About the London Ambulance Service
The LAS is the largest ambulance service in the country, serving the metropolitan area within the boundary of the M25. It employs around 4,400 staff, and numbers are set to rise to 4,800 by 2010.
Ambulance services have been transformed by new vehicles, technology and equipment. Staff acquire a wide range of life-saving skills with continuous training a vital part improving service delivery. Ambulance response times are a challenge in the capital’s traffic, but the response to 999 calls has improved dramatically in recent years and this improvement is being sustained.
Issues at the London Ambulance Service
Unions and management recognised in 1999 that the future of LAS was in jeopardy by:
- the perceived failures in the service, in particular response times
- a lack of public confidence as a result of sustained negative media coverage
- the low morale amongst staff.
Drastic steps were being considered, including breaking up an integrated London service. Major investment of £50 million was needed to start to bring the service up to scratch, but the funds would not be forthcoming unless confidence could be built within government and the wider health service that the service could be reformed.
Discussions between management and the unions
Unions and management came together to discuss recovery plans. Both sides accepted that the relationship between the unions and management wasn’t working and was contributing to difficulties at service and station level, with constant threats of industrial action, petty disputes erupting regularly and large numbers of grievances.
Union leaders were concerned that the industrial relations climate was making it difficult to recruit new staff. Above all, they recognised that the poor relationship made it difficult to get issues of importance to staff discussed and resolved.
Senior managers admitted publicly that the service was struggling – this honest admission was vital in gaining the trust of staff.
A new approach
A new approach was developed to improve the situation and to gain policy makers’ support. A partnership framework was drawn up, this set out new ways of working based on the principles of:
- building trust and mutual respect
- honesty and transparency
- a positive approach
- willingness to learn together and from each other
- early discussion of emerging issues.
This new approach was supported by regional union officials and senior union representatives.
UNISON staff side secretary, Eric Roberts admits that partnership working is a challenge - union reps have to represent the interests of individual members and staff’s collective interest within the partnership framework.
“We are here to deliver a fair deal for our members. We are still trade unions, after all, pursuing specific aims and goals. But at the end of the day, to deliver an excellent service to the public there is no alternative to a partnership approach. Partnership gives staff a voice in strategic discussions, as well as enabling progress on pay, terms and conditions as well as day to day issues at a station level. If trade unions support public services then working in partnership to improve them, and staffs’ terms and conditions, is the right thing to do.”
Chief Ambulance Officer, Peter Bradley emphasises the importance of the partnership process, in that it has enabled some quick wins that have helped staff and managers see real progress and changes being implemented.
“Both sides had become ground down, and were finding it difficult to know which way to turn. Relatively small issues that should have been resolved at station level were being escalated up all the time.”
Embedding partnership working
- At station level union reps are involved in decision making and are regularly consulted.
- Senior managers and union reps make annual visits across the service to engage directly with staff at station level.
- The LAS partnership forum meets every six weeks.
- Service wide partnership conferences involving reps and managers are also held annually, with presentations on strategic issues.
- There are regular informal meetings ensuring that partnership operates on a day to day level.
- Senior management has a clear expectation that station leaders will involve staff and unions on a partnership basis, and regards embedding partnership working as a strategic priority.
In 1997, the London Ambulance Service was criticised by the media as the ‘worst’ ambulance service in Britain, ten years later it was hailed as the best in the country.
- It is the only ambulance service to receive a double Good/Good rating from the Health Care Commission for both its services and its use of resources two years in a row.
- It has the highest clinical performance indicator compliance results in England.
- The service won the NHS Innovator of the year award for London in 2008 and achieved the best emergency preparedness independent audit results in England.
Impressive service achievements include:
- doubling of cardiac arrest survival to discharge
- it’s the only ambulance service to undertake region-wide direct admission for percutaneous coronary intervention 24/7
- 56,000 fewer patients have been admitted to A&E over the last two years
- a 30 per cent reduction in the number of complaints.
Partnership working has enabled LAS to deal with poor operating systems and working practices, as well as improve pay for front-line staff, deal with staff safety concerns and replace outdated IT and other equipment.
“We now have a service that responds appropriately to all our patients, and that looks, feels and behaves differently. And that is down to effective partnership working.” says Peter Bradley.
The future and next steps
Both sides are aware of the need to keep both the partnership growing and to regularly consult. There is also commitment to:
- ensure that the success of the LAS reflects positively on public services
- tackling an ever-present agenda of improving terms and conditions, and developing staff training and development opportunities
- be engaged in active succession planning to ensure new generations of managers and union reps understand and support the partnership approach.
The partnership will look at the recent staff survey results and develop plans to continue improving engagement levels. Other challenges include:
- implementing a new CAD system
- the roll-out of a new digital radio system
- improving hospital handovers.
Top tips from LAS
If it is clear that things are going wrong, take the plunge and start talking. You’ll be surprised at just how much you share a diagnosis of the problem and the vision of what needs to happen to improve ways of working.
Build up trust both on a personal level, and trust in the service itself.
Be clear about the behaviours expected at all levels.
- Really engage staff in improving service delivery – the people doing the job always know ways of doing it better and delivering a better service.
- Ensure that engagement is regular and expected by both sides.
- Make sure there are no surprises.
- Ensure that all managers and staff understand your strategic vision, that they have the skills to do their jobs, as well as the incentives and resources. Action plan to bring all those aspects together.
- See building partnership as a long term project.
Further information and contact details
For more details regarding partnership working at LAS contact: