Inquiry into access to emergency services

TUC recommendations 

The crisis in our emergency services are a result of the recruitment and retention crisis, driven by a decade of government imposed pay cuts. The TUC is calling on the government to take immediate actions to remedy this and improve the quality of emergency services, including:  

Deliver a Spending Review this autumn, that uprates departmental budgets in line with inflation, ensuring all emergency service and public sector workers get a real terms pay rise that at least matches the cost of living and begins to restore earnings lost over the last decade. 

The Government should take immediate action to put in place an urgent NHS retention package, with a decent pay rise at its heart. The 2022 pay award is well below current inflation levels, which amounts to a real terms pay cut for emergency service workers and their NHS colleagues. It needs to be set at a level which will retain existing staff within the NHS and recognises and rewards the skills and value of health workers.  

The government needs to act now to stabilise and grow the NHS workforce, including the number of emergency services workers, doctors, nurses and midwives. The Government needs to implement a fully funded, long-term workforce strategy designed with workers and their representatives. 

To address the long-term issues facing the NHS, the government must: 

Implement a fully costed and funded long term workforce plan that addresses vacancy issues, supports retention and that improves services for patients.  

Significantly increase investment in the NHS that reverses 12 years of cuts and enables employers to recruit for and maintain safe staffing levels.   

Pay restraint  

A recent TUC analysis shows that wages of NHS staff still haven’t recovered from 12 years of sustained falls in real earnings.5 In emergency services: 

Paramedics’ real pay is still down by £5,600 compared to 2010 

Paramedics’ real pay will be down by over £1,500 this year (2022) 

Call handlers’ real pay is still down by £1,950 compared to 2010 

Call handlers’ real pay will be down by over £350 this year (2022) 

Stagnant wages have played a major role in the crippling staff shortages that vital NHS services are facing. 

In July 2022, the TUC’s General Secretary Frances O’Grady reacted 6 to the publication of the pay review body recommendation for NHS pay: 

“NHS workers have already endured a brutal decade of pay cuts and freezes.” 

“Many are at breaking point and cannot afford to have their wages held down further – especially in the middle of the worst cost of living crisis in generations.” 

“Ministers should be giving nurses and other NHS staff the fair pay rise they have earned – not driving them towards foodbanks.” 

Frances O’Grady, TUC General Secretary 

In response to below inflation pay rise offers in 2022, hundreds of thousands of NHS workers are being balloted on industrial action in the coming weeks, including those working in emergency services. 

Recruitment and retention crisis 

At the beginning of 2022, the TUC published a report on NHS workforce crisis – a decade in the making.7 The report8  highlighted how the workforce crisis currently facing the NHS had been a decade in the making, driven by savage funding cuts and government-imposed pay restraint.  

One in ten posts in the NHS are vacant (9.7 per cent).9 In some areas of the country, vacancy rates in ambulance services are higher than the NHS average – 12.1 per cent of ambulance roles are vacant in the South East, 10.5 per cent of roles in the North East and Yorkshire.  

Recent analysis by the GMB union shows that ambulance calls have almost doubled to 14 million a year since 2010, rising ten times faster than the increase in ambulance workers (up 7 per cent) over the same period.10

Staff that remain are left trying to plug the gaps, battling against ever increasing workloads and pressures arising from staffing shortages elsewhere in the system. This undermines and damages patient care: 

“Ten years ago, paramedics would do between 12-14 jobs in one shift, but now many paramedics have to stand in corridors with patients for hours. I've known [ambulance service] staff to wait in a corridor for up to four hours.” 

Steve11 , Clinical care manager, Ambulance Service, Union member  

While paramedics are stuck in hallways or carparks waiting to unload patients, they are unable to attend to the next emergency, causing delays for other patients. A third of ambulance workers have been involved with cases where a patient’s death was linked to delay, according to an exclusive GMB Union survey for ITV.12  The findings of the poll, also reveal  

• 85 per cent of ambulance workers have witnessed delays which have seriously affected a patient’s recovery  
• 82 per cent feel the current pressure on ambulance workers puts them at an unacceptable level of stress  
• 72 per cent of ambulance workers have considered leaving the service  

The Association of Ambulance Chief Executives reports that in August 2022, the volume of longer patient handovers, and associated hours lost, remain substantially higher than August 2021. They estimate that around 35,000 patients experienced potential harm as a result of handover delays (more than 60 minutes) in August.13

The increase in pressure on ambulance workers is the result of cuts to other health and care services. While the government have indicated tackling the backlog is a priority, the health system’s ability to do this will be undermined without additional investment and action to tackle the recruitment and retention crisis facing the NHS and the crisis in social care.  

“We're taking the brunt of other failings in the NHS; the lack of hospital beds, lack of hospitals, and GP appointments. If everything else was fine we'd manage ok. But obviously it's a knock-on effect. 

