Leaders must do more to transform the culture within ambulance trusts

Julian Hartley profile picture

14 August 2023

Julian Hartley
Chief Executive

The 45,000 people working in the ambulance sector form a vital, and sometimes overlooked, part of the NHS workforce. Due to the nature of the work they do, there are unique challenges for services in terms of cultural cohesion and staff wellbeing. The sector has faced high turnover and vacancy rates, as well as low morale and increasing rates of stress and burnout in March this year, ambulance trusts had a sickness absence rate of 6.7%, notably above the national average of 4.9% for all trusts.

To understand the unique nature of the workforce challenge in the ambulance sector better, and how it can be addressed, we interviewed two ambulance trust chief executives, Daniel Elkeles from the London Ambulance Service NHS Trust and Tom Abell from the East of England Ambulance Service NHS Trust.

The challenge

Increasing demand and working under sustained and severe pressure is taking its toll on the wellbeing of staff in the ambulance sector. These experiences are reflected in the NHS annual staff survey, with ambulance trusts showing some of the worst results on key measures around experiences of stress, burnout, anxiety and staff members' intention to leave their current role.

In addition to an extremely challenging operational environment, the ambulance sector faces unique cultural challenges. The remote, high pressure and unpredictable nature of the role can mean teams lack cohesion and face barriers to accessing support, which have had an impact on staff wellbeing and morale.

The importance of compassion in leadership

We know that compassionate leadership is key to the wellbeing and retention of staff in the NHS. Fostering a sense of inclusion in the ambulance sector must be at the heart of workplace cultures to provide high-quality, continually improving and compassionate care for patients.

Effective teamwork is also fundamental to the delivery of high-quality care and greater job satisfaction.

However, the ambulance sector has at times faced difficulties, including instances of negative workplace culture, bullying, blame and toxicity. These instances can lead to heightened anxiety for staff, and lower self-esteem and motivation. Leaders across the ambulance sector are working hard to address this. For example, after a recent history of unacceptable behaviours among staff, East of England Ambulance Service NHS Trust (EEAST) has worked hard to cultivate a transparent and honest culture, building trust among staff and the senior leadership team.

The trust has introduced a fortnightly open "Q&A" session where staff are able to engage with senior leaders and question them about issues of concern. This approach, promoting constructive and open communication, a positive attitude to change and psychological safety, is viewed as essential to improving the workplace culture and staff wellbeing.

In another example from London Ambulance Service NHS Trust, we see how promoting a culture of supporting creativity and innovation within teams to implement ideas can cultivate effective team working and a sense of autonomy. The trust has implemented a new approach which sees local operational teams managing their own rotas and having team huddles ahead of a sequence of shifts to create a clear sense of shared objectives. Embedding this type of leadership culture that fosters collaboration and team cohesiveness is central to a positive cultural change that greatly improves staff wellbeing.

The link between positive culture and improving operational performance

The Covid-19 pandemic placed significant demands on the ambulance service at a time when operational performance was already challenged due to longstanding, pre-pandemic, factors including a decade long financial squeeze on the NHS; a demand and capacity mismatch; severe staff shortages; and a social care system in need of reform. As such, a central priority for ambulance trust leaders is recovering core operational performance standards. Fostering a workplace culture that enables staff to thrive is key to sustainable staff commitment and productivity, and therefore vital to improving performance.

It is important for staff to feel effective in their roles and part of a team that is delivering a good service. As such, it is imperative that senior leaders promote a culture of learning and development and increased staff support, to engender an empowered and committed workforce.

Ambulance trust leaders face unique challenges in creating attractive workplace environments for their staff teams, to support staff wellbeing, inclusion and retention. Wellbeing for NHS staff is a core part of NHS England's NHS people promise, equality, diversity and inclusion improvement plan and Long Term Workforce Plan. Implementing these plans nationally and fostering compassionate leadership throughout the NHS will be key to enhancing staff engagement and morale, and embedding a positive workplace culture that in turn leads to better patient care and high quality ambulance services.

This opinion piece was first published by HSJ.

About the author

Julian Hartley profile picture

Julian Hartley
Chief Executive

Sir Julian Hartley joined as chief executive in February 2023, having been chief executive of Leeds Teaching Hospitals since 2013, where he led a major programme of culture change and staff engagement to deliver improved quality, operational and financial performance.

Julian’s career in the NHS began as a general management trainee and he worked in a number of posts before progressing to a board director appointment at North Tees and Hartlepool NHS Trust.

In 2019 Julian was asked to be the executive lead for the interim NHS People Plan, having previously worked as managing director of NHS Improving Quality, and in 2022 he was awarded Knight Bachelor for services to healthcare in the Queen’s Birthday Honours. Read more

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