NHS Pay Review Body Evidence

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Recruitment and retention of ambulance staff

Recruitment-and-retention-of-ambulance-staff-PRB-November-2015-FINAL (Download document in full)


Following the 2014/15 NHS pay dispute, the majority of NHS staff accepted a pay settlement for 2015/16. Contained in the letter from the Secretary of State , and further outlined in an NHS Staff Council paper , the pay settlement included specific commitments to ambulance staff. One of these commitments was to look at recruitment and retention as a specific issue in ambulance services with a view to finding solutions to the existing problems.

This evidence is submitted to the NHS PRB following a number of months of work between trade unions and employers through the National Ambulance Strategic Partnership Forum (NASPF).

The three main trade unions representing the majority of staff working in the ambulance service are UNISON, Unite and GMB. This is a joint submission from these three unions who also form the staff side for the National Ambulance Strategic Partnership Forum (NASPF).

The evidence is submitted by the Trade Union side following a failure to agree with the employers about the solutions to the recruitment and retention problems. The employers do not share staff side‟s view that retention of existing staff is related to pay and reward. Staff side believe this is in part due to the lack of central funding for the 2015/16 pay settlement, meaning that the discussions have been restricted from the outset due to the existing financial pressures on ambulance Trusts.

This evidence supplements evidence submitted to the NHS PRB in the form of additional questions for ambulance staff (April 2015)3 . It also follows a brief submission titled “NHS Pay Review Body Evidence. Recruitment and retention of ambulance staff” in September 2015.

Collection and analysis of data has been a challenge for this evidence, in part due to the difficulties with employers providing timely data in response to requests, and also due to the lack of centrally held, consistent data on workforce movements and retention planning.


The numbers of ambulance staff leaving ambulance services across the UK is increasing every year. This is borne out in a number of surveys , research material , Staff Side evidence to the NHS PRB including anecdotal evidence shared through discussions with staff and trade union members and press stories. Indeed, Health Education England (HEE) have recognised this fact as has the recent Partial review of the Shortage Occupation Lists (SOL) for the UK and for Scotland stated that “on balance, the Migration Advisory Committee (MAC) recommend adding paramedics to the SOL subject to a thorough review once the British trainees come on–stream”.

The MAC state; “Although there has been an expansion of training places to boost labour supply in this occupation, we are told that they will experience a severe shortage for the next four years before the trainees graduate. In the meantime, ambulance services are looking to recruit from overseas (for instance, from Australia) using the Tier 5 Youth Mobility route as not all paramedics would qualify under Tier 2 General.”

The reasons people cite for leaving, or considering leaving, the ambulance service are varied and include some of the following:

  • Pay and reward
  • Demand placed on 999 services
  • Workload on individuals and working practices
  • Increase in working hours and work related stress
  • Bullying and harassment and physical violence
  • Performance management
  • Increased stress when working with and being expected to mentor „unqualified‟ staff
  • Inappropriate 999 call outs / misuse of services
  • Increases in retirement ages of ambulance workers
  • The long-term physical demands of the work
  • The long-term mental demands of the job, including but not restricted to, trauma and traumatic incidents
  • Illness and injury, including permanent injury and disablement
  • Lack of training and development opportunities
  • The transferable skills of paramedics

Although retention in ambulance services is a concern in almost all occupations, the most acute recruitment and retention problems facing the UK ambulance service are in paramedic roles. The current UK vacancy rate for paramedics is 12% (MAC SOL). Poor workforce planning, changes in education routes for paramedics from vocational training to university education and a change in the training budgets for ambulance services has led to a reduction in the national recruitment pool of trained paramedics.

The problems for ambulance services are two-fold. Ambulance services are experiencing unprecedented annual increases in demand on their services placing increasing pressure on their staff. This is leading many staff (including paramedics) to leave their jobs in the UK NHS ambulance services and employers are finding it increasingly difficult to recruit to posts due to the lack of trained paramedics in the UK. This then puts pressure on those remaining staff which exacerbates the retention problems.

The Health Care Professional Council (HCPC) states that there are 21,3848 paramedics on their register (01/07/15).

Continue reading this document by downloading the PDF Recruitment-and-retention-of-ambulance-staff-PRB-November-2015-FINAL

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