Steve14 , Clinical care manager, Ambulance Service, Union member 

Unfilled vacancies in the NHS have put a huge strain on staff, leading to burnout, sickness absence and turnover. The cumulative impact of coping with these shortages whilst working on the frontline of the pandemic has driven many key workers in the NHS to breaking point, exacerbating the retention crisis.  

“The NHS has become more strained in every capacity. The staffing levels are much worse than they were when I first started [12 years ago]. People are leaving. They have had enough.” 

Philipa 15 , Business manager, NHS hospital Foundation Trust, Union member. 

Recent UNISON survey of staff working in ambulance services across the UK found that over half (57%) said they fe​lt “overwhelmed” by work and ​a similar proportion (5​3%) are struggling to cope with the demands of their jobs. 

Worryingly, the survey found that Of those ​ambulance workers who reported ​feeling stressed, three in five (60%) are concerned that ambulances are taking too long to reach people in need​. ​More than half (5​8%) sa​y long handovers outside hospitals are putting patient lives at risk. ​More than a third (3​9%) say they fear making clinical mistakes that could harm patients.16

The latest (2021) national NHS staff survey17  asked NHS staff in England about their experiences of working for their respective NHS organisations. For those working in ambulance trusts, the results are stark: 

• Ambulance trusts saw the greatest decline in the percentage of staff happy with the standard of care provided by their organisation down from 75 per cent in 2020 to 62.9 per cent 
• Only 22.6 per cent of ambulance staff were satisfied with their level of pay  
• The percentage of staff who said there are enough staff at their organisation for them to do their job properly dropped over 11 percentage points across all occupations since last year and by over 16 percentage points amongst staff at ambulance trusts (2020: 36.7 per cent, 2021: 20.3 per cent) 
• Ambulance (operational) staff were particularly likely to describe feeling burnt out, with more than 1 in 2 (51 per cent) saying they feel burnt out because of their work 
• Only around a third of staff in Ambulance (operational) roles (33.8 per cent) felt they achieved a good balance between their work life and their home life. This is the lowest percentage among all NHS occupations. 
• Amongst all NHS occupations, an average of 46.8 per cent of staff have felt unwell as a result of work-related stress in the last 12 months. for paramedics, this number rises to 66.9 per cent. the highest level.  

By reversing a decade of underfunding in the NHS, increasing investment to enable employers to recruit for and maintain safe staffing levels, the Government can bring down levels of work-related stress and resulting absences. 

A recent survey by Ipsos carried for the health foundation 18  shows that the public support creating opportunities for new people to join the NHS workforce (90 per cent) and expanding the number of spaces available at medical and nursing school (87 per cent).  

The Conservatives’ general election manifesto in 2019 promised to deliver 50 million more GP surgery appointments a year. Earlier this year, the then-Secretary of State for Health and Social Care, Sajid Javid admitted that the figure was unlikely to be met.19 Instead of relieving pressure on hospital and emergency care services, the failure to recruit and retain GPs is worsening the strain.   

Inadequate funding  

The TUC has long advocated for an increase in NHS funding to help reduce the backlog and cope with a growing and ageing population.  

In recent analysis, the Institute for Fiscal Studies showed that between 2009−10 and 2019−20 UK government health spending grew at an average real-terms rate of 1.6 per cent per year – lower than any previous decade in NHS history.20

High inflation is expected to wipe out any planned real terms increases.  

A recent survey by Ipsos carried for the Health Foundation 21  shows that the public supports a mix of measures for addressing workforce shortages, even if they require an increase in funding for the NHS which could result in tax rises. 71 per cent of the public think the NHS needs additional funding over and above the health and social care levy.  

• 5 TUC (2022), nurses and paramedics will suffer real terms pay cut (tuc.org,uk)
• 6 TUC (2022), nurses and paramedics will suffer real terms pay cut (tuc.org,uk)
• 7 TUC (2022) NHS workforce crisis – a decade in the making (tuc.org.uk)
• 8 The report was referenced in a House of Lords debate on ambulance waiting times on 1st February 2022 (hansard.parliament.uk)
• 9 NHS Digital (2022), NHS vacancy statistics England (digital.nhs.uk)
• 10 GMB (2022) Ambulance calls double to almost 14 million (gmb.org.uk)
• 11 Name has been anonymised
• 12 GMB (2022) 35% of ambulance workers witnessed deaths due to delays (gmb.org.uk)
• 13  AACE (2022) National ambulance data (aace.org.uk)
• 14 Name has been anonymised 
• 15 Names have been anonymised
• 16 UNISON (2022) Ambulance pressures taking a significant toll on staff (unison.org.uk)
• 17 NHS (2021) staff survey 2021 (nhsstaffsurveys.com)
• 18 Health foundation (2022) Public perceptions of health and social care (health.org.uk)
• 19 The Guardian (2021) No 10 set to break promise of 6,000 more GPs in England, Sajid Javid says (theguardian.com)
• 20 IFS (2021) IFS green budget October 2021 (ifs.org.uk)
• 21 Health foundation (2022) Public perceptions of health and social care (health.org.uk)