As with staff throughout the Health and Social Care system, those working in the Northern Ireland Ambulance Service have demonstrated huge commitment and professionalism in recent months in providing a service and dealing with the pressures associated with the Covid-19 pandemic.
As business returns to normal and demand on our service continues to increase, NIAS is facing increased challenges in maintaining planned levels of cover across all of our Divisions across Northern Ireland. Regrettably, this will mean that on occasions our response times to some calls will be delayed. We will continue to target our resources at the most seriously ill or injured to ensure they receive the fastest and most appropriate response to suit their clinical need. However, NIAS envisages that response times to those patients whose clinical need is less urgent will be longer than might be expected by patients and their carers. At all times, NIAS will seek to respond to all calls in the shortest possible time.
The reasons for this anticipated drop in cover/delayed response times are a result of a number of factors which individually would not be without impact but, when combined, have a much greater impact on our ability to provide cover.
- Activity levels which have been increasing steadily over recent years without a commensurate increase in staffing levels. A recent, independent, demand/capacity review has indicated that NIAS requires an uplift of more than 300 operational staff to cope with current and projected demand on the service. NIAS is currently developing a business case for consideration by the Department of Health to secure the necessary funding.
- Almost 20% of frontline staff absence from duty due to ordinary sickness or reasons related to Covid-19 which require at risk staff to take precautionary measures in relation to their own health.
- A seasonal reduction in staff availability due to annual leave commitments. NIAS staff have an entitlement of two weeks leave over the summer period, which is rostered. This leave is planned and accommodated by other staff making themselves available for overtime. We are very grateful to our staff who were willing to postpone their leave normally taken in the Spring to ensure an effective ambulance response during the Covid-19 peak, and for making themselves available to work additional hours. However, those staff are now tired and need to be able to take their leave to recharge their batteries in order to deal with the normal high level of activity but also to be ready, both physically and mentally, to deal with a potential second wave of the virus and the normal winter pressures.
- The challenges facing NIAS are also experienced across the other five Health and Social Care Trusts and this can impact upon the ability of NIAS crews to handover patients at Emergency Departments.
These delays in ambulance turnaround times, due in no small measure to reduced space in the EDs as a result of social distancing requirements, impact greatly on the number of crews we have available to respond to emergencies in the community, in a timely manner.
NIAS continues to work with colleagues in the Department of Health, Health and Social Care Board and the five hospital Trusts to find solutions to these issues.
- These challenges are also compounded by a totally unacceptable increase of assaults on our staff who will, temporarily, be taken off frontline duties to recover.
NIAS anticipates that reduced levels of cover will be experienced across all areas at different times. However, all available resources at any particular time are managed regionally by staff in Emergency Ambulance Control to allocate the nearest available ambulance to the most urgent calls.
Additionally, highly skilled Paramedics within our Control Centre are available to give advice to patients with less urgent clinical needs, advising them of options other than ambulance or ED attendance. These Paramedics are an invaluable resource within our service delivery as they often ensure that ambulance crews are not tied up unnecessarily with inappropriate calls.
NIAS crews are also trained to consider if patients, to whom they have attended, would be better suited by options other than ED attendance. This “see and treat” protocol assists greatly in ensuring the earliest availability of crews to respond to other emergencies.
We are also very grateful for the support of our colleagues in the Voluntary and Private Ambulance Services who assist us by providing crews on a nightly basis.
These crews are not despatched to Category 1 or 2 calls. They assist us in those calls which are of a less urgent nature including hospital transfers and Healthcare Professional (e.g. GP) calls. Their invaluable contribution enables us to protect our own resources to respond to those calls which are identified as life-threatening or serious in nature.
NIAS Chief Executive, Michael Bloomfield, appealed for support from public representatives and the community in general to ensure that ambulances remain available to respond to life-threatening emergencies
“I appreciate the genuine concern of community and political representatives when informed of shortages in a particular area. However, I would like to reassure all stakeholders that we will continue to manage our available resources in a way which best serves the interests of patients and staff.
The public also have a role to play and we would appeal to them to do so. We still receive too many calls for which options other than calling 999 are available. We would ask that people only consider calling 999 for real emergencies, while at the same time advising people not to delay in the case of a real emergency.
We are there to help you. We want to provide you with the quickest and most appropriate response to your clinical need. We would ask you to remember that not all 999 calls require an immediate response and that if you experience delays to please remain patient. Our crews will be with you as soon as possible and will treat you with the utmost care, compassions and respect.
