- Interview by
- Ronan Burtenshaw
When it comes to the NHS, 2023 started off with a grim warning. Dr Adrian Boyle, president of the Royal College of Emergency Medicine, appeared on Times Radio on 1 January and gave listeners his organisation’s estimate for deaths taking place due to the present crisis in emergency care: between 300 and 500 every week.
His intervention joined a growing stack of stories exposing the desperation now underlying every day in the ambulance service. For those in the frontline, the forces behind these figures seem clear. Low pay and high pressure are driving healthcare staff away from the NHS, heaping more pressure in turn on those who stay. A decade of austerity and privatisation not only in the NHS but in local government and social care has cut away at resources and limited capacity. And until recently, the government that made these political decisions refused to listen to the needs of those workers facing the consequences, let alone act on them.
Having now agreed to negotiations, ministers are reportedly more interested in discussing what’s left for them to squeeze out of exhausted health service workers than what they can do to help. Their other approach is to legislate against them: on Monday, the government published its Minimum Service Levels Bill, with which it intends to strip health workers—among others—of their fundamental right to strike.
The government claims to have brought this legislation in the name of public safety. In reality, it’s an attempt to paper over the catastrophic consequences of thirteen years of failure, and to obscure the fact that it’s exactly concerns about public safety that have forced so many health workers onto the picket lines. When up to 500 a week are dying, workers are being driven away by the cost of living crisis, and those in power won’t do anything about it, industrial action is often the only option left.
This is backdrop against which ambulance workers in the GMB and Unison are striking today, having first taken to the picket lines on 21 December. Tribune spoke to Deanne Ferguson, a GMB union organiser in the ambulance service, about the fight facing ambulance workers, the strength and power of public support, and why there isn’t much time left to save our NHS.
In recent weeks, GMB has been talking about a ‘lost decade’ of earnings for ambulance workers as the backdrop to this dispute. Can you tell us about that, and how frustration has been building not just over weeks or months but years?
Over the last decade, ambulance workers have lost just over 20% in pay by not keeping up with average inflation rates year-on-year. The government relied on the Pay Review Body (PRB), which often gave below-inflation recommendations. This year, we’re seeing record high inflation rates, rising in living costs and additional pressures inside the service, for both the ambulance service and the NHS generally. That has been a catalyst for workers to say, ‘we’ve had enough.’
When the government imposed 4%, we balloted our members and had an 80% turnout and a 90% vote for industrial action. These are ambulance workers, frontline and back office as well. The last time a strike like this happened in the service, or there was this level of anger, was around 30 years ago. But when you speak to the workers, it’s clear: this is not just about pay, it’s about the conditions that they have to work in.
When a colleague leaves, they’re not being replaced. And that happens almost every time. There’s a huge shortage of staff. There’s around about 130,000 vacancies across the NHS, which is putting additional pressure on those who remain. So, as well as the ‘lost decade’ of pay, which has pushed so many to leave, those who now work in the service are absolutely on their knees. They are outside A&E in lines most nights, ambulances packed up for 4, 8, 12, 16 hours waiting to deliver just one patient. It’s an appalling situation.
Those long lines of ambulances are such a stark image of this NHS crisis. How motivating has that experience been in driving this latest strike?
It’s huge. The most difficult thing is hearing the stories from ambulance workers who go home from work every day feeling that they have let somebody down. That takes a massive toll on them and it is completely wrong. You can see that through the increased levels of sickness over the past decade as well. In some cases, in order for workers to finish a shift, another crew will come on and take over with that same patient in the back of the ambulance. That’s not what they signed up to do.
We’ve got examples of members that have turned up to respond to a 999 call where somebody’s been laid on the floor for several hours. Immediately, when they walk into that situation, they’re apologising. They’re the ones that take the blame. And when they then get to the hospital, they can’t even do an immediate handover of that patient. They’ve got them on the back of a trolley.
There has been study around how long patients should lie on trolleys for. The maximum time that they should be on a trolley is around four hours. But that isn’t even close to where we now are with the NHS. You’re talking 16 or more hours in numerous cases. I think the largest handover time was 26 hours a couple of months back. It is putting patients at risk for everything from skin conditions to muscle injury and far worse.
