East Midlands Ambulance plan flawed
GMB VOWS TO FIGHT PLAN TO REDUCE EAST MIDLANDS AMBULANCE STATIONS FROM 66 TO 13 AS PUBLIC CONSULTATION BEGINS
Staff working for EMAS are loyal and dedicated to the NHS and the public they serve and they not want to turn a lifesaving service into a postcode lottery says GMB
GMB, the union for staff in the East Midlands Ambulance Service, has published the GMB submission on the major changes proposed by management to the shape of the service and the list of questions GMB want to see answered in the consultation process that has just started.
(See Notes to Editors 1 and 2 below for submission and list of questions )
Colin Todd, GMB Organiser for East Midlands Ambulance services said “GMB is disappointed that EMAS has gone into consultation over a plan they released to the public in July. These proposals received wide-spread condemnation from unions, staff, public and politicians.
(See note 1 for GMB position on the proposals)
The EMAS management has admitted that the current plan will need to change yet they have forged ahead with these fool-hardy proposals. GMB wrote to the CEO asking them to postpone any formal consultation until we could look at some alternative solutions, but we did not receive a reply.
GMB will actively take part in the consultations. GMB has sent a list of questions to the management to ascertain how they can make the claims about improved service, better staff welfare and the fiscal robustness of the proposals we will want to see the evidence to support these claims. (See note 2 for list of questions.)
As it stands, GMB is totally opposed to the plan in its current format and will do everything we can to persuade the EMAS management to think again.
Staff working for EMAS are loyal and dedicated to the NHS and the public they serve and they not want to turn a lifesaving service into a postcode lottery.”
Contact Colin Todd – Regional Organiser
07966 327981 or 01522 525579
Notes to Editors
Note 1:
GMB submission on proposals to reorganize East Midlands Ambulance Service
Overview
East Midlands Ambulance Service was formed in 1999 with the merger of the previous county Ambulance Services of Nottinghamshire, Leicestershire and Derbyshire.
The vision back in 1999 was to improve efficiency and raise standards; this intention never reached its intended goal.
In 2006 against massive public objection East Midlands Ambulance Service was expanded to include the counties of Lincolnshire and Northamptonshire, the same vision was behind the expansion.
The vision of one big Ambulance Trust providing efficiency and strong leadership has never reached its goal.
The drive to provide a better faster response to the needs of the public has never materialised.
Performance standards have fallen, demand has increased and investment into frontline services has been almost non-existent in the six years since the formation of EMAS in its current form.
The Management structure and personnel of EMAS, since 1999, has changed frequently. The expansion of the management team has been extraordinary the cost of this expansion has never been made public. If front line services had expanded at the same pace as our management structure the service we would be delivering to the public would be the envy of the world.
Being There for Patients – Our Programme to Improve Response Times
The majority of the EMAS estate is very old and generally in a poor state of repair. Lack of investment, and maintenance, over decades has seen an unprecedented depreciation in EMAS’ physical assets. Bad decisions on taking out long term leases on properties, owning the land but not the building, and vice versa, has left EMAS in a fiscally challenged nightmare. Structurally and visibly the estate shows the signs of millions of pounds worth of under investment.
The Estate as a whole needs to change, we have a mixture of prime locations in both rural and urban areas: with foresight and collaboration with staff, trade unions and service users a large proportion of the estate could be upgraded and improved to better position the service to deliver its commitments to the public of the East Midlands.
The proposal that has been approved by the EMAS board plans to decimate the current estate by reducing the number of ambulance stations from 66 down to 13.
A service which covers 6,425 square miles, receives over 700,000 Emergency calls a year requires its estate to be geographically spread across the whole of the region to provide both accessibility of Ambulance services to both rural and urban communities.
The proposal laid out by EMAS management in July 2012 totally isolates many of the rural communities of the East Midlands.
The Proposed Estates Model
The proposal focuses on what they are calling ‘hub’ stations, these will be very large purpose built, environmentally friendly and low maintenance sites, the proposals state these sites will contain the following:-
· Full Vehicle workshops
· Vehicle Preparation Teams
· Training Facilities
· Administration
· Staff Rest Room Facilities
· On site 24 Hours Access to Operational Management
The size of the sites will vary dependant on location, it is proposed that they will cater from 101 to 253 operational staff, again dependant on location. In addition to this facilities will need to include adequate consideration to other non-operational staff working on these sites, in short the sites will need to be huge in size to allow for up to what we believe to be over 300 staff working from the larger sites.
The size of the building, the design and construction all need to be carefully considered, to date this has not happened.
In addition to the 13 proposed “Hubs”, the estates plan includes 131 Community Ambulance Posts (CAP), these will be spread out across the East Midlands, and the propaganda is that crews will respond from these CAPs providing greater community cover than currently exists.
The CAPs will be portacabins, with basic facilities for staff; it is proposed that 90 of the CAPs will be new portacabins costing £30,000 each. The exact locations are unknown, the additional 41 CAPs locations could be anywhere from supermarkets to Fire Stations in short EMAS do not yet have any idea where just a grid reference on a map.
A big concern of the GMB is the repetition of the word ‘estimate’ in the proposals released in July 2012. To date EMAS have only have rough valuation. That being the case, the papers presented to the Board are fictitious and cannot reflect the reality of what the estate is actually worth.
