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Crumbling Britain: Bullying, stress and death in the ambulance services

Why paramedics and ambulance crew are suffering from poor mental health.

Russell Burgess dreamed of becoming a paramedic. He worked his way up over 13 years from a 999 call-taker to ambulance dispatcher to emergency ambulance crew at the London Ambulance Service (LAS).

In July this year, aged 39 and one level away from qualifying as a paramedic, Burgess failed three resit exams. He believed he would be kicked off the course, in accordance with LAS policy. His tutors told him he could appeal, citing stress and anxiety as a mitigating circumstance. But Burgess felt his circumstances weren’t exceptional.

The next day, he was found dead at his home in Hackney, east London. On 31 October 2019, at the inquest into Burgess’s death, the coroner delivered a verdict of suicide. Suicide is complex and cannot be attributed to one cause, but his death has exposed an ambulance service in distress – involving bullying, trauma, stress, mounting pressures and a lack of support.

Burgess joined the LAS in 2006, taking 999 calls in the emergency operations centre. Staff there always have more incoming calls than they can take, and often feel unable to take a break after distressing calls, as this would put more work on colleagues, according to a former emergency operations centre manager I speak to who wishes to remain anonymous

Burgess was proud and excited to join the LAS, but the pressurised environment soon took its toll and he developed an anxiety disorder, started smoking, drinking too much and had difficulty sleeping.

“This is where his mental health collapsed,” says Burgess’s husband, Dave Raval. “It made him vulnerable later on.”

Burgess developed claustrophobia. For the last ten years of his life, he didn’t board a plane, despite previously having a job in a cabin crew.

He wrote in his diary in 2010: “Stress over the last 4 years changed me into a monster really! A person on edge, in fight mode and stressed.”

He later wrote that the “job is destroying me and it has to STOP!”

LAS paramedic Richard, whose name has been changed on request, describes the emergency operations centre as “the most stressful, unhealthy job you could ever have”.

Burgess moved to the emergency ambulance crew in 2013. He was diagnosed with Generalised Anxiety Disorder.

Four years later, he reached LAS in-house paramedic training school, where students study alongside their jobs. Unfortunately, this wasn’t the end of Burgess’s stress.

According to his Google Calendar, in the 12 days leading up to his death, Burgess worked seven 12-hour shifts, one eight-hour shift, one rest day following a night shift, and spent the remaining three days studying for his re-sits. Because of short staffing, his manager had to refuse him additional annual leave to revise, so he took his textbooks in the ambulance and studied between call-outs.

In text messages to friends, he described himself as: “Tired. Just beyond tired. Stressed about exams. No time to study and tired.. Are we just expected to cope with this?”

Raval tells me that LAS paramedics he’s spoken to since his husband’s death, and current attendees of the in-house training school, describe paramedic training as the most stressful thing they’ve ever done.

The LAS has policies on stress management and wellbeing, and an LAS spokesperson commented:

“More than fifty of our internal paramedic programme students graduate each year... However a small number of students, an average of less than two each year, choose to withdraw citing personal reasons.”

Once students qualify, the pressure continues. Several staff members tell me graduates go out with limited experience of the road, pressure to reach targets and a culture of being admonished for mistakes and ignored for going above and beyond.

“The degree is horrendous. Students study from 8am until 5pm every day and somehow have to get 900 hours of work in per year while living in London,” the LAS paramedic Richard claims. He’s noticed the workforce getting younger and less experienced during his 20 years in the LAS. Since 2018, only those with a bachelor’s degree can become paramedics. “People in their early twenties with no life experience shouldn’t be seeing what we have to see.”

Neil Blackwell, 52, a former paramedic who worked for the LAS for 20 years until last year, predicts an increase in stress, mental illness and suicide as further older staff leave and younger paramedics take to the road.

“A lot of older staff are leaving because they can’t take it anymore,” he says. “People will fall through the cracks and there will be a lot more suicides.”

Blackwell developed depression after a call-out to a particularly traumatising accident. When he asked for the rest of his shift off, his manager suggested he got straight back into the ambulance.

On a Change.org page set up by Raval outlining steps the LAS should take to reduce stress for student paramedics, former students have shared their stories. One writes that they were “told by our training officer if we contacted her for help she would ‘stab us in the neck’.”

The LAS loses the most paramedic days through stress out of all of England’s ambulance services. But there are signs of mounting pressures, stress and lack of support further afield. In 2016, one in 20 emergency service workers in England and Wales said they attempted suicide, according to figures from the mental health charity Mind.

Adding to the stress is a reported culture of bullying. In 2014, an independent report by the Andrea Adams Consultancy found that over two-thirds of LAS staff had experienced bullying or harassment at work. A year later, it became the first emergency trust in England to be put in special measures by the Care Quality Commission (CQC), partly due to its culture of bullying.