And that’s not even the worst of it. I don’t know if you saw the story that came out over Christmas—it was kept relatively low key during the worst of the crisis, but some media did get hold of it: ambulances were running out of oxygen tanks because patients were on the oxygen for so long. There was a national shortage of oxygen over Christmas, because obviously there are a lot of respiratory issues at the minute. It’s really bad when you actually drill down and hear what happens day-to-day.
Recently, there have been stories in the press of elderly people having to lie in their back gardens under a tent for hours after falls. There was another story about someone whose family put them on a piece of wood in the back of a van to be brought to a hospital. What impact do stories like that have on ambulance workers and their mental health? It must be awful to know people need ambulances but can’t get them and it isn’t your fault.
One of our reps, who’s been working for the trust for six years, resigned in January. He said, ‘I cannot cope, every single day, coming in to know that this is what I have to deal with. I’m never actually doing the job that I was employed to do. I’m constantly feeling that I’m not making a difference.’ They’re leaving the service at the rate of knots. This rep moved to get a job in Jet2. The pay is so low, these options are far more attractive. We’re losing ambulance service workers to budget airlines because they feel that at least there they might be able to have a decent work-life that isn’t so full of stress.
Lee Edgerton, who was an emergency care assistant, went on the BBC earlier in this dispute to explain the reasons behind it. He has actually left now as well. He had two strokes and he’s only 26 years old. In six years of being a frontline ambulance worker, that is how bad it got. He was working during Covid and caught it five times, with possible complications. He was working throughout the pandemic with very little PPE and obviously catching it from patients that he was then caring for. What a tragedy that is.
It has a massive impact on families. You’ve got husbands and wives that are swapping over childcare arrangements and leaving kids with neighbours because the wife’s had to go and start her shift in the hospital and the husband’s not finished yet from the ambulance shift. But then you hear Rishi Sunak and the government saying, ‘We’ll potentially talk about pay when we talk about productivity.’ I honestly do not know what more these people can do. The answer is not ambulance workers giving more, it’s the whole system that needs looking at: social care, NHS, how it’s managed, how people are being paid. The health system has gone badly wrong because the government hasn’t listened to its workers.
What was the response of ambulance workers to that comment about productivity?
It’s pissed them off, is the honest answer. It’ll be reflected in this industrial action and the people on our pickets. Every single time this government has spoken publicly, it has driven the workforce to take further action. While we were out on the pickets on 21 December, we watched the press interview with Steve Barclay on the BBC. One of the members said, ‘That’s exactly the reason I’m standing on this picket, because they’re not listening. They don’t care.’
I think the government has seriously misjudged the level of public support, which was incredible on the picket lines. I’m confident that will be replicated again today. And once the day is done, we’ll be back around the table discussing what action comes next, with the workers motivated to fight.
How much is this all linked to the broader NHS crisis? Are we looking at a situation where you can’t solve any single piece of this mess without taking a different approach to the NHS, one where there’s better funding and staffing across the board?
What you’re seeing is the result of a decade of austerity. And now they want to do it all again. We’ve got a crisis in the hospitals and with the GPs and in ambulances and in the social care sector. You’ve got outsourced cleaners and porters on strike and nurses and junior doctors and paramedics. And they do all relate.
Take social care. The failures there are causing bed blocking within the hospitals. We’ve seen over a decade of cuts in local government, which means that local community services around mental health and social care and community living have all been stripped back or privatised—companies asset-stripped and left with huge portfolios that were once local government-held properties.
We could go on and on. It’s not just one issue, it is definitely a decade of policies that, taken together, have smashed the NHS. They have made it unsafe for people and unworkable for staff. They have brought in private companies that try to siphon off money into profits. Added together, it is the beginning of the end of proper public healthcare. There’s just no way it can go on like this. People will be forced to choose other options or free at the point of access will just disappear.
I think we’ve got to get that message across to the public. To be honest, if we carry on this trajectory, I don’t think we even have six months left of what we once knew as the NHS. If we want to save it, we’re going to have to fight.
