By NHS Providers policy advisor Jonathon Holmes, policy officer Zosia Walecka, and Association of Ambulance Chief Executives deputy managing director Anna Parry.

Addressing and improving staff wellbeing can be challenging in any organisation, within the NHS and other sectors, but the ambulance sector faces a unique set of challenges. Covering large regions, working with a broad range of partner organisations and having a workforce that is disparate, working variable shift patterns across a large geography, often isolated from colleagues.

The unique pressures created for staff by the complexity of the working environment are only amplified by the sustained pressures the ambulance sector is facing:  

Demand has been rising relentlessly placing pressure on those in clinical and call-handling roles in ambulance trusts, exacerbated by record vacancy rates and ongoing industrial action, high rates of sickness absence and high turnover. These experiences are reflected in the NHS' annual staff survey, where ambulance trusts have seen some of the worst results on key measures around experiences of stress, burnout, anxiety and staff members' intention to leave their current role (NHS England 2022).  

Staff absences and vacancies risk undermining efforts to recover services and ensure performance meets the expectations of patients and the public. Staff absences and vacancies risk undermining trusts' efforts to recover services and ensure performance meets the expectations of patients and the public. As ambulance trust leaders work hard to restore core operational performance standards, workforce issues remain the major rate limiting factor in reducing waiting times and transforming services. At the same time, there is a large body of evidence showing that staff burnout and poor wellbeing can impact the safety and quality of healthcare services (Hall et al 2016; Janes et al 2021; Hodkinson et al 2022).  

The equality, diversity and inclusion improvement plan and Long Term Workforce Plan recently published by  NHS England highlight  staff wellbeing as a national priority,  and we know that trusts are at the same time embedding local initiatives to support the wellbeing of their workforce. 

To understand some of the challenges and approaches to embedding wellbeing and inclusion in ambulance trusts specifically we spoke to two ambulance trust chief executives, Tom Abell from the East of England Ambulance Service NHS Trust (EEAST) and Daniel Elkeles from the London Ambulance Service NHS Trust (LAS).

Research shows that staff need to have a sense of autonomy, belonging and contribution, to feel valued in their role. This is known as the ABC framework. We use this structure below to set out the interventions and learnings we heard about in our interviews (West et al 2020). We would like to thank both our contributors and hope this proves a helpful summary for colleagues in the sector.