first person

Sharing a night shift with an ambulance paramedic team caused trust non-executive director Lynn Massey-Davis to question her role

I had a very humbling experience recently. Some time ago I was challenged by a couple of our paramedics to spend a 12-hour night shift with them, preferably on a Friday - usually their busy night.

As a director I had often regarded my 'strategic role' as a buffer zone, created to enable our operational staff to do their work with as much support and as little hindrance as possible. Given that I have been out with crews on a number of occasions and attended too many station meetings to remember, it shouldn't have come as any surprise to me that the crews don't see my role in that light.

It was the quietest Friday night the accident and emergency services had seen in Hull and east Yorkshire for months. We visited A&E several times during the night, and it was almost empty. Even so we were kept busy. The longest call-out during the night was to an outer-city estate with 40,000 inhabitants - enough to fill a small town in other parts of the country. A young man, who we later found out was a persistent hoax caller, claimed that a young woman had taken a drugs overdose and had run away into an alley of empty houses. We searched carefully for a proverbial needle in a haystack, wary of a potential set-up. Failing to find her, we called for police back-up, and returned to our van, only to be taunted and shouted at by a couple of gangs of drunk onlookers. If this had been a busy night, the 40 or so minutes this hoax took could have cost someone else's life.

During the long night we exchanged stories about experiences both within and outside the service. Subjects included the real fear that one day one of them may be stabbed by a client out of their head on God knows what, the frequent 12-hour shifts without a lunch break, and the recent 10 hours spent at the headline-making Hull Prison siege with only two cups of tea and two pees each. On top of all of this, we expect paramedics to continue working until 65 before they can claim a full pension. One patient we transported weighed 24 stone and had to be lifted down several flights of steps.

I have been in the NHS since 1986. My husband, a senior manager in another trust, regularly breaks the spirit of the working-time directive, so I know the score. Contrary to popular belief, it isn't just nurses and doctors who carry the NHS. Secretaries, information technology staff and paramedics are all giving over and above what should be reasonably required of them.

Salary and status aren't the only sticking points. I am unable to explain to them how we can reasonably expect them to add 2 per cent to their workload each year, as demanded by the white paper cost-efficiency saving targets. That 2 per cent represents a paramedic's ulcer - perhaps he's 50 and his body won't stand for rushed lunch - or no lunch - followed all too quickly by a dessert of cardio-pulmonary resuscitation. That 2 per cent is a family breakdown due to stress.

The whole system appears to be built on blackmail, not because paramedics and other NHS staff are too stupid to get work anywhere else, but because they care and people may die if they don't.

Morale appears to be very low at our trust. Increasing numbers of calls, combined with a feeling of insecurity, appear to be the main causes.

At the end of our 12 hours together I had an argument with one of the paramedics. He said: 'What we need is more ambulances on the ground. People are dying - and I don't just mean our patients. It is us, too. What it needs is a board who have the bottle to say this out loud.'

I said that it was a matter of what the public was prepared to pay for and they had indicated this by their behaviour at elections. At policy level, the government is expecting individuals to take more responsibility for their lives, with initiatives such as the New Deal, while state support gradually retreats. In lengthy conversations with colleagues I have called it The Gap. PD Anthony, in his book Ideology of Work, talked of 'management retreat from responsibility'.1 Perhaps the government, faced with finite resources, is being forced down the same route. The trouble is that, as individuals and as organisations, we are like dogs chasing short tails - ever hopeful but destined to fail.

At 6.15am, the streets still dark, but with sunrise imminent, I drove home. I had learned a great deal. But I was less clear about my role as a non-executive and what I could achieve.

Lynn Massey-Davis is non-executive director, Humberside Ambulance Service trust.


1 Anthony P. The Ideology of Work. Tavistock, 1977.