By Dr Minh Alexander retired consultant psychiatrist 12 May 2022
Staff suicides at ambulance trusts in recent years
It is well known that ambulance services have been troubled organisations with higher levels of staff stress and reported bullying. This is reflected annually in the NHS Staff Survey.
Staff deaths were much publicised at East of England Ambulance Service NHS Trust, where serious leadership failures were also reported.
In October 2021 it was reported that an inquest had determined a “self-inflicted” death of David Cullum a paramedic at another trust, West Midlands Ambulance Service NHS Foundation Trust. The coroner considered intent was not clear. Prior to his death David Cullum had a disagreement with a manager:
In November 2021, local media reported that an unnamed paramedic whistleblower disclosed eight suicides at West Midlands Ambulance Service NHS Foundation Trust in four years. The paramedic told the media of concerns about unsafe and stressful working conditions. These conditions had reportedly resulted in fifty staff leaving the service during one period.
“We’ve had eight suicides in the past four years. It’s just not sustainable….I’m having phone calls with paramedic friends who are saying, ‘I just want to quit, I just want to quit’….I’m turning up and I’m seeing this many 999 jobs and I know I’m going to have to do everything, I’m driving a four and a half tonne vehicle all night, I’m having to do everything and I can’t carry on. We’re not wimps as paramedics, we get on with it….The thing that annoys me is that the Service always has a get out clause, that ‘it’s the demand’ that’s to blame...…”I cannot and my colleagues cannot continue to work 15 to 17 hour shifts…
….But they couldn’t give two tosses about the staff that are run into the ground.
…I am very concerned that so many friends and colleagues are leaving the system because there’s so much pressure on them.… Lower management knows how bad things are. But the higher management… all they are doing is working the rota harder and that is killing us all.”
In particular, the whistleblower was concerned about downgrading of skill mix:
“The ACAs [Ambulance Care Assistants] are coming out with us in an ambulance uniform, but they can’t drive an ambulance on blue lights or normal conditions…The paramedic has to drive there, do all the care, all the paperwork. We can’t drive the person to hospital because if the patient needs paramedic intervention, the person we’re working with (ACA) can’t provide it….If the patient needs to be taken to hospital, the paramedic cannot do anything apart from request another crew – so literally they’re sending ambulances to people for nothing.”
Contrasting with this picture of life on the frontline, with diluted skill mix, is the trust board’s plan to build new headquarters.
I asked the trust about the eight suicides reported by the whistleblower and related matters. This is the full FOI response by the Trust:
Very sadly, these are the figures produced by the trust on staff suicides:
I asked the trust if it had examined whether there was any link between suicides and the working environment at the trust.
I do not think that the trust’s response addresses whether there were any stressors in the work environment that may have contributed.
And yet here is a WMAS trust executive telling the local press only yesterday about untenable pressures and impact on staff as well as patients:
“Late shift finishing, reduced training opportunities through reduced patient contacts, concern about safety for deteriorating patients, moral hazard from dealing with deteriorating patients on the phone, as well as violence and aggression being experienced by crews when they attend patients who have been waiting sometimes for hours on end.”
The trust does give a lengthy description of its approach to staff mental health.
I asked for reports and equivalent documentation showing learning and action arising from deaths. The trust stated there had been much learning, but it disclosed no documents. The trust stated:
“Much learning has been taken from the deaths of our colleagues, mental health awareness training and additional support services have been embedded directly as a result.”
| West Midlands Ambulance Service NHS Foundation Trust and the Care Quality Commission |
The CQC has rated the trust as “Outstanding” since 2017.
This is despite worrying coroners’ reports to Prevent Future Deaths.
It was also despite serious failures in safeguarding practice revealed by a computer glitch.
Safeguarding referrals were sent but not followed up by the organisation. When hundreds of emails failed to “send” due to an IT glitch, the referrals were never made, with referrers unaware of this.
During the period of this safeguarding failure, the CQC specifically vouched for safeguarding practice at the trust.
After the failures became evident, CQC changed tack and advised that systems changes were needed: “The service should consider how to alert staff that safeguarding reports to the central contact point have been actioned.”
Should CQC’s effusive claims about the trust’s leadership and support for its staff now be in doubt too?
I found no reference to staff suicides in CQC’s last report of 2019. Instead, CQC emphasised the quality of staff support:
“Staff had access to support for their own physical and emotional health needs. The trust positively promoted the well- being of staff. The trust valued the well-being of its staff. There was wide range of well-being options and resources available”
CQC was effusive about trust leadership in general and the trust CEO in particular:
“There was strong, clear leadership in place, led by a chief executive who was regarded as inspirational by every staff member and service trust wide.”
Did the CQC inspection team in question, led by Victoria Watkins, CQC Head of Hospitals Inspection, speak to every member of staff at this trust in order to justify making this expansive claim?
Certainly, the staff who sued the trust in the Employment Tribunal in recent years did not seem to feel inspired:
CQC also claimed: “Every level of the trust had sustained a highly positive culture that supported and valued staff, creating a sense of common purpose based on shared values. Staff felt supported, respected and valued and were exceptionally proud to work for and represent the trust.”
