Promoting Staff Wellbeing in UK NHS Ambulance Personnel

Ambulance staff (not just frontline clinicians) have the highest rate of sickness absence in NHS at 5.36% compared to the NHS average of 4.0%1, and there is also considerable variation in sickness absence rates between ambulance services (3.40–6.42% during quarter 3, 2017). While reasons for absence are not included in NHS sickness absence figures, a previous report into reducing sickness within the NHS identified that mental health issues were one of the top three reasons for sickness absence. In addition, only a small percentage of NHS trusts provided managers with training for early recognition of these issues2. This was a key theme highlighted in a recent review into how employers can positively impact on the health and mental wellbeing of employees3.
In a UK survey by the charity Mind of over 1,300 ambulance service responders, problems at work were often cited as the main cause of mental health problems. These included excessive workload, pressure from management, long hours, changing shift patterns, and exposure to traumatic incidents4.
Office for National Statistics (ONS) data show that male paramedics are at a 75% greater risk of suicide than the general population and it is likely that there are occupational risks for suicide in this professional group5. Risks for female paramedics and non-paramedic ambulance roles could not be quantified due to the small numbers of deaths in these groups within the time period examined (2011–2015). Research commissioned by the Association of Ambulance Chief Executives (AACE), found that in 2014–2015, 15 suicide deaths were reported within eight ambulance services6. These deaths included those from non-frontline positions e.g. urgent and emergency call centres and support roles.
Some trends in suicide deaths are consistent with general population (e.g. relationship or financial problems and psychological illness), but there are additional factors which may be specific for the ambulance service staff e.g. sickness absence before death, disciplinary proceedings, loss of driving licence, and young females working in 111 and 999 call centres6. Limitations of this work mean that the factors for suicide risk for this occupation are not well understood.
Recommendations from this work included specific training for leaders, line managers and supervisors; and specific consideration to offer additional support for staff who are:

? Required to change their job roles
? Involved in an adverse/serious incident
? Subject to disciplinary procedures and/or fitness to practice processes
? Under sickness reviews
? At risk of losing, or who have lost, their driving license.