The current economic climate does not lend itself to misguided investment. The Bank of England stated in August 2012 the growth of the economy to be zero for 2012 with a prediction of a bleak economic outlook for the foreseeable future, with experts claiming that the UK is in the worst double-dip recession ever.
EMAS would need to sell over twenty nine million pounds worth (£29,000,000.00) of assets into an economic structure which has no present growth prediction. The final cost of rebuilding the estate into the proposed model has yet to be sourced. No direct plans have been commissioned, therefore a final price has to date not been produced.
The GMB has studied in detail the proposals and if implemented in its current format the following obstacles need to be addressed:-
· No defined budget
· No land highlighted for purchase
· No contingency plan in place (should it fail or run out of money)
· Decimation of rural cover
· Increase mileage on already over worked vehicles
· Dangerous extensions to working days
· Catastrophic effect on staff morale, welfare and health
· The fact that for the first time in history an ambulance service will be, intentionally or not, imposing a life or death postcode lottery on the very populous they are there to help.
The Utopian Vision
This dream like utopian vision of the perfect ambulance service where one huge station will contain everything the modern ambulance person could want, where by removing services up to 40 miles away from current locations will improve response time is truly a work of fiction.
The intention is for large, medium and small sized Hubs; Leicester for example will have a large hub housing 253 operational personnel. The plan does not say whether this figure includes managers, trainers, cleaners, mechanics, administrator’s, etc. This may mean a site of up to 300 staff in total.
If the figure of 253 is on-road staff, that would mean 50 staff on shift at any one time, requiring a minimum of 25 vehicles on the road and another 25 additional vehicles being fully stocked, cleaned and serviced ready for the next shift and an unspecified amount of vehicles being repaired, serviced and deep cleaned.
How big a site will be required to house this amount of operational vehicles both Ambulances and Response Cars? In addition to this there are spaces required for parking for staff and visitors, approximately 150 car parking spaces.
The Community Ambulance Posts (CAP)
Providing Community Ambulance Posts (CAPs) at 131 locations throughout EMAS would be a mammoth task. It would be both costly and in the current model of operation a waste of time.
Given the improbability of crews based actually reaching their assigned CAP and the time crews would spend at such points we have to ask ourselves one basic question, ‘would it be more prudent to consider other options before committing to spend over £3,000,000 of public money on 90 CAP ‘portacabins’ than on patient care?’
In addition to the initial cost of purchasing them, they would need to have cleaning services, be secured to the highest level, have regular checks made on them and graffiti removed, couple all of that with the cost of ground rent or purchase and it becomes something resembling a white elephant.
Staff Welfare
If EMAS succeed in implementing this estates model we believe it would have a negative impact on the welfare of our staff.
Many staff will find their journey times to and from work increasing. It is not unfeasible to imagine that a 12 hour shift could be transformed into a 16 hour working day on a regular basis.
For example, a crew get a call in the High Peak area 30 minutes before the end of their shift. They then convey the patient to Stepping Hill in Stockport (closest A&E).
The crew would then face a drive of over an hour (at best) to return to the proposed ‘hub’ station. They would then get into their own vehicles and face a similar journey to their home address.
We believe that staff would be more fatigued, more unmotivated and demoralised and sickness levels may rise because of the fatigue alone.
The Statistics
Based on the fact that 1 in 10 calls received by EMAS are categorised as life threatening, the current standard is to reach 75% of these calls within 8 minutes.
The Trust is currently meeting those standards. It would only take a small improvement in call ratio for EMAS to exceed those targets. On average EMAS receives 77,000 life threatening calls a year of which 19,750 calls fall outside the agreed response times.
The break down would mean even a small 10% shift of the 50 or so calls a day we fail to reach inside the targets would elevate the Trusts’ status in response targets, and the proposed plan would aim to achieve this by decimating our Ambulance Stations when other areas of poor performance have not been considered.
The whole plan does not include any increase in operational resource.
We have looked at the proposal and find it flawed, from the limited information we have been given costing and expenditure doesn’t add up. When it is completed the Trust will still have to find a way to save a further £12,000,000. The carte blanch selling of the EMAS “family silver” once done could never be regained.
The personnel that work for EMAS are loyal and dedicated to the Trust and the public they serve, we do not want to turn a lifesaving service into a postcode lottery.
Note 2
List of questions from GMB to EMAS managers regarding changes.
Please find below a list of questions which GMB require answers to and evidence of as soon as possible. If this has not been provided by close of play on the 19th October 2012 then GMB will be asking for an extension to consultation.
1. Has EMAS consulted with other services that have gone through a similar process of change to a hub and spoke model and if so what was their feedback regarding how successful this model is in both rural and densely populated areas?
2. You claim in your documents that the estates review will provide “better support for staff”, you state that staff will be able to speak to a line manager at the beginning or end of their shift, this would indicate 24/7 management cover at the hubs. Will this mean that the team leader will be ring-fenced from responding to calls and solely office based?
3. At the EMAS AGM the Chief claimed that “staff will no longer have to check oil, washer bottles or equipment” and that “staff will be able to turn out straight away with a clean, well stocked vehicle”, has EMAS confirmed with the HPC and Police to see if this is a suitable practice and therefore no responsibility lies with the crew for the level of equipment on board or road worthiness? If so can we see copies of this correspondence?
4. On many occasions the Chief has stated that “it takes around 30 minuets at the start of each shift for the highly trained clinicians to check the vehicle”, can we see evidence of this statement?