In profile: Rob Ashford, Deputy Chief Operating Officer, East of England Ambulance Service

“I have a specific portfolio for managing and delivering our major change projects, or any form of significant projects, facing the organisation hence at this time our response to COVID and associated need to increase our resources to respond to the demands it present,” he said, “Most of it sits in my lap.”

Now his responsibilities assume gigantic proportions as he manages demand for an ambulance service dealing with the twin pressures of the COVID-19 pandemic and the usual increased pressure during winter. Owing to the need for ambulances to be driven on a licence with a C1 entitlement, these issues can be compounded by a lack of suitably qualified drivers

SERVING A LARGE SLICE OF ENGLAND

The area covered by the East of England Ambulance Service is vast. Following a merger of three trusts in 2006, it now serves a population of 5.8 million, making it the third largest ambulance service in the UK. Its reach stretches from the metropolitan commuter belts of Hertfordshire and Essex to the more rural communities of Suffolk, Cambridgeshire, Bedfordshire, and Norfolk.

The NHS is always going through constant change. Ashford’s role is to manage that change and ensure that it is being delivered on a consistent and consultative basis. When the COVID-19 pandemic struck the UK in early 2020, it was Ashford who had to coordinate much of the service’s response. Although now in his 33^rd year in the ambulance service, even this long experience had not prepared him for the unique challenges of ensuring the smooth delivery of an emergency service during a pandemic.

CHANGING LEVEL OF DEMAND

It would be easy to assume that demand for the ambulance service has increased exponentially since the outbreak of the pandemic, but the true picture is more complicated and nuanced.

“It’s been considerably variable,” Ashford said. “During the first period of lockdown we saw a significant reduction in activity.”

The reason is that much of the demand the service would normally have seen as a result of the weekend and night-time economy dropped off. Plus, elderly people and others who were deemed at risk tended to stay at home, so the service received a smaller volume of calls concerning trips, slips and falls.

SECOND LOCKDOWN SPIKE

The service’s experience during the second national lockdown in November, however, was significantly different. Ashford largely attributes this to the fact that the daily case volumes were so high at this point.

“The hospitals were under significant pressure,” he said. “Staffing levels were massively reduced through people not only contracting COVID themselves, but also from general winter illnesses which affect all workforces.”

The other issue was that ambulance staff were transporting patients into hospitals, where beds were often in short supply, so often experienced a considerable delay before they were able to discharge patients into the hospital’s care.

“On an average 12-hour shift we would expect a crew to undertake anything in the region of five or six jobs as an average,” Ashford said. “If you’re spending eight and a half hours at the front door of an emergency department that crew’s only undertaking one. So not only do we have fewer crews, we’re getting less out of the ones we do have.”

The pressures of the pandemic combined with the usual challenges of winter illness to form what Ashford described as a ‘perfect storm’, as the volumes of cases and the service’s ability to respond to them became increasingly out of kilter.

SHORTAGE OF ELIGIBLE DRIVERS

The East of England Ambulance Service has experienced an acute shortage of qualified drivers during the pandemic, although Ashford maintains that its experience is just part of a wider national problem.

One of the issues is that since the law changed on 1 January 1997, people acquiring a new driving licence do not automatically receive an entitlement to drive a vehicle in the C1 category of between 3.5 and 7.5 tonnes, often known as ‘grandparent rights’.

Added to which, test centre capacity has been severely limited during the three national lockdowns, with many centres closed.

“We have a huge backlog in our ability to qualify people on C1, and that’s nobody’s fault,” Ashford said. “It’s just the circumstances that we are faced with. So we have a whole raft of junior but clinically trained personnel who to all intents and purposes can’t drive our ambulances, because by law it’s required you have a C1 driving licence classification.”

CALL FOR DRIVERS WITH C1 ENTITLEMENT

An innovative solution to this issue of too few qualified drivers, has been for the service to call on those from other sectors, including logistics, to register their interest in driving ambulances.

While the service would not expect commercial drivers to drive an ambulance at speed on a blue light, which would require attending a four-week nationally-recognised course, they would be able to drive ambulances at normal road speed.

“A lot of the calls we respond to are not of a classification that requires an immediate blue light response,” Ashford explained. “Some of them are quite routine and are quite low acuity, so by default they can wait for a response, but they still need physical transport and they still need clinical care during that journey.”

While the service can provide clinical support in the rear of the vehicle, it often has a shortage of people qualified to drive both at normal road speed and in blue light conditions.

Therefore, it has sought the support of police and fire colleagues to help provide blue light driving colleagues, as well as a limited amount of commercial companies that supply blue light driving services.

SUPPORTING THE HEALTH OF YOUR LOCAL COMMUNITY

With many industry sectors, such as non-essential retail and hospitality, effectively closed for business during the national lockdown, many commercial drivers have found themselves furloughed or on reduced hours.

Ashford is encouraging drivers in that position with a C1 entitlement to register their interest in volunteering or accepting secondment to the ambulance service during this period. This, he said, represents a great opportunity for drivers to support both the health service and their local community.

“This isn’t about people flying around at high speeds on ambulances,” he said, “This is about supporting us in safely transporting people to hospital at normal road speed. It’s around people who are willing to support that process and work with one of our clinicians to enable good, easy, and timely access to hospital care to people that call our services.”

Every applicant would need to have an enhanced DBS check, which would be paid for and processed by the ambulance service. And Ashford points out that applicants would not automatically be excluded for minor misdemeanours committed several years earlier.

“We would only look to exclude people if there was something significant on their DBS that we felt posed a risk to patients or the public or our organisation representationally or otherwise,” he said.

Applicants will also need to complete a health declaration, so anyone with a letter to shield would probably be judged unsuitable. In addition, there is a need to declare that applicants have kept up with their immunisations, including tetanus. 

AN IMPROVING POSITION

Thankfully the picture has recently begun to improve for the East of England Ambulance Service. Staff absences are reducing, its staff vaccine programme is well advanced, and it is seeing fewer staff needing to self-isolate as a result of government COVID-19 guidance.

“We are seeing a slight reduction in pressure,” Ashford said. “The inbound calls that we receive are reducing slightly also, which is helpful.”

However, it may take several weeks for these factors to filter through and for the benefits to be realised from a wider health perspective.

“In short, we’re certainly not out of the woods yet,” Ashford said, “but we are seeing an improving position.”

LOOKING AHEAD

When restrictions are eased post-lockdown, however, and the pubs and the wider night-time economy reopens, a further spike or period of pressure cannot be discounted. And this will come at a time when the NHS has a very tired workforce.

“We’ve been dealing with this constantly for coming up to a year now, and it’s tough to continually deal with that level of pressure,” Ashford said. “That level of pressure and that level of responsibility for a protracted period can be quite challenging and people all need a break.”

In order to be prepared for a potential future spike in demand, Ashford is keen to build up a database of willing volunteers who live or work in Essex, Suffolk, Hertfordshire, Bedfordshire, Cambridgeshire or Norfolk, and have a C1 entitlement on their driving licence.

“Given the nature of what we do, our ability to flex our workforce needs to be reasonably quick but safe,” Ashford said. “We would love to start a relationship with interested drivers and build a database of willing volunteers to start that ball rolling.”

If you would like to register an interest in driving volunteer opportunities for the East of England Ambulance Service, please contact press.office@logistics.org.uk in the first instance.

 *https://www.eastamb.nhs.uk/

Published On: 04/02/2021 17:00:15

Comments Section

If you are a Logistics UK member login to add comments.