"Let me just get these out the way," says Niall. He's peeling off post-it notes that are surrounding his laptop screen. As I recount my reasons for wanting to talk to him I explain that we can go into as much or as little detail as he wants. "It's only Tuesday”, he remarks. Given the topic, we both know the potential this conversation has to be challenging.
For the past 5 years Niall has worked as a paramedic, a profession which has been at the forefront of everyone's minds recently. From people gathering on doorsteps, banging pots and pans to thank NHS staff for their pandemic work, to months later debating fiercely about whether people with such important jobs should be allowed to even contemplate strike action.
Niall sits in a small home office wearing a forest green north face jumper and although he transitioned away from his role as a paramedic recently, he looks strikingly similar to how he may have looked on the job. His calm presence and conversational manner instantly put me at ease, an experience I'm sure countless patients he's attended to have had.
He tells me what it was like to be at the start of an important career at such a young age, and to be faced with the unprecedented changes that COVID brought. "Originally I'd ask my colleagues, how do you do this? How do you do that? And they knew the answers because they'd been doing it for decades. But when it came to anything Covid-related, I was asking questions, some people 30 years on the job didn't have any answers for me."
When studying to become a paramedic, Niall told me that his tutors did a great job of preparing him for his role. They made sure he was ready to face life-threatening emergencies, but also made it clear that these weren't happening around every corner and that there were many other aspects to the job, such as non-emergency and social care. However, the pandemic dramatically changed this reality and what ambulance services were facing each day.
"It was almost a cardiac arrest a day, which is quite abnormal... Sometimes you'll only do one a month, there'll be some in the area and it's just chance that you don't go, but almost everyone, it felt like every day, had at least one." Niall broke down the pressure that this put on the system, explaining that it could take up to two ambulances and one car for one cardiac arrest, and those jobs could take between 30 minutes and 2 hours. The cumulation of multiple emergencies alongside all of the other non-life threatening jobs meant that waiting times could be quite staggering at the time.
For a lot of people now life has mostly returned to normal, but as shops reopened it didn't feel the same within the NHS. Niall told me, "that was probably the point where the ambulance services, and the nurses, and social care, and just everyone in the NHS would have been ready to catch their breath and just have a breather, and that didn't come. Because things weren't easy before Covid and since Covid, it just stayed the same." The pandemic put a massive strain on the NHS but the service was already under immense pressure before then, with waiting times for A&E hitting an all-time low in the winter of 2019. Niall explains that some moments during the pandemic relieved some pressure, as the roll-out of vaccines saw fewer people getting dangerously ill, and that others were wary of interacting with the NHS for fear of coming into contact with Covid. Thankfully those fears have subsided and people feel more comfortable engaging again, but a return to normal for the NHS and its staff means a return to an already struggling workload.
"You'd show up and it'd look a bit busy, and you'd ask, at least we did, what corridor are we on?" In busy times the prospect of a corridor would be much more likely than a bed. In the hospital Niall worked in there was an option of 4 corridors, the last he said he hadn't seen used, even during covid, until this year 2022. The start of which saw for him the busiest time for the hospital "by the time you're on the fourth corridor that's 15-20 patients on hospital beds which is arguably 15 ambulances that can't be watched." They did have systems to manage when things got like this, a nurse was able to monitor one corridor but due to staffing issues in the hospital, some ambulance crews would have to stay to monitor the others. The staff would be working out systems as they went with some ambulance staff taking on 2 patients to free up others to go out or at extremely busy times 3. Although they found ways to manage where they could, Niall says they were often "facing a losing battle with numbers".
It's easy to think of some of these pressures as due to unpredictable influxes of patients but there is a lot of complexity around the issues ambulance crews face every day. Niall highlights social care underfunding as one of many chain reactions that can lead to issues. The social care sector is responsible for helping people who may be leaving the hospital with mobility or access needs that they didn't have at the start of their care. "If social care is underfunded, it can't do its job. So people get stuck in hospitals that don't need to be in hospital." Niall explains "now you've got people in hospital beds that don't need them but can't go anywhere else and as a result, the people who need a hospital bed but can't get them are stuck where they are. Either in A&E and can't be sent to a ward or they're stuck on an ambulance bed." This leads to the ambulance crews needing to stay with patients in corridors and meaning that when you call 999 there won't always be people available to come "if you need an ambulance and you can't get an ambulance. Something bad is going to happen."
"That is just one example of a landslide effect. Just the poor funding of social services can have a direct result on hospital, A&E staff, emergency ambulances and ambulance response times and I'm sure there are hundreds of examples with other areas being underfunded like mental health."
