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23 December 2022

Behind ambulance strikes, there’s an elephant in the emergency room

The A&E crisis has a hidden cause that cannot be fixed with paramedic pay.

By Anoosh Chakelian

A 999 call is perhaps the most acute contact with the state a UK citizen can experience. Now it’s broken down – responses are taking too long, or there is no crew available at all. Emergency patients are taking taxis to hospital. Private ambulance firms are cashing in.

Strikes are making it worse. Sources at one major ambulance service told me this week they’d only reach half the incidents they usually would. Patients suffer. Dialling 999 moves an inch further from an act of expectation to one of hope.

Yet there is a reason this is happening that goes beyond paramedic pay and working conditions. I’ve spoken to paramedics a great deal this year and I know the pain they’re going through, watching patients suffer unnecessarily, and wasting shifts sitting around in hospital car parks. This is not what they signed up for, and they should be granted the pay deal that they need to stay in their jobs and live a decent life. One paramedic messaged me on 21 December, strike day: “We are all exhausted from apologising to patients and relatives for circumstances out of our own personal control. Stop clapping and give us a hand.”

Those circumstances beyond their control, however, cannot be fixed with more money for the NHS – whether in pay packets, or otherwise. They are caused by a separate service altogether: social care.

In the UK, social care is not run as part of the health service. Stretched council budgets and eye-wateringly expensive private providers are responsible. This broken patchwork combines with an ageing population, and disabled and chronically-ill people living longer due to medical advances. Demand spirals as funding shrinks.

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This is why you’ve seen paramedics on the picket lines. They can’t do their jobs properly because emergency departments are full; hospital beds are occupied by people who could otherwise be discharged back home with a care plan, or to a care home.

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As the now Chancellor and former health secretary, Jeremy Hunt, candidly told me earlier this year: “When you see people waiting an hour to get an ambulance for a stroke, one of the reasons that’s happening is because the ambulances are stuck at hospitals because they can’t get people out of A&E. Because there aren’t enough beds because people can’t be discharged into the social care system.” He called social care cuts in his time as health secretary a “silent killer”, and his “biggest regret” is failing to address the crumbling social care system.

Carers aren’t on strike, but the elephant in the emergency room is that their demands would likely go further to fixing the problems in the health service than anyone else’s.

[See also: What Rishi Sunak doesn’t get about strikes]

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