services within the NHS and retention and recruitment is proving difficult with cases of shortage of paramedic staff reported nationally. A recent report pointed out the levels of discrimination reported by ambulance staff as highest amongst the NHS staff. Cases of harassment and bullying are also being regularly included in official reports.

There is also a lack of clarity on the important issue of work force professionalisation. The three services are also moving at different speeds and with different agendas. A national curriculum for police is available but will have implications for the fire services staff in the proposed merger plans. Entry level qualifications for paramedics are in operation but differences in roles and responsibilities across different organisations can create problems. The traditional and historical models of ‘heroic’ and ‘top-down’ leadership will also need to give way to a more collaborative and pluralist approach which allows development of leadership across all levels in the organisations.

Routine ambulance conveyance to hospital A&E is being replaced by ‘see & treat’ and ‘hear and treat’ options due to enhanced clinical skills and education of paramedics who may have many complimentary skills with nurses. A joint emergency services model to help reduce unnecessary hospital admissions is currently in operation. Paramedics are now working in GP surgeries, out-of-care facilities and increasing the involvement of nurses in ambulance services would be mutually beneficial and a welcome development.

Emergency Nurse (RCNi), Vol. 25, No. 4, pp.14, July 2017 
New thinking needed for emergency services
https://journals.rcni.com/toc/en/25/4