Health Service Focus

Paramedic workforce shortfall – is it Solvable?

Earlier this year, the Migration Advisory Committee (MAC) recommended that paramedics should, for the first time, be added to the ‘shortage occupation list’, which would allow positions to be “sensibly” filled using labour from outside Europe. 

At the time, Centre for Workforce Intelligence (CfWI) evidence presented to the MAC showed that there were 1,251 paramedic vacancies recorded for England in 2014 – about 10.4% of the total paramedic workforce. 

The evidence demonstrated that the shortage was nationwide and was expected to last three to five years as a minimum. 

In the past, the occupation of paramedics was not skilled to level NQF6. But work being led by Health Education England (HEE) will mean all paramedics will be trained to degree level in the future. 

Speaking to NHE, Richard Webber, a spokesperson for the College of Paramedics, and a paramedic himself, said: “There has been a lack of workforce planning in the past, and where we knew people were leaving we know they [trusts] didn’t put enough training in to replace them. There has now been a move from in-house to higher academic training. 

“But of the 16 professions regulated through the Health and Care Professions Council (HCPC) paramedic is currently the only one not at degree-level entry.” 

There has been a lot of discussion with HEE about academic training and funding more places. Solving the problem will require the right people to have the “will” to do it, he said. 

Up-skilling review delay 

Back in August 2013, the Paramedic Evidence Based Education Project (PEEP) report, published by the Allied Health Professionals Health Education Advisory Group, recognised that paramedics are very well regarded by the general population. 

Even so, the “potential contribution that a well-educated and highly-trained paramedic workforce can make to healthcare, through its unique field of practice that intersects healthcare, public health, social care and public safety, has yet to be fully appreciated and understood”. 

The study highlighted areas in the education and training of paramedics that could be developed, and proposed a model that leads to an all-graduate paramedic profession by 2019. 

HEE and the College of Paramedics then established the Paramedic Education and Training Steering Group to review the potential benefits of up-skilling and training paramedics to allow them to deliver more treatment in the community, as well as to better deliver on-site triage and treatment in emergencies (where clinically appropriate). 

At HEE’s most recent board meeting, though, it was revealed that the Steering Group’s review – originally due for January 2015 – has slipped back until 30 June 2015. 

The report said: “Paramedic is currently a high profile area of work with increasing ministerial interest, HEE is at risk of reputational damage if it is unable to meet its mandate commitment.” 

As NHE went to press, HEE could not comment further. 

HEE’s Workforce Plan for England 2014-15 did, however, show that the number of paramedic training places that local education and training boards commissioned was 30% higher for 2014-15 than 2013-14 (up from 655 to 853). 

But the effects of this increase in training commissions will not be seen until 2017 when the first cohort of graduates will qualify. 

Another consequence of the review is that HEE is introducing a BSc degree qualification for paramedics along with the requirement that new entrants hold this qualification. 

Supply not keeping up with demand 

The CfWI said that data from the College of Paramedics has revealed that whilst training posts on courses have been consistently filled, the demand for paramedics has been increasing and the supply has not kept pace with this. This was in part due to a reduction in the number of training posts between 2008 and 2010. 

Webber added: “Paramedics are one of those few significantly over-subscribed courses. Most of the universities [require] high grades to get onto the courses, simply because of supply and demand. They get far more applicants than they have funding for places.” 

NHE contacted all 10 ambulance trusts using Freedom of Information requests to look at how they are tackling the national workforce shortfall. The results varied. 

Recruiting down under 

In response to our FoI request, London Ambulance Service NHS Trust (LAS) revealed that during the last three years the number of wte (whole time equivalent) paramedic vacancies has increased substantially: 

• 2012-13 – 34
• 2013-14 – 187
• 2014-15 – 455 

LAS told us that from January 2015 it had brought in 104 paramedics from Australia, plus a further three from Ireland, to help plug the gap. 

A spokesperson said: “We are doing all we can to recruit in the UK by encouraging people to consider paramedic science as a career. 

“The service is working with universities to increase paramedic places on courses, and training paramedics in-house, but more are needed to bridge the gap until these are qualified. So the LAS has been recruiting in Australia and New Zealand.” 

LAS also supplied data to the MAC report which concluded that because of changes to the healthcare system – for instance the push to treat more people at home rather than in A&E – the nature and volume of job opportunities for paramedics have expanded, resulting in a nationwide shortage of paramedics working in the ambulance service. 

Webber told us that London’s staffing establishment is approximately 3,300 and there is a worrying 15% paramedic vacancy factor. But he believes that recruiting from overseas is only a short-term solution. 

“I know that South Central have gone to Poland to recruit quite a few people and London has gone to Australia,” he said. “But they are certainly not solutions. They are short-term fixes.” 

At South East Coast Ambulance Service NHS Foundation Trust (SECAmb) the paramedic headcount, excluding bank staff, has steadily increased from 461 in 2011 to 666 in 2015. 

In 2014-15, the trust recruited 184 paramedics but had 21 vacancies unfilled as of 31 March 2015. During the same period, SECAmb recruited 24 paramedics from Australia. But data is not held on previous years. 

NHE was told that SECAmb is working with UK universities to engage with paramedic graduates offering career pathways to specialist paramedic roles, such as paramedic practitioners and critical care paramedics. 

Moving on, not leaving the profession 

In April this year, a Unison study revealed that approximately 90% of ambulance workers said they were suffering stress from the long hours and mental demands being placed on them by the job. The survey found that of 2,977 ambulance workers polled, 82% had thought about leaving the job. 

Trusts’ own 2014 figures showed that the number of paramedics leaving the NHS each year has nearly doubled since 2011. At least 1,015 paramedics left their job in 2013-2014, compared with 593 in 2011-2012. 

Webber said this is happening not just because of increased pressure and workload, but also because there are many more opportunities available now. For example, the NHS 111 service is recruiting paramedics, and GP surgeries are also recruiting paramedics with advanced qualifications to work in the same role as practice nurse. Also, many can get paid more for working as a disability assessor for Capita, which carries out the controversial Personal Independence Payment assessments for the Department for Work and Pensions. 

“There aren’t that many people leaving the profession, but they are leaving the ambulance service,” said Webber. 

So far at the North West Ambulance Service NHS Trust (NWAS) no paramedics have been recruited from outside the UK, but the trust – which had a wte vacancy rate of -64.35 for 2014-15 – is considering recruiting overseas (though still within the EU) during this financial year. 

It is considering ways of maximising recruitment, including offering full- and part-time vacancies, opening up higher-graded paramedic positions to external recruitment or offering targeted relocation support in hard-to-