Whenever there are healthcare strikes, there are people who are legitimately worried. They’ve got an elderly or sick relative and, even though they might support the cause, they worry that this might put lives at risk. The media and the government play up that narrative. What do you say to those people?
We had our strike on 21 December and I think that shows you the answer. We’re still waiting on the full data, but from the Yorkshire ambulance perspective, we had one serious incident in the 24 hours. Normally that would be in double figures. We actually provide a better service for extreme cases on the day of strike action than we would normally see in day-to-day running. But that’s because so much of what ambulances do aside from the immediately life-threatening work isn’t being carried out.
When it comes to ‘life and limb’ cases, we take that very seriously. Ambulance workers are committed to helping patients and they are the first ones to insist that life-saving care is available. That is the case when crews are responding to what are called ‘category ones’. We had an ambulance station in Castleford where a category one was called and the crew responded to a cardiac arrest within two minutes. They saved that person’s life. The director of the trust actually said if they were not on that picket and we didn’t have that category one response time, the ambulance could have been outside of an A&E in a queue, that crew would have been tied up and not able to respond. It’s likely that person would have died.
That is the reality of the normal day-to-day NHS at the moment. The service itself, with its lack of funding and staffing, is putting patients at risk. That is what the government doesn’t want you to hear. It’s not about trade unions or frontline workers, it’s on them. We have worked really hard, as a union, to provide derogations to ensure that we have life and limb cover. We do our best in spite of the government, how they pay workers, and how they treat us.
There is another point, though. We need to educate the public on the situation with 999 emergency calls. Across the ambulance trusts, there is an increasing tendency to pass everything to either 111 or 999, because they can’t say no. You’ve got GPs referring their calls through, you’ve got hospitals which refer their calls through. And then you have members of the public that are ringing 999 or 111 in cases that are not an emergency. There are reasons for this, but we also need to get a message out about trying not to run our ambulance services into the ground.
One example of broader problems that play into this is the mass underfunding of mental health services. The truth is that our ambulance crews are spending hours on scene with people suffering with mental health problems. These people should be in local crisis teams. That’s because the local government funding has been cut, and so have services in hospital areas that would be supporting people. Everything gets passed to the ambulance service. The government must realise this, but they refuse to change.
How many people in ambulances could have called or gone to a GP? But what if that GP has been working seven days a week and providing support to their community outside of their job description? These are the knock-on effects. And I can honestly say all of that is far more dangerous every single day than the workers who provide the services taking a few days of strike action to stand up for better.
Where does the dispute go from here? What, in your view, does the government need to do right away for ambulance workers?
They need to start negotiations. We keep hearing that there will be a reasonable and fair offer. Well, what is that offer? Because they haven’t made us that yet. If we get it, as any democratic trade union would, we will refer it back to our members. But right now, it’s a lot of hot air.
Monday’s talks were a wasted opportunity. We could have been in a situation where an offer was made. The Treasury could have put aside an amount, a lump sum payment, or increments that worked over the next two or three years. They could have offered another two, three, four percent on what was already given in ’22. If our reps then felt that offer was good enough, we would have postponed the action today and we would now be going through a balloting process.
That obviously didn’t happen. We saw lots of PR and then a 45-minute meeting. Workers, unions, and I think the public want to see serious talks, they don’t want to see PR stunts. We need them to negotiate. And when they do, obviously that will determine the next action by our members.
Instead of making offers, the government is making threats. One of the latest of these is a new set of legislation to try to enforce what they call ‘minimum service’, which would mean the government intervening to say who is allowed to strike and who isn’t—in effect, curtailing the right to strike. What’s the view of ambulance workers, who would be one of the groups targeted, about that legislation?
You’ve got a group of workers here who go above and beyond, every single day, in their duty at work. I think that legislation is massive disrespect to those workers. They’ve got a fundamental right to take industrial action. And to remove that right from these workers is a further kick in the teeth. We see daily what they do for our communities. Often the amount of unpaid hours that these guys work, and the burden that they take on in their own personal health and family life, is extraordinary. There isn’t a price you can put on that.
So for this government to spend more time writing legislation to attack ambulance workers than actually sitting down with them to negotiate is pathetic. I think it says everything about the government that we’re dealing with. I don’t think public support will be on the side.