Professor Duncan Lewis of Plymouth University was commissioned by the LAS last year to write another report on bullying in the LAS. The report was completed in September but Raval says he has been told it “isn’t ready” and was unable to obtain it using a Freedom of Information Act request. The LAS has yet to respond to my question about why the report has not been published.

Burgess felt he was deemed a “trouble maker” and bullied by his tutors after asking for extra support before his exams. On one occasion, he emailed his tutors and boss to say he was stressed and felt unsupported by them. He described in messages to friends that the ensuing meeting to discuss this felt like an “ambush” and “all 4 of them bullied me in typical LAS style”. When looking through his browsing history from the day after this meeting, Raval found that Burgess had googled methods of suicide.

The LAS has yet to respond to my questions about these allegations of bullying.

Richard, an LAS paramedic who attended the same training school as Burgess in Fulham, says he had “nothing but problems” there. “It was the most miserable time of my life. I felt like I was being manipulated, controlled, messed about. I complained, but senior management closed ranks.”

Raval is continuing to fight for improved support across the LAS and is pushing for a formal investigation into the allegations that Burgess was subjected to bullying behaviour by his course tutors. “I’m not going to give up until the bullying is properly investigated. I think it’s an open and shut case,” he says. “How many more LAS staff need to die before senior management clamp down on bullying? There should be zero tolerance towards this sort of abuse.”

Again, the LAS isn’t alone. According to NHS figures, ambulance services face the highest rates of bullying and harassment from staff in the NHS.

The East of England Ambulance Service NHS Trust (EEAST) has commissioned an independent investigation into allegations of bullying, after the suspected suicides of three of its workers in 11 days last year. Ambulance dispatcher Luke Wright and paramedics Christopher Gill and Richard Grimes were found dead over the course of a fortnight between 11 November and 21 November – the month after a whistleblower had written to the head of the trust to complain about bullying and “the risk of suicide”.

Back in 2017, Alison Twist – the consultant who investigated bullying and harassment in the LAS in 2014 – was approached by the union Unison to investigate bullying within the EEAST. She claims the trust refused to cooperate.

“The level of bullying harassment I found in the organisation shocked me,” says Twist. “Some of the personal stories I heard were horrific – it had a very toxic culture… They didn’t encourage speaking up, and if someone did, there were consequences.”

Earlier this year, the Norfolk Unison branch asked Twist to do another survey to see if the trust had improved. But she says she feared repercussions for emergency workers represented by the union if she went ahead.

When approached regarding these allegations, an EEAST spokesperson said its directors at the time of Twist’s attempt to investigate are no longer employed there, and so they could not answer questions about how the trust reacted at the time. The EEAST has a voluntary recognition agreement with Unison, which means the union is recognised by the employer.

After the deaths, the EEAST’s medical director Dr Tom Davis commented:

“We are extremely sad about the deaths recently of three of our colleagues. We have extended our sympathies to their families and friends at this difficult time and we have provided immediate support to them and to our colleagues, including a helpline staffed by trained experts. The Trust takes any concerns about the health and wellbeing of its staff extremely seriously and will always offer support to those staff who may require any help.

“Through our values as an organisation, we encourage a working environment of openness and honesty that embraces staff, volunteers and external partners. We listen to concerns expressed by staff and learn from and share our experiences.”

An LAS spokesperson said:

“We have a range of resources to support staff. We encourage all our staff, including those undergoing training, to access and use the services available if they need any further support for their wellbeing.”

But while the LAS offers staff counselling, which Burgess used, a peer support network, for which Burgess volunteered, and an independent support line, it’s evident that the LAS and other NHS trusts have a long way to go to avoid more deaths.

“Emergency services will always have issues unique to them. But a lot more needs to be done,” says Alison Twist, the investigator. “If something goes wrong, there needs to be learning, not blame. We have to listen to unpalatable truths and find solutions. People forget these employees go home to their loved ones, to whom they mean a great deal.”

UPDATE 4/1/20

The LAS has sent a response to two queries, which it was given the opportunity to respond to before publication. On the allegation that course tutors bullied Russell Burgess:

"Following the tragic death of Russell Burgess we fully investigated the allegations of bullying in our training centre. We spoke to both course tutors and students and the investigation found no reports of bullying in this case.

"The inquest into Russell Burgess’s death in October also found no issues of bullying. The feedback from students on the course illustrates a supportive culture. The vast majority – more than 90 per cent - reported they felt ‘supported’ or ‘extremely well supported’."

On the delay of publication of the Professor Duncan Lewis report into bullying:

"The report, which focuses on a small number of teams and is not organisation-wide, is still in its draft stage and will be shared with relevant people once it is finalised."

 

Jessica Brown is a freelance journalist covering social affairs and trends. She has reported for the BBC, GuardianProspect, and the New Statesman.