Stories of the NHS’ desperate struggles are rarely out of the news. There is no doubt that working in emergency healthcare is physically and emotionally exhausting. But as tremendous as these pressures are for healthcare professionals, what is it about the NHS that drives people to continue to devote the best part of their lives to it?
Over the last five years, I have been working closely with NHS paramedics to learn about the changes they have experienced as professionals.
On my travels with the ambulance service I came across alternative perspectives which over-shadowed the regular themes of resource shortages, exhaustion and poor mental health we’re used to hearing. “Please don’t only report our miserablist stories,” pleaded an emergency medical technician at a shabby old ambulance station far from HQ. “We can moan for England” was a phrase I heard almost everywhere. Many of the ambulance workers’ complaints about their organisation were valid. But there was an interesting cultural angle to it.
Paramedics and technicians reflected on “the moaning” with me. They described it as habitual, a remnant of the canteen culture, part of the territory and not to be taken too seriously. The scene could be light-hearted: one ambulance crew was described as “a comedy double act”, and another paramedic described what he called “the baboon pack” - certain crews on station would form a closed circle to share stories, gossip and complaints. One of the paramedics spoke at length about the pointlessness of the moaning: “The constant moaning is a problem. It’s cultural, it’s like a stuck record. Sometimes, yes you are exhausted, it’s hard, it’s bloody hard, but the constant whinging and moaning just makes it worse. You are wasting energy, dragging everyone else down, too. Sometimes I join in, other times I’m like, right that’s enough, this isn’t helping you or anyone else.”
But he also spoke glowingly of serving the public: “I love my job, the majority of times patients are lovely people” - comments I’d often hear. I’d see thank you letters posted on mess room notice-boards. Even when attending terribly sad scenes, paramedics often described their role as “a privilege”, or “a witness to suffering”.
So, to what extent are these people and organisations really broken? Can we find optimism amid the despair?
The paramedic profession has taken great strides, moving from a manual occupation to a complex clinical role that involves a wide range of pre-hospital and unplanned primary care duties. Paramedics today are increasingly empowered to treat patients at scene, cutting down on unnecessary transportation to overcrowded A&E units.
Paramedics are also encouraged to be increasingly autonomous. The Health and Care Professions Council has recently recommended that university degrees should now be the only entry point for the registration of new paramedics. These are major developments that offset the frustrations and constraints that ambulance workers have faced for decades. Paramedic science degrees are in high demand. In an era of automation, gig economy and “bullshit jobs”, the promise of a meaningful, identifiable role where one can help the public in its hour of need is an attractive one.
There is no doubt that the NHS requires substantially increased Government funding. But there is always more that employees, managers and even members of the public can do to make working life that bit more tolerable.
We should all encourage self-care and care for others in an effort to minimise unnecessary callouts that are a challenge for overstretched services. We should be appreciative the quality of care we receive. We should say thank you to these public servants.
The fact that a clinically-advanced system free at the point of use exists at all is a powerful reminder of what society can achieve, and what the public expects and supports. Amid all the breakage in modern society, optimism is a strategy we should all try to pursue.