Somewhat dispelling this rose-tinted view, an FOI request previously showed that the trust failed to keep records of a meeting held by the trust CEO with whistleblowers about racism, because the meeting was not considered “formal”:
CEO of West Midlands Ambulance Service NHS Foundation Trust led meetings on whistleblowing about ‘racist staff’ but trust claims no records were generated because the meetings were not ‘formal’
Is West Midlands Ambulance NHS Foundation Trust a specially protected organisation?
Is the National Freedom To Speak Up Guardian taking effective action to support ambulance staff?
An earlier FOI to the National Guardian’s Office (NGO) revealed that the Office had been discussing a thematic review of Speaking Up in ambulance trusts since June 2020 – around the time that public concern about East of England intensified – but had not actually done much to progress the project.
Thematic reviews often hide a multitude of sins, may diffuse accountability and shield individuals.
Notwithstanding, a request to the NGO for documents relating to the planned thematic case review was met with a blanket refusal under Section 22 FOIA (material intended for future publication), when not all the material requested was intended for publication.
In its FOI response of on 6 April 2022. The National Guardian’s Office asserted that it would be publishing information about its proposed review “in the near future”.
I enquired a month later on 4 May about timescales for publication of the withheld information about the review and timescales for the review itself.
On 10 May the National Guardian’s Office replied off the point as follows:
“In your email of 3rd May, you asked for any update on our Speaking Up review on Ambulance Trusts. We are working on the co-design of this review with the Ambulance Trusts and will deliver updates on this piece of work in due course.”
I have repeated the request for clarification of timescales for publication of information and for conducting the review and have forwarded the FOI response from WMAS confirming staff suicides to the National Guardian.
The correspondence follows below:
Dr Jayne Chidgey-Clark
National Freedom To Speak Up Guardian
11 May 2022
Dear Dr Chidgey-Clark,
Information about and progression of your planned thematic case review of Speaking Up in Ambulance Service NHS trusts
I asked you on 10 March 2022 for information on this planned review and for clarification and assurance that the relevant whistleblowers would be invited to participate, whether currently or formerly employed by ambulance trusts.
On 6 April your Office refused my request for relevant documents and declined to answer my questions about how the review would be conducted, citing exemption Section 22 FOIA (material intended for future publication). Your Office asserted that the withheld information was scheduled for publication in the “near future”.
When I asked on 4 April if there was an identified timescale yet for publication of the withheld information, and a timescale for the review itself, your Office simply stated in reply yesterday (see below):
“We are working on the co-design of this review with the Ambulance Trusts and will deliver updates on this piece of work in due course.”
I wonder if it is possible to have timescales as requested, even if they are only rough and provisional.
Also, I am a little concerned that you are co-designing with employers but do not appear to be including relevant whistleblowers at this stage. Could they be included if they wished to be?
Underlining the necessity to progress the review, please find an FOI response from West Midlands Ambulance Service NHS Trust at this link:
This very sadly confirms that there have also been nine staff suicides at this trust, including two deaths last year, in addition to those more widely reported at the East of England Ambulance Service NHS Trust.
This has been accompanied by WMAS staff whistleblowing to the media.
Although I asked the trust to disclose documents showing evidence of learning and action arising from any staff deaths, none were disclosed.
Dr Minh Alexander
My condolences to families, loved ones and colleagues affected by the above tragic losses of ambulance staff.
Advice for whistleblowers
In a broken system for whistleblowing, with unreliable regulators, I would advise whistleblowers to consider going directly to the press as a means of protecting themselves and the public. It can be empowering if done carefully and responsibly, choosing your media outlet wisely to protect your confidentiality and identity, and the accuracy of reporting. Each case needs to be weighed on its own merits. A record of going directly to the press may count against you in any subsequent employment dispute, because there are legal tests for going to the press under employment law. It is accepted under the rules in some circumstances. But equally, an untraceable disclosure to the press can reduce the risk of reprisal and an employment dispute, and reduce delay in bringing very serious risks to attention. It is very important that accuracy is maintained in order to preserve confidence, credibility and fairness. A drawback of anonymous whistleblowing is that you may not be able to disclose all relevant details. Seek the best advice you can before deciding what to do.
Please click and add your signature to this petition to reform UK whistleblowing law – whistleblowers protect us all but weak UK law leaves them wholly exposed, lets abusers off the hook and it is a threat to public safety.
Vexatious referrals by ambulance trusts of paramedic staff to the HCPC:
South West Ambulance Service NHS Trust:
Workplace Culture at Southwestern Ambulance NHS Foundation Trust 2018, a report on bullying at the trust Ambulance trust chief executives have produced these documents on suicide prevention in the ambulance sector:
Late on 21 May 2022 the Sunday Times published an investigation on management cover ups of care failings in patient deaths at North East Ambulance Service NHS Trust, which has resulted in staff whistleblowing. Some of the details of this affair are provided in this blog, which examines how the matter has been hijacked to augment Jeremy Hunt’s political fortunes, coinciding with the re-launch of his Tory leadership bid.