My 12-hour shift with a London ambulance crew
Ambulance staff are striking, citing record pressures, low wages and the NHS in crisis — so what’s the reality on the ground? Katie Strick spends a day on the frontline
IT SOUNDS like something you’d hear in an episode of 24 Hours in A&E — “999 mode activated.” But for London ambulance workers Omar and Llamar, it is the soundtrack to their working day. “We’ll look after you,” emergency medical technician (EMT) Llamar tells a tearful septuagenarian on her way to St Mary’s Hospital in Paddington, holding her hand as we weave through the west London traffic. Understandably, the patient, Margot*, is scared. She doesn’t like hospitals but she’s just been told she might have sepsis and has been struggling to breathe for six days. “We’re getting you to hospital quickly because you’re showing signs,” Llamar tells her over the sound of the siren. “Don’t be too scared, OK? Your oxygen’s really good, you’re still managing on your own.”
Llamar and his colleague carry Margot down the ambulance ramp and join a queue for the rapid assessment room inside the hospital. “Thank you, Llamar, you look after us so well,” says Catherine*, a neighbour who’s accompanying Margot to hospital. Llamar smiles and puts his hand up. It’s not the first time he’s been thanked that day. On an earlier job, Damiana Louis, 65, a Grenfell survivor living in a flat in Ladbroke Grove, thanks Llamar and his colleague for being faster than any doctor she’s tried to get hold of in recent months. “You are good men, you know,” she calls after them as they descend the stairs to her flat. “I hope your bosses are paying you enough”.
Omar and Llamar exchange knowing glances. My day accompanying them on a shift comes just 24 hours after more than 11,000 of their ambulance colleagues across England and Wales joined the latest strike over pay, down by £5,600 compared to 2010 for the average paramedic. Salaries vary, from £47,965 to as little as £31,163, but at the end of the day, it’s the same gruelling reality they all face; saving lives for over 12 hours a day in often difficult and squalid conditions, encountering potentially violent and intimidating patients and not being able to make evening plans day-after-day. “Deliver a baby, save a life, elderly fall, all in the same shift,” reads a popular placard on the picket lines. “Resuscitation takes approximately one hour. A newly qualified paramedic would earn £14 to save your mum, grandad or child,” reads another.
Omar, Llamar and their London Ambulance Service colleagues weren’t takingpart in last week’s strike, but they have several times over recent months — and they will again, if their pay doesn’t rise above the four per cent they’ve been offered. “It’s about pay, but it’s also about the conditions in which the NHS finds itself at the moment... it takes its toll on you,” their colleague John Martin, 42, London’s chief paramedic, tells me of the strikes, which still see staff responding to “life and limb” incidents and take significant preparation to happen safely — factors that are only adding to the high levels of overwhelm across the NHS.
“Crippling” delays, 12-hour A&E waiting times and heart attack patients waiting more than three hours for an ambulance — 12 times the NHS target — were among the horror stories reported in December, the worst month for ambulance response times in England in recorded history. So how do waiting times compare now? What are the main pressures facing paramedics in 2023? And are those headlines about record-breaking waiting times actually the reality on the ground?
“If you’d come with us six months ago, it would’ve been,” says Llamar, 29, a former physio and recruiter who’s been working as an EMT for three years. Two of these years he’s spent with Omar, 35, a paramedic for the last six years. We’re 16 minutes into our shift and exchanging banter about Pret coffee versus Gail’s coffee with some of their ambulance colleagues — far from what I pictured
Call volumes have dropped by a fifth since December – patients are only calling in emergencies since the strikes
for my first hour on the NHS frontline. But Llamar tells me moments like this — waiting for a first job to come in — are not uncommon at the moment. Since the strikes started several months ago, call volumes have noticeably decreased, and not just on strike days. Before Christmas, the London Ambulance Service was receiving around 6,000 calls a day. Two months on, that figure has dropped by more than a fifth, to 4,700.
Martin says this lower call volume is partly down to external factors like the milder weather and a drop in infections like Strep A, flu and Covid. But thanks to the strikes, “patients are [also] getting better at knowing what’s critical and only calling in emergencies,” says Llamar. Waiting times have vastly improved since December, falling by almost an hour in a month and now at their lowest level in 19 months.
But winter isn’t over yet. Even if ambulance callouts are currently going down, the wider health service is still on its knees. Paramedic Rachel* looks weary when Llamar asks her about her first job of the day. The patient had been in mild pain for three days, hadn’t taken any pain relief and hadn’t spoken to their GP. Rachel’s tone suggests conversations like this have become a daily script — a “frustration”, says Martin, when attending to that patient means not being able to go to another one that might be more life-threatening. He doesn’t blame the individual or their GP, but it’s a symptom of the system as a whole.
Omar tells me calls like this — when a patient really needs a doctor, not a paramedic — are standard practice. Many 999 callers simply need to go to the pharmacy or a walk-in centre. Martin says roughly 80 per cent of 999 patients would be taken to hospital 20 years ago. Now, that figure is more like 50 per cent.
Some 26 minutes into our shift, a job comes in. We turn on the blue lights and head to an address in Kensington, where a woman is having difficulty breathing. My crewmates snap into work mode as soon as we reach the flat: taking heart rates, holding vomit bowls, asking questions. People assume the job is all blood and guts but half the job is just listening, they tell me. Our patient wants to tell us all about her struggles to see a district nurse, her children, her grandchildren. “People just want someone to talk to. We become their counsellors,” says Llamar. Loneliness has “massively increased” post-pandemic.
OUR fourth call of the day is a female in her thirties with suicidal thoughts. Mental health call-outs have soared since the pandemic, says Omar — and it was even worse at the height of lockdown. “I’m talking about stress,” says Llamar. “Stress-induced mental health. That was the hardest bit for me in the pandemic.”
At the height of the first lockdown, Omar and Llamar once spent six hours — half a shift — waiting in a queue outside a hospital. Martin says six-hour waiting times were not unusual back then. Even as recently as December, “the radio was constantly going,” says Llamar. But things have calmed down since the strikes started. “People have got nicer to us... I think it’s because of what they’re reading about [in the news].”
A minute later, another job comes in. We arrive in three minutes — four minutes under the NHS target — and a mother rushes in holding a baby. At Charing Cross Hospital in Hammersmith, an A&E nurse tells Omar she’s got 20 patients waiting to be triaged — unsurprising, given the queues of ambulances outside. This, Omar points out, is what the papers are referring to when they describe the NHS at breaking point. The reason paramedics don’t always see this is that they can only see one patient at a time.
Llamar says he does voluntary overtime every week to top up his salary. Some of his colleagues say they work 70-hour weeks just to pay the bills (standard weekly hours are 37.5). But there’s only so long you can do 70-hour weeks if you want to stay healthy. Colleagues of Omar and Llamar say they’re considering going back to their home countries because they cannot afford to stay.
Later, my Uber driver assumes I’m a paramedic when I leave the ambulance station. “Not on strike today, then?,” he asks me. “Not today”, I say, too weary to go into detail. But he wants to tell me about the injured woman he drove to A&E last week. “I’ve been the ambulance during these strikes,” he says. “Beats me how the Government wastes all this money when the people who really matter are being ignored.” You and half the country, mate, I think, wishing we had a blue light to get me home faster. *Names have been changed