NIAS staff have, quite rightly, been lauded by the public for their professionalism and commitment during the Covid Pandemic. As Chief Executive, I am aware that this commitment and professionalism is ever present and I would like to take this opportunity on behalf of the Senior Team and Trust Board, to offer my sincere thanks to them all. From engaging directly with them I am aware of the great personal sacrifices they have made to make themselves available to respond to the crisis and protect the community. They do this selflessly and it is greatly appreciated. I am keen that we now enable those same staff to take a well-deserved rest during the coming weeks to give them a chance to be with their families, to whom I would also like to express my thanks for their patience and understanding.”
Health Minister Robin Swann has today published the Trust rebuilding plans for July to September 2020.
The Minister said: “When I published the Rebuilding Health and Social Care Services Strategic Framework on 9 June, I was clear that increasing activity would be a significant challenge. Covid-19 is still with us and will continue to impact on the extent to which and how we deliver health and social care services.
“We need to increase the services as soon as possible and at the same time prepare for potential future surges. We need to be able to maintain social distancing while delivering for the many citizens who are waiting on a procedure or a diagnosis. I do not underestimate the challenge ahead and there will be a need to prioritise services given the significant constraints that our health and social care services continue to face.
“The public support throughout the pandemic has given strength to all of our health and social care staff. This has helped them deliver vital services during the most challenging period ever encountered by the sector. As we now move to increase capacity and activity, we will need to adopt a flexible and adaptable approach. I would urge the public to continue supporting our health and social care staff and show patience during this rebuilding phase.”
The document is accessible at:
The Minister of Health, Robin Swann, launched his “Strategic Framework for Rebuilding Health and Social Care Services” in the Assembly today, 9 June 2020.
Each of the six Health and Social Care Trusts have been working on their individual plans to rebuild their services in this period following the first phase of the Coronavirus Pandemic.
The Northern Ireland Ambulance Service, today, publishes its plan for Phase 1 of the rebuilding process. The plan examines the steps taken by NIAS that enabled us to adequately manage the first phase of the Pandemic while charting a way forward, initially, to the end of June when recovery plans will commence for the period July to September.
As we continue to move out of the first phase of the Pandemic, we do so with one eye firmly on the horizon for the emergence of any future waves of the virus which will require us to respond quickly to meet the needs of our patients. We are confident that, based on our experiences over the past number of months, we will be able to re-direct our resources to quickly respond to any changing needs of our patients.
Our staff have been the main reason that we were able to manage the situation thrust upon us in March. It is they who will have a key role in managing the NIAS response to future waves of the virus and protecting them remains our priority.
We will, in this recovery phase, reinforce those measures which can impact their ability to be available to respond to patients at their time of need. We will continue to emphasise the importance of social distancing and infection control as the key barriers to the spread of the virus. We will continue to work at securing adequate supplies of the most appropriate PPE for their use.
We will also build upon the positive experiences from our management of the first phase of the Pandemic. We want to explore the potential for greater use of technology in creative and innovative ways which became evident during that time.
We will seek to do all of this while working with our staff, our patients and our partners in HSC, guided by the principles contained within the introduction of our plan, which is accessible at:
The Minister has indicated that services will not and cannot resume as before. Better ways of delivering services will require innovation, sustained investment and, crucially, society-wide support. NIAS will be part of that rebuilding process, seeking to improve with new ways of working that will bring tangible benefits to our patients, staff and HSC partners.
We would ask for your continued support and patience while our full range of services begin to come online and we assure you that we will do our very best to be there for you at your time of need and provide the care most appropriate to your needs.
Throughout the Covid crisis, NIAS staff have been among those who have come into closest contact with the virus and have, quite rightly, been recognised for their efforts by the public and healthcare colleagues.
Many have had to make huge sacrifices by moving out of their family homes to reduce the risk of passing the virus, to which they have been exposed on a daily basis, on to at-risk relatives. This, they do out of a sense of commitment to the communities in which they live and serve and in whose health and well-being they are invested, attending to and serving the most vulnerable in our society.
In the early stages of the Pandemic, there was a reduction in the number of calls that NIAS crews were required to attend. Lockdown also meant that our staff were at lesser risk of assault in public place and fewer incidents of assaults were recorded in the period covering March and April.
However, during May we had forty-four physical or verbal assaults on our staff, with almost half of these occurring in the final week of May. Five of these assaults happened on one day - 30th May.
Some of these incidents have involved patients spitting at our crews and urinating over equipment whilst telling staff they have COVID and intend to pass it on to them.
In the period between 29th May to 7th June, thirty-five incidents of verbal or physical assaults, on our staff, have been reported and involved forty-two members of our staff. On too many occasions, staff noted that the perpetrator was under the influence of drugs and/or alcohol.
Assaults are not just restricted to operational staff responding to calls, but are also experienced by staff working in our Control Centres and just recently, by members of a private ambulance service working on our behalf.
The impact on staff is not just in terms of physical injuries, but these events have a lasting psychological impact on those involved. We are also concerned about the increased stress placed upon family members, who are already having to cope with the added worry of their loved ones dealing with the risks associated with the COVID-19 Pandemic.