There is no doubt that everyone views emergency service workers and NHS practitioners as important and extremely difficult professions but as our conversation continues it becomes clear just how much working within the strained systems of the NHS adds to the difficulty of roles. "Your managers are very understanding but the service itself is not very understanding." he tells me as he details the stress that comes when you contract illnesses from patients "it's not your fault, there's only so much PPE you can put on and infection prevention control you can do, without just picking up a sickness," Niall says that staff worry about picking up illnesses as they are almost punished for it being put on a stage 1 sickness warning after being off twice in a year.
That is just the physical side of things too. "I like to think of myself as quite a resilient person," Niall tells me but even with a good support network around him of friends and family, after 5 years in the service he had to take a few weeks off for his mental health. The first signs that his job was taking a toll on him came after two particularly hard jobs both involving children that needed CPR "I talked with a manager and he explained that I was showing signs of being burnt out." In hindsight Niall says he should have taken time off then but didn't and carried on with his role recovering on his days off. This feeling came around again a few years later when he realised he had begun to change "I wasn't as pleasant as I normally am. I had a very short temper. I would get really frustrated at things that would frustrate me normally but I'd normally be able to contain it." After 5 years Niall found that he needed to take time. "It was a decision almost within myself, like assessing myself. Is this person safe to be in work? And that was a really strange feeling of almost feeling guilty for not being in work. Because why am I not in work because mental health is obviously a strange one when you can't point at an impressive x-ray."
During this time Niall said he went to colleagues apologising to them for not being at work but each one of them understood, either saying they were lucky to not have reached the point where they needed time off or had already taken time off themselves. Thankfully he says his work was also understanding while he was off, not pressuring him to come back. He has heard stories of other ambulance services not being able to be as understanding due to staffing issues. Even in situations where staff are trying to look after themselves, there can be a sense of urgency for them to come back to work.
Niall has now stepped away from working with the ambulance service, his time off gave him the perspective to see that if he kept going he would likely find himself in a cycle of slowly becoming overwhelmed again and then needing more time off. He didn't want to leave the NHS as despite the harder elements of his role he loved his job and found a place for his skills in primary care where he could continue to work with patients daily. He explained that as a paramedic you can upskill and do a prescribing course which allows you to prescribe many of the drugs that a GP would. This new role also helps to take pressure off another part of the NHS "all of a sudden you don't quite need as many doctors if you have paramedics and nurses, that you can give some doctor-like responsibilities to." The lack of GPs within the NHS is another major problem it faces.
Today a lot of NHS staff have reached a point where they have felt the need to turn to strike action to address issues they are faced with. The reaction to this from the public has been mixed which has been hard for many NHS staff. "I've always felt appreciated in the NHS, people have always been nice to me. People have understood that just because the ambulance took a while, doesn't mean it was me.`` For Niall it is hard to balance this with the criticism that can be given around strikes "The idea now that we are the villains for striking and asking for these things... The NHS has always had a strange place with striking because we are almost held in a moral chokehold by the government which is; how can you strike? People will die and you're not doing your job, which is completely immoral and they are not wrong in that sense but the main reason I think people are striking isn't for financial reasons."
He says money is part of the strike action saying that the talent and hard work of these roles deserve more. "I don't know what it is but they deserve more. Because that is why people are considering other jobs and there is nothing wrong with those other jobs but it is less responsibility, the hours are better, there is no stress that your mistake can kill someone. People need to be paid more because it doesn't make sense to work for this money sometimes."
However, he believes and has heard from many people that the main reason for striking is to fight for better and safer working conditions. This isn't just safer working conditions for the staff though as with better working conditions for them comes better care for patients. "We need more staff across the board and for some reason there doesn't seem to be the budget for that or the capacity for that. Even though everybody I know, in every department could do with more colleagues... I know a lot of people are striking for better working standards and safer standards, not for their own money"
Niall rounds off by highlighting how many people work across the NHS and how nothing would function without the porters, the cleaners, the maintenance staff, the food staff "all of it, every single person in the NHS, I feel deserves a bit better. Not a miracle but everyone deserves a bit more support from the government, be that financially, be that morally, be that through policies that are better for everyone."
Nurses are currently striking with strike actions occurring across some organisations from 15th December to the 20th of December and ambulance strikes planned from 21st and 28th December 2022.
For more up-to-date information on strikes and their impact on treatment see https://www.england.nhs.uk/long-read/information-for-the-public-on-industrial-action/