• Ambulance trusts do not expect to hit targets for two more years despite April deadline
  • Retention issues exacerbated by other NHS services “poaching” paramedics, says chief
  • Ambulance providers piloting new “portfolio” contracts to try and improve retention

Ambulance trusts will not hit most of their new response time targets for “another two years” largely because of significant workforce shortages, a sector leader has told HSJ.

South West Ambulance Service Foundation Trust chief executive Ken Wenman also warned in an exclusive interview that the sector’s workforce problems had been further exacerbated by other NHS services “poaching” senior paramedics by offering better work-life balance.

Mr Wenman said: “It will probably take around two years [from now] before all of the [six core Ambulance Response Programme] targets are being met, largely because of workforce issues.

“Most trusts should hit the category one target [the most urgent life threatening calls] much quicker than that, there is no reason why trusts should not be achieved within the year…But [it will take longer to meet the] category two calls, which is the largest proportion of our work, and also the non-life threatening cases, the category three and four.”

The NHS’s 11 ambulance trusts were told by system leaders they must hit the new standards, introduced in 2017-18, by April 2019, but they remain off target.

They recorded a mean of seven minutes 17 seconds in August 2018, against the seven minute C1 target, the best since the standard was introduced this year but still in breach. And performance is also expected to dip over the winter. 

The C2 mean average response time, however, was 20:42 in August 2018 – a long way off the 18 minute target, according to NHS England’s official data.

Mr Wenman’s comments followed a major national review published last week laying bare the ambulance service’s workforce crisis. Ambulance staff reported the highest sickness and bullying and harassment rates across the whole NHS, according to Lord Carter’s review.

Mr Wenman, who joined as a paramedic aged 21 and has been a senior manager since 1999, leads on workforce issues for the Association of Ambulance Chief Executives.

In addition to insufficient numbers of paramedics being recruited overall – an argument accepted by Health Education England – those new recruits which were joining were not staying in the sector as long as previous generations.

Around half the current paramedic workforce have spent more than 25 years in the service while newer recruits expected to leave after between 10 and 15 years, or even earlier.

Retention problems were then further exacerbated by other NHS services, such as out-of-hours and urgent care providers, hiring senior paramedics with the lure of a better work-life balance on similar remuneration.

Mr Wenman said: “Over the last couple of years we have seen, particularly our specialist paramedics, poached by other parts of the NHS because they are now viewed as a very useful clinical resource in a way that haven’t been in the past.

“So, we are looking at how we can retain our staff through some form of portfolio contract like, doctors often [have].”

The trust is set to pilot a “rotational contract” where a paramedic could work two month stints on an ambulance, then in an urgent facility, “then perhaps a couple back on the ambulance, then perhaps to an emergency department”.

This would give a wider range of opportunity and also offer respite, he said. Senior paramedics are being appointed into roles such as emergency care practitioners and based in a range of settings, including community hospitals, GP surgeries and minor injury units, he said.