Published: 01/07/2004, Volume II3, No. 5912 Page 34

John Williams finds lessons from the poor showing of ambulance service managers in the NHS staff survey

A 'truly awful' performance from a service 'struggling valiantly' with 'shockingly low organisational direction'- HSJ's verdict on ambulance services in England ('Stretcher cases', pages 32-33,22 April).

HSJ 's analysis of one area out of 30 in the NHS staff survey portrays a management performance significantly adrift from other areas of the service.An analysis of the actual scale summary scores of the same subject area - quality of senior management leadership - does indeed show that the ambulance service is behind the rest, and there is a wide variation of scores from one ambulance service to another.

Senior managers in Staffordshire and London were given a score of 3.9 out of five by staff and the trust regularly records the best response times in the country.Surrey, Isle of Wight, Two Shires, Warwickshire, West Country and Greater Manchester all scored a creditable 3.8 on the quality of senior management, and a brief examination of the other questions reveals a reasonable correlation with a good performance in areas such as flexible working, staff satisfaction and delivery of training.There are dangers in drawing definitive conclusions from staff surveys without being aware of the full context, however.

Ambulance managers are operating in a fast-moving environment.Some are leading emergency care networks across health economies - all are delivering significantly improved response times and all have quietly succeeded in equipping and training hundreds of staff for chemical, biological, radiological and nuclear occurrences.

The need for the improvement programme for ambulance services is emphasised by the survey. Its work is already improving the sharing of best practice, and the production of effective guidance has increased.Perhaps the real lesson is that, like my own service and some others, ambulance trusts should also be looking at their health economies and working in partnership with acute trusts, primary care trusts and others to improve performance and, consequently, patient care.

John Williams is director of HR and communications at Greater Manchester Ambulance Service.