The Northern Ireland Ambulance Service was subject to industrial action on 6 May in the form of withdrawal of labour by the UNITE Trade Union in addition to ongoing “working to contracted hours only” action by UNISON, GMB and NIPSA.
The combination of both led to the Trust developing contingency plans with a specific emphasis on the action planned for 6 May and its potential impact.
The Trust cancelled planned non-urgent work to free up the available PCS and ICS crews to assist their colleagues in the emergency tier by playing a bigger role in hospital discharges.
Further contingencies involved the Trust making use of voluntary and private ambulance services to support A&E crews by undertaking work within their scope of practice.
From midnight on Tuesday to 08:00 on Wednesday the Trust operated with 40 of 52 planned NIAS crews. From 08:00 to 20:00 on Wednesday 44 of 61 crews were on duty and from 20:00 to 23:59 on Wednesday 39 of 52 crews were on duty.
In the 24 hour period NIAS responded to 441 emergency calls. 149 of these calls were Category A (life threatening calls). NIAS responded to 47% of Category A calls within 8 minutes against a performance target of 75% and a more recent performance of mid 50’s%.
The average response time for Category A calls was 12mins 11 secs.
NIAS Chief Executive, Liam McIvor said,
“6 May was a particularly challenging day for NIAS. I would like to express my thanks to all those who played a role in ensuring that whoever called for our help yesterday, got it. I would also like to acknowledge the professionalism of all involved in delivering our service. We see this dedication day-in and day-out but I am aware that many people went the extra mile, putting the best interests of the patient to the fore. To those who had to wait longer for an ambulance than they would have expected, I offer my apologies but am sure that, when our crews arrived, the care received was second to none.”
I want to take this opportunity to write to you following last Friday's day of industrial action and in particular the declaration of a major incident which placed NIAS at the centre of media attention.
I want to tell you in all honesty that the declaration of a major incident was not a cynical attempt to "break the strike" but a sincere attempt to ensure that ambulance response was maintained for emergencies and clinically critical patients, throughout the planned day of action.
The Trust recognises and accepts your right to ballot for and take industrial action. I acknowledge the importance and depth of feeling around the issues on which you were balloted for industrial action. While agreed outcomes have not been reached on any of those particular issues, I can assure you that we are committed to finding resolutions that will be both practical and sustainable.
As Chief Executive of NIAS I am charged with ensuring adequate levels of ambulance cover to protect patients who have need of our service. It was in that context, and only in that context, that a major incident was declared.
Discussions, relating to the maintenance of emergency services to patients, with Trade Unions at a regional level had resulted in an agreed Memorandum of Understanding on 6 March whereby emergency services were to be protected. This agreement had enabled ambulance staff to participate in previous industrial action while maintaining emergency cover and public safety.
In line with these regional agreements the Trust cancelled non-emergency patients and facilitated industrial action for non-emergency and administrative staff.
The situation changed following meeting with local branches whereby the Trust was informed that ambulance staff were reserving the right to totally withdraw labour or, alternatively, provide cover for Category A patients only, which you will be aware covers only 40% of emergency services to patients.
Discussions continued throughout the week and NIAS continued to develop contingency plans to maintain an emergency service to the public. By mid-afternoon on Thursday, the Trust was in a position whereby it was left with a degree of external support and an understanding that NIAS crews on duty supporting industrial action would respond to Category A calls. The levels of ambulance cover projected as being available at that time were sufficient to maintain limited emergency cover.
Late on Thursday afternoon, Resource Management Centre (RMC) reported that it had been receiving calls from staff, who were due to start the night shift, that they would be "withdrawing their labour" at midnight. It soon became evident that the Trust would not have been able to provide safe patient care from midnight and there was no option but to declare a major incident.
Channels of communication with Trade Union officials were maintained through the planning stage leading to the day of action, throughout the actual day and remain in place to discuss any issues that have arisen from the day.
On the Friday, Trust management met with Trade Union officials to discuss the situation and to seek a way forward that would facilitate staff supporting and participating in industrial action while maintaining adequate levels of cover for emergency care. The Trust sought to have an assurance that crews, should the major incident be declared over, would remain on duty and cover Category A and B calls. It was agreed that staff on duty would be canvassed for their views. Initial contact by Trade Unions was followed up with a direct contact with staff via MDT but this did not provide assurance of adequate levels of emergency cover, so the Major Incident remained in place.
I am in no doubt that relations between staff and NIAS, and between trade union representatives and NIAS have been seriously tested and damaged by these events. I want to try and repair relationships and rebuild them so that we can continue to pursue the same aim of ensuring that patients who need the ambulance service receive the highest levels of clinical care.
I would aim to meet as soon as possible to discuss a way forward for us to be able to demonstrate in a practical way our recognition of your right to take, and support, industrial action while maintaining emergency ambulance services for those who need us most. I believe that with goodwill on both sides this can be achieved.
I would, in closing, like to re-iterate that the declaration of a major incident, due to the critical levels of cover rendering us unable to provide a safe service, was regrettably the only course of action open to us at the time. I applaud your professionalism in the manner in which you dealt with patients throughout the day despite your obvious displeasure at the decision. I sincerely hope that engaging with you and your trade unions on this issue can usher in a new productive relationship which will allow us to approach with, renewed vigour, those outstanding issues, including A4C banding, rest periods, late finishes and leave, which have been on the agenda for too long.