Like every other part of the HSC, NIAS has been overwhelmed by the outpouring of support and respect shown to our staff and the work that we do. Whilst we realise that we continue to have the full support of the vast majority of the people of Northern Ireland, it is regrettable and concerning, that a number of people who call on us for help, feel it is acceptable to treat our staff in this way. Our staff should never be subject to the levels of abuse and physical harm which they sometimes encounter. It should never be considered an occupational hazard.
Michael Bloomfield, Chief Executive of the NI Ambulance Service, said
“I am greatly concerned at the recent rise in the number of physical and verbal assaults on our staff. These attacks occur too frequently and they are totally unacceptable to our staff, us and society in general.
Ambulance Service staff provide an essential service to the whole community. This is a difficult role at all times, but particularly so during the past few months dealing with the challenges and risks associated with Covid-19. For our staff to face the added fear of assault – physical and verbal, when they are trying to provide the best possible care and treatment is disgraceful and I call on all those with influence to condemn it.
I have no hesitation in calling for appropriate action to be taken, through the judicial system, against those who are responsible for these assaults.
These attacks can have a lasting emotional and psychological impact on our staff when physical wounds may have healed much quicker. Our staff deserve better and we will continue to support them through measures available to us, including immediate management and peer support which will continue for as long as necessary.
The impact of these attacks go far beyond the staff directly affected. They often result in our levels of cover being reduced as staff are unable to continue with their duties. Affected areas may be left vulnerable due to longer response times as crews attend from neighbouring stations. This could have potentially fatal consequences for those who urgently need of our service.
Our message is quite simply that these attacks must stop and that those who continue to assault our staff must become accountable to the full rigour of the law.
We would appeal to anyone in a position of influence to support us in our efforts to eradicate this totally unacceptable behaviour”
The Minister of Health, Robin Swann, expressed his outrage on hearing of the latest assaults, saying;
“I am absolutely appalled at these assaults. Ambulance staff have put themselves on the line for the rest of us time and time again during the Covid-19 pandemic.
We owe a massive debt of gratitude to them and to all their colleagues across the health and social care frontline.
It is beyond belief that they should be on the receiving of this kind of thuggery.
My thoughts are with all those affected. I hope they take comfort from the fact that the vast majority of people here regard them as heroes and will be as incensed as I am about these incidents.”
Ambulance Crews deal with the most vulnerable in our society on a daily basis. This is their vocation. They have always done it and often, when delivering highest quality care to patients, they expose themselves to considerable risk.
None of them, however, could have predicted the frequency with which they would have to face the risks associated with the spread of the Coronavirus. Every call is now one of major concern for our crews. They have the constant worry that this call, or the next, might be the one when they contract the virus. Of course, they fear for their own health but, even more so, they fear for their families – their children, their parents, their partners. They do not want to pass this virus on to the ones they love most. The added pressure on every call makes a 12 hour shift seem very long indeed.
They could, therefore, be forgiven for just switching off and thinking only of themselves when their rest days come around, but they don’t! Their minds are still out there with their friends and colleagues continuing this battle against Covid and the other challenges ambulance crews face daily.
One of our colleagues, Emma McClughan, who is based in Magherafelt station possesses a particular talent apart from the qualities of compassion, kindness and empathy which she brings to her job. Emma is also an artist.
Recently, having completed a shift pattern, Emma found that, on her day off, her thoughts were still with her colleagues and in an effort to make sense of the situation we all find ourselves in, she took to the canvas. The result has captured the imagination of her friends and colleagues in the ambulance service and beyond.
Emma captured on canvas those things from her working day that are most important to her. Her image captures, in the form of a guardian angel, the worry felt by the crews in the ambulance and on the Air Ambulance, and the hope that one day this will be past us as represented by that ever-present rainbow.
Emma posted her painting on her social media and was overwhelmed by the response and the positivity of the comments. She had obviously struck a chord. People offered to buy the painting and she could have sold it and kept the money. However, in a characteristic act of great generosity, Emma decided that any money she received would go to charity. As she works regularly with the HEMS crews and understands the vital role charity, Air Ambulance Northern Ireland, plays to continually raise funds, Emma has decided that any money raised from the limited edition prints of the picture will all go to AANI. The selection of charity was made easier by the family connection of a cousin being married to one of the doctors who is part of the HEMS team.
