(This post will probably be boring if you do not work for the LAS, so please scroll past if you like!)

The East Central desk are seriously persona non grata with the East Central Ambulance Crews at the moment. No one wants to bring us Percy Pigs, in fact we barely get a grunt from some of the crews when they answer the phone. We are The Enemy, a bunch of saddos whose purpose in life is to make crews’ lives difficult. What have we done? Well, basically, we’ve been checking up on their every move. For instance, if a crew is at hospital for longer than 30 minutes, they get a message telling them asking them exactly what the delay is. If they are trying to avoid their rest break (to get their £10 missed break payment or an early finish), we have to report them to their managers. Not only are we watching the crews’ every move, our managers our watching us, so if we miss something, it’s not just the crew concerned who get in trouble – we get in trouble for letting them. So I’m there banging out the messages: “Report delays!” “Return for rest break!” “Go out on Active Area Cover!” I occasionally give out the odd emergency call, too…

The trouble is that contrary to popular belief, ambulance crews are adults. They don’t like being told when to take their lunch and they don’t like being told they can’t hang around the hospital for a five minute cuppa after they’ve booked their patient in. The more we treat them like children, the more they act like them. They twiddle their statuses, drive round in circles and backchat to us on the radio. In turn, we get irritated with them and think “well, if they’re going to be like THAT they are DEFINITELY getting their rest break. And then I will send them to Horace Halfpenny! Hahaha.” But crews don’t play up if we just let them get on with their job without all those annoying messages. Well, some of them do, but the bad apples stick out like sore thumbs, and I have no hesitance in reporting a crew who are genuinely slacking off. The rest of them are just playing up because they feel their professionalism is being called into question, and I can see their point.

The sad thing is that there’s a real sense of “us” and “them” at the moment and it’s counterproductive, because we need to work together. I need the crews on side when I want them to do me a favour (work late to cover a call I that I really don’t want to keep waiting, for example). The more we annoy the crews, the more they annoy us, the less gets done and the worse service we provide to patients.

I propose that to solve this problem, we abolish all the current LAS targets and bring in a new rest break system where all crews get a break that they actually want. Who cares whether we meet all Cat A calls in 8 minutes when it is proven that most of the time they are not even life threatening? Who cares if all your crews get a break if they all claim “dirty uniform” and go home early anyway? Can’t we count the number of lives saved and the number of patients satisfied with the service we provide? Making a real difference to patients is an achievement, meeting an arbitrary target is not.

Published Jun 12, 2009 - 35 Comments and counting

35 Comments on “Them and Us”
  1. LargeBrotherCCTV Says:

    We have a new thing in Smalltown. All a-grades are now dispatched with the helpful caveat "Please drive carefully and responsibly while responding to this A-Grade" because police, like Ambulance crews need to be reminded to behave sensibly every now and again.

    I mean what if they forgot to drive sensibly and used the pavement or drove down some stairs italian job style?

  2. Bob Says:

    You forgot to mention the LAS using the cctv network to spy on crews. No wonder crews are cutting the airwave microphones out of the cabs of the ambulances, cos they are worried about the "ambiant listening"!

  3. Suzi Brent Says:

    I have heard of this happening but have never seen it in person so am not sure if it is true! The only time I have ever used the CCTV to spy on crews is when they are on an interesting job!

  4. Suzi Brent Says:

    Heh! Just to redress the balance, the other day we sent a crew to a massive fight with knives involved. The crew came up on the radio and asked if we'd called the police. The radio operator's response was nearly "Duh, of course we have!"

  5. Chapati Says:

    Spying on staff is a big bug-bearer in a lot of places, and you're right -the more you're spied on the more you act out. People are a lot more productive if they feel trusted!

  6. boy on a bike Says:

    I work in a completely different field, but I worked with a manager who treated his staff like children. He dictated when they could have lunch, even when they could go to the toilet. Every aspect of their day was minutely directed by him.

