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  • Rotas that meet demand and employee aspirations will be key to the future of ambulance services

Attending the Ambulance Leadership Forum always reinforces how demand and a range of other changing dynamics are at the root of many complex and inter-related issues facing Trusts.

Listening to speakers it was clear that, in order to address current and future workforce challenges, new resourcing frameworks are required.

These must be able to respond to the changes created by evolving public demographics, emerging practices new performance standards and employee expectations.

The new normal

A fascinating session from Managing Director of ORH, Chris Polden, demonstrated the scale of demand growth over the last 10 years, with a 35% increase in patient contacts and much higher utilisation rates (average DCA utilisation is now 70%).

He also neatly illustrated the impact of perpetual change.

Whilst new processes have delivered more capacity (freeing up 2,000 more ambulance hours per day), gains have been swallowed up by changes to treatments and services. These have seen the average time with patients effectively double, requiring 6,000 more ambulance hours every day.

It’s interesting to consider that throughout these changes many Trusts have maintained relatively static working patterns.

With Chris pointing out that the next 10 years are going to be just as volatile, ensuring that resourcing responds quickly to change is going to be crucial.

Protecting your key ‘asset’

Linking to the themes of ORH’s session was a presentation by Jason Eden, CEO of Sleep and Fatigue Research Ltd.

The impact of growing demand and process change has taken its toll on a workforce that arguably has one of the most stressful and relentlessly challenging roles you’ll find in any industry.

Jason pointed out that 92% of Ambulance Service employees report fatigue, with 88% saying it affected performance and 48% admitting to falling asleep while driving.

He highlighted scientific research that shows, whilst people acclimatise and get used to feeling sleepy, the effect on performance worsens over time. He reinforced the widely known fact that a long shift has essentially the same impact on performance as drinking alcohol.

With capacity gaps being compounded by absence and recruitment/retention issues, Trusts need to find mechanisms that protect workers, not just from dangerous fatigue, but from mental health challenges and the impact of unsociable hours on their personal lives.

In our experience working patterns hold the key to addressing this most pressing of issues.

Trusts have it within their power to harness rota design and management systems that minimise overruns, lock-in meal breaks, identify and protect those at risk of fatigue/isolation and ensure shift distribution supports rest and recuperation.

Engage to change

The session hosted by Alan Lofthouse from UNISON and Kerry Gulliver, HR Director at EMAS, highlighted that workers in Ambulance Services feel less engaged than other staff within the NHS, something they felt was having a direct impact on wellbeing and retention. 

The presentation also linked to that given by Tony Walker, CEO of Ambulance Victoria, which highlighted initiatives that have contributed significantly to the mental health wellbeing of his staff.

Among many other issues relating conditions, the pressures brought about by changing demand are having a significant effect on morale.

Engaging staff around their working patterns will be essential to ensuring the systems and processes are in place to effectively manage change over the long-term.

Giving employees increased choice and flexibility around hours is also a key consideration if Ambulance Trusts are to improve the appeal of roles in the service.

Achieving this, whilst ensuring changing demand is met, is a delicate balance that requires flexible frameworks that incorporate elements of demand-led and self-rostering.

What’s clear is that landing on the right solution will require the input of an engaged workforce if it is to successfully adapt to change.

What next?

The themes highlighted at the Ambulance Leadership Forum and covered in this article will form part of Working Time Solutions’ Emergency Services Roster Review Seminar taking place on the 27th June 2018.

It will be an opportunity to engage directly with peers and experts around creating working patterns and practices that respond effectively to change.

I do hope you have the chance to attend. If you would like to discuss your Ambulance Service’s needs sooner, you can reach Robert Crossman at

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