Emma hopes to raise more than £2000 from the sale of the prints which are available today from the AANI website. Breige Mulholland, welcoming this latest donation to AANI, emphasised how important it was to AANI at this time when fundraising activities have been affected by social distancing measures that have been introduced in the fight against the virus;
“We are so touched that Emma has used her talents in such a heartfelt and positive way in recognition of all that NIAS and AANI do 365 days of the year. As a charity, we need to raise £2m a year to keep the HEMS operational. Due to the virus all fundraising events in aid of AANI have been axed and our community are no longer able to support in the usual ways. Yet trauma incidents continue to occur, and public support is crucial. We thank Emma for her creativity and generosity and encourage those who can to buy a print from AANI’s website. It could save a life!”
NIAS Chief Executive, Michael Bloomfield praised the generosity and kindness of Emma saying
“I am constantly in awe of NIAS staff. Every day they give their all for patients and many go over and above what is expected of them. They are all being asked to give more at this time and I am so proud of the manner in which they have risen to the challenge.
But over the past couple of months, we have all been lucky to have been given an insight into some of their other talents – musical, dancing, poetry and now artistry. This image is one that has touched the hearts of many in the way in which it shows that we are all in this together and that there will be brighter days for us all to enjoy again.
The fact that Emma’s first thoughts were that this should be sold to raise money for the Charity Air Ambulance says so much about her as a person. It reflects a generosity of spirit which is so common among our staff and which is getting a chance to shine, like a rainbow, in these dark days. I am sure that her family is as proud of her as we all are. I just want to say to her – well done and thank you.”
Emma presented Michael Bloomfield with a framed print to be kept on display in the reception area.
Don’t forget you can buy your own signed limited edition print from AANI.
As the demands on the Health Service relating to Covid19 are expected to increase over the coming weeks, the Northern Ireland Ambulance Service has implemented plans to ensure that we are best placed to respond to the most clinically urgent calls during that period.
From today, NIAS will implement a level of escalation which includes a specific Covid-19 protocol to categorise 999 calls. The protocol allows for more specific questioning of patients to assess the likelihood of Covid-19 symptoms so that crews can be pre-warned of the need to use appropriate PPE. The protocol will also enable improved diagnosis of the severity of Covid-19 symptoms, resulting in more specific advice being provided to patients.
As the demand on ambulance services increases this protocol also enables NIAS to ensure that ALL patients with immediately life-threatening and serious conditions, whether or not they are related to Covid-19, will be prioritised for the most immediate response.
Regrettably, it may be necessary to withhold an ambulance response to calls and deal with some calls through triage. These will be calls which have been assessed as less serious in nature and do not need an Ambulance Response. NIAS apologises to any patients who may find themselves in this situation but we would ask for your understanding in advance. These are exceptional circumstances requiring exceptional measures. NIAS will continue to monitor and review our response capacity and will react to any improvement in the situation without delay.
Until then, we would ask you to stay safe by following the measures identified to reduce the spread of the virus – stay home, keep socially distant and, regularly, wash your hands. We would particularly ask that the public consider the safety of our staff and reduce the risk of infection to them, and their families, by only calling 999 in real emergencies.
Air Ambulance Northern Ireland and Northern Ireland Ambulance Service have reached the difficult decision to temporarily suspend the Helicopter Emergency Medical Service with effect from 19.00 today, 3rd April.
The temporary suspension of the service has come about in order to free up key clinical staff to be redeployed to use their specific skills and expertise in critical care during the current public health emergency. The suspension of the service will be reviewed on an ongoing basis with all parties committed to recommencing the service immediately when the staff can be reallocated.
Michael Bloomfield, NIAS Chief Executive said:
"For the past 32 months the HEMS team has provided critical pre-hospital care at trauma incidents across Northern Ireland, saving lives, brains and limbs. From today, the HEMS service will be suspended. This has been a difficult decision to take however having the highly skilled members of this team at the frontline is crucial to support our community in the most appropriate way during the extraordinary challenges we are facing in managing the pandemic. I would like to thank every member of the team for the incredible work they do and look forward to seeing them return to that role as soon as possible."
Ray Foran, Chairperson of Air Ambulance NI added;
"Please be assured that this is a temporary measure. We are actively working with our colleagues in NIAS to identify other ways in which we can support patient care as the pandemic develops and other ways in which our aircraft might be deployed in support of the national response.
The public have been a crucial part of the Air Ambulance NI journey providing vital funding to the charity to ensure daily operations are possible. We at AANI thank everyone for their support and ask you to continue with donations as the team do everything necessary to help out in this crisis. Please donate online at www.airambulanceni.org
We want to take this opportunity to reinforce the government message to stay at home and stay safe during this crisis."
Supporting the decision, Health Minister Robin Swann said:
"The decision to temporarily suspend HEMS was not taken lightly. It further illustrates the difficult choices that are having to be made. I sincerely thank the consultants and HEMS staff and paramedics for the ongoing support as they now prepare to undertake a further critical role in the fight against COVID-19."
NIAS Health and Social Care Trust Annual Quality Report 2018/2019
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