    I ran another team with a much more laid back attitude. I simply gave them goals to achieve each week and told them to get on with it, only coming back to me when they'd run out of work or struck an insoluble problem.

    Morale in his team was non-existant. Sick leave was a big problem. Customer service sucked. Their performance was dreadful.

    My team, bless their cotton socks, were magnificent. It had stuff-all to do with me – I simply treated them like adults and unleashed them.

  7. Flora Gardens Says:

    I used to work on an East Central station, but moved to the West sector. It has to be said that there are some very bolshie crews in east London. However, it equally has to be said that some of the management in the east area – both past and present – are interested only in figures, statistics and strict adherence to regulations. In my honest opinion, some of them – especially those who are ex-road staff – have totally forgotten what the job of the LAS is. Patient care comes first, followed by welfare of LAS staff.

  8. ben Says:

    I agree with you 100%. The other day a message was sent out reading as follows: "All crews not reporting delays at hospital when asked to, will be reported to their Station Management". Strangely enough, it sounded as though every ambulance in the sector was calling in to report delays, real or not. I don't work in your sector, but it's the same all over. I'll do anything I can to help if people are being nice. Start threatening me, and there's not a hope… Doesn't matter who you are… I think that most crews realise that it's not the people at the other end of the radio/phone who are at fault, but that it comes from higher up. Unfortunately you're the only ones we get to talk to, so face the brunt of our frustration! Sorry…

  9. Steven Says:

    I can only assume that this CCTV is in the back of the ambulance and is there for patient and crew protection, presumably to provide evidence in the event of an assault or otherwise.
    So what on earth do you think you are doing, spying on "interesting jobs"?
    Aside from patient confidentiality, and the fact that you should probably be getting on with your own job instead, is it any wonder that there is this "them and us" attitude?
    No wonder the vehicle staff see you are the Enemy!

  10. Steven Says:

    Do you always delete comments that you don't like?
    I thought my questions were fair – why do you spy on "interesting jobs"? Don't you have better things to do? Isn't this a misuse of the CCTV in ambulances. It certainly wasn't put there for the entertainment of dispatchers.

  11. Suzi Brent Says:

    I didn't see your original comment – it may have got caught by a spam filter, that sometimes happens. (And no, I never delete comments unless they are spam or solely intended to be offensive). I think I can work out what you said from this comment though.

    The CCTV I was referring to isn't in the ambulances – it's the cameras in the streets, so nothing you wouldn't happen to see if you were walking past. It would certainly be an invasion of the patients' privacy if we were looking inside the ambulances. We look at the interesting jobs for the same reason we go on observation shifts and watch ambulance documentaries – we are fascinated by the ambulance crews' jobs and want to see what they are up to. When we are dealing with a serious incident, we want to see what the scene looks like.

    I should add that I meant that we take a quick peak at the CCTV, by the way, we don't sit and watch it for hours because we do have work to be getting on with.

  12. Suzi Brent Says:

    I didn't see your original comment – it may have got caught by a spam filter, that sometimes happens. (And no, I never delete comments unless they are spam or solely intended to be offensive). I think I can work out what you said from this comment though.

    The CCTV I was referring to isn't in the ambulances – it's the cameras in the streets, so nothing you wouldn't happen to see if you were walking past. It would certainly be an invasion of the patients' privacy if we were looking inside the ambulances. We look at the interesting jobs for the same reason we go on observation shifts and watch ambulance documentaries – we are fascinated by the ambulance crews' jobs and want to see what they are up to. When we are dealing with a serious incident, we want to see what the scene looks like.

    I should add that I meant that we take a quick peak at the CCTV, by the way, we don't sit and watch it for hours because we do have work to be getting on with.

  13. Suzi Brent Says:

    By the way, I have just retrieved your original comment from the spam filter!

  14. Suzi Brent Says:

    Oh yes, our area controller sent down a similar message yesterday and the radio went CRAZY with disgruntled crews. It didn't help that he had inadvertently worded it badly so it looked like it crews had been singled out, and crews who had been at hospital five minutes were saying "We haven't even got our patient off! Leave us alone!" It was a nightmare!

  15. Medic999 Says:

    This is all a bit of a night mare and goes on in every ambulance service. I can see things from both sides and understand the frustrations from both.
    What annoys me though, is not so much the messages from control (as I realise that they are just doing what they are told from their managers, and ultimately, we as a crew are there to work for 11 hours a shift, not sit outside A&E for as long as possible), but the MINORITY of crews that do stand around and not clear when they should, because it is them that give all crews a bad name. Everyone needs a cuppa every now and then. If you have a tough job, I would assume that control will be aware of that and act accordingly (Or I should say, I would HOPE). Its all about being reasonable, from both sides.
    Its also up to Team Leaders (or whatever the supervising paramedics in your service are called) to ensure that everyone is doing their fair share of the work and not have one crew at the front of a que of ambulances who has been there for 30 mins, so that all the other crews sit and wait because "Im not going to clear if they dont"
    I understand how frustrating it must be for an allocator with jobs backed up and no crews to give them to.
    The crews and control, need to work together to get the best service for our patients and its up to both parties to ensure that we are fair with each other.
    The best thing that can happen is what I did, spend some time in control and see things from your perspective. If LAS if anything like NEAS, the controllers/allocators are HEAVILY performance managed, and have to account for every poor statistic that they contribute to the overall performance. I personally would hate to be under that sort of pressure.

    Lecture over!! (although im sure I will get some haters after that!!)

  16. hoododp Says:

    Firstly congrats on coming up with this blog, think its really good to have such a debate as its obvious each side has strong views. I agree with the point made about how staff are treated, i have been in the service only three years and I can honestly say two things spoil the job, resources (B rota,ahhhh!) and eoc.

    Three examples of eoc, firstly…me and my collegues resussing a baby, i had to give mouth to mouth running through a shop, obviously went off the road after, a nano second back on station get a phone call asking how long we are going to be as "we are holding calls!!!". One question, when arent we holding calls?! please remember we are human beings in the trucks, not robots and we have feelings and emotions!

    Second example, we get no answer on a call and the allocator asks me if Ive thought of knocking on the patients door?!Please treat us with some degree of intelligence!

    And lastly the third, get a call to a 35 stone patient on the floor, i asked if the fire brigade have been dispatched, get told to report on arrival. Spoke to the patient and he stated the only way to get him up is the fire brigade. ask eoc for the fire brigade and get told theres another ambulance round the corner, i explained that wasnt enough and asked again for the fire brigade- get told they are coming. 5mins later a ambulance arrives telling me the fire brigade have not been dispatched, again ask for the fire brigade, am asked do i really need them?! finally fire brigade arrive and the first appliance ordered another two appliances for special lifting and man power!

    I have only been in three years and have soooo many negative stories, please please please we all need to get along and work together because the job could be so good!

    ok rant over!

  17. Suzi Brent Says:

    Thanks for the rant and I hope I will not make any of the mistakes you've mentioned – I can see why you are thoroughly irritated!

  18. Bob Says:

    No steven, this is the "so we can spot criminalsterrorists" cctv that is on every street corner. Great use of tax payers money, so despatchers at control can take a look at us working.

  19. Suzi Brent Says:

    Well, excuse me for being interested in your work! I'll just go back to doling out rest breaks, shall I? ;-)

  20. skid k1 Says:

    Let me give you a clue, you turn round an say to gold suite NO, it does work.

  21. Suzi Brent Says:

    You have a good point. I think, though, that the way to get things changed is not to rebel and say "No, I won't do that", because that will just get me disciplined for not obeying orders from my seniors. Instead I'm going to feed back exactly what the crews have told me hear and tell them WHY the current approach doesn't work and what I think we should do instead.

  22. Steven Says:

    Okay, given that i completely misunderstood the CCTV remark, i should probably retract what i said.
    I didn't realise ambulance control rooms had access to the CCTV network in towns and cities.
    Although I don't really understand why?

  23. Suzi Brent Says:

    No worries – the original comment was a bit ambiguous so you weren't to know where the CCTV was.

    The CCTV is only viewable at the managers' desk and it's used to look at traffic delays, road closures and boring stuff like that. Or if there's a large incident we can see where the police/fire brigade/cordons etc are. It's not used an awful lot, but it comes in useful sometimes.

  24. hoododp Says:

    Just out if interest Suzi what do u think should be done? Just another point, I think I speak for alot of crews that the occasional message of praise or thanks really does help on a busy shift, it certainly beats the usual messages that come down the mdt!

  25. Suzi Brent Says:

    Good question! Okay, what I'd like to see:
    * Totally new rest break system. Every crew gets a break every single day at time and place of THEIR choosing. No missed break payments. Everyone gets a payrise instead.
    * Less pressure to send "nagging" messages, let crews get on with their job whilst actively trying to spot slackers.
    * Control should not question crews so much (eg. about the route they are taking to station, why they've been off the road so long) and crews should not question control so much (eg. are we the nearest? why have you sent us on this? haven't you got any green trucks?)
    * It should be compulsory for all crews to do one paid observation shift in control per year and vice versa. Will help build staff relations and understand each other's job.
    * Less emphasis on performance targets/more meaningful performance targets.

    I shall remember to send more thank you messages to crews – thanks for your feedback, it's all helpful!

  26. Ambobod! Says:

    No im sorry but thats a load of rubbish when it comes to the vast majority of EC desk staff.

    I work in EC, im polite and friendly with the staff on the desk 100% of the time, this is not for personal gain but simply who i am!
    I do hope that this is taken into consideration when allocating jobs, especially at the end of my shift – but NO! EVERY SINGLE TIME me and my mate get shafted – it seems that this 'looking out for decent crews' thing is lip service and every time we end up off late it chips away at our good will a little bit at a time.

  27. Suzi Brent Says:

    I can't talk for everyone in Control, but I definitely *do* take into account how crews behave when making allocating decisions. The issue of giving out calls is a bit different, though, because often it comes down to a choice between making the patient wait ages or screwing over a crew. Near end of the shift loads of crews have already gone home early because they have missed their break and I know that if I don't give the call to the one crew who've been honest enough to green up at 6.30am it's going to be holding for at least half an hour. Sadly, that does mean it is the decent crews that get screwed over with late jobs. I hate doing it though – I'm cringing as I send the call down, imagining the look on your faces as the MDT rings. But what else can I do?

  28. CSU Says:

    I now work in the newly formed CSU and really everything in this post is to do with us and what we do. It's us that sends out the general broadcast messages asking everyone to report delays or be reported to management. It's us who generally chases people up when they've been on station for 90 mins cleaning their vehicle. Please don't blame the desks for everything we make them do.

    And now I shall explain why. As with any job, managers spend 90% of their time dealing with 10% of their staff. We know damn well that 90% of the crews don't take the piss at hospitals, clean their vehicles as quickly as they can, get themselves on the road as soon as they can. But too many crews don't. All I do all day is sit and watch crews take the piss (and crews that do twice as many jobs and that is also noted). I know most people won't believe me but the crews consistently being arses are being followed up – I know because I have the list. But before we "pick" on certain crews, we have to be seen to blanket the whole service so that we can't be accused of "picking" on them.

  29. CSU Says:

    (sorry comment was too long so had to split it up!!)

    To be completely boring about it – by decreasing turnaround at hospital (on average) 5 mins earlier, w will get back 167hours of crews. And by decreasing job cycle time (again on average) by 10 mins, we'll get back a 300 hours. That's what the service is looking at. All we ask is for you to book delays within 30 mins. If theres a reason just let us know. We can then send DSO's down to try and sort out the problems at hospitals who are as much to blame as we are.

    Comment over – Suzi, you know who I am – keep up the good work (as I can't anymore!!)

  30. Suzi Brent Says:

    I wondered how you were getting on up there! Thanks for the comment. I don't envy you working in CSU as it would drive me mad within ten minutes but I'm glad there are people like you up there.

    I see the logic behind getting crews to report hospital delays but unfortunately it's not working at the moment. I think the trouble is that for some calls, 30 minutes isn't long enough. Sometimes it just takes longer than that to book a patient in, especially if the crew want a quick loo and cuppa break afterwards (which I think is totally acceptable). The crews feel they are being hassled and they just ignore the messages. Also, I've noticed that now 30 minutes is the "standard" time allowed at hospital, crews never seem to green up earlier than that – I'm sure they think "well, we're allowed 30 minutes, better make the most of it".

    I think it would be better if we eased off on the messages and allowed crews to report hospital delays under their own steam, only sending them messages if it becomes apparent there is a problem the crew has forgotten to report (eg. a crew has been there 45 minutes plus, or several crews have been there longer than 30 mins).

    I am glad to hear you have a list of the misbehaving crews. I can guess which crew from our sector is on the list – one infuriating pair that drive us utterly mad. Can you get them moved to Pinner or something? ;)

  31. emd Says:

    <<<<And lastly the third, get a call to a 35 stone patient on the floor, i asked if the fire brigade have been dispatched, get told to report on arrival. Spoke to the patient and he stated the only way to get him up is the fire brigade. ask eoc for the fire brigade and get told theres another ambulance round the corner, i explained that wasnt enough and asked again for the fire brigade- get told they are coming. 5mins later a ambulance arrives telling me the fire brigade have not been dispatched, again ask for the fire brigade, am asked do i really need them?! finally fire brigade arrive and the first appliance ordered another two appliances for special lifting and man power!>>>>

    belive it or not the lfb have a "no lifting policy" , they will not assist the LAS with a heavy lift unless the crew on scene states its a "medical emergency"

  32. Suzi Brent Says:

    Yep, and I believe if it isn't life threatening they won't come out either. Someone should have explained this to hoododp, though, then he/she would have known we weren't just being obstructive.

  33. Jack Worthing Says:

    Looking at this from a more detached perspective – This seems to be a common issue in many organisations (public and private sector) when two sets of people have to work remotely from each other. I myself work heavily with a regionally based sales force, with my back office function based at head office and the them and us trap is very easy to fall into very quickly. It takes work from both sides in order to gain a sucessful working relationship, which must in the main be based on trust. I strongly reccomend Suzi's idea of shadowing and suggest that you could almost take this further by having assigned 'buddies' in the two functions, ideally with someone on a similar shift pattern to minimise distrubtion. And yes, managers will allways be anal on targets and may lost sight of what matters, i think it's what their trained to do!

    JW

  34. onscene Says:

    Yes but thats very nice on paper, yet there is to many calls not enough staff/ ambulances. what about nect year shave another 5 mins off???
    Simply booking or handing over a patient takes time, let alone if 2 or 3 crwews waiting infront. What about basic rights of eating and replenishing fluids into your body.
    Then claening the ambulance with mrsa risks now!
    More like 60 mins!

  35. jack worthing Says:

    [...] to visit the ravishing Gwendolyn (Frances O’Connor) … Mail (will not be published) (required) …Nee Naw – Them and UsJack Worthing Says: June 20th, 2009 at 8:36 pm. Looking at this from a more detached perspective – [...]

    Nee Naw
    Nee Naw was a blog about life in the London Ambulance Service control room. It was written by Suzi Brent from 2005 to 2010. The blog is no longer being updated, but the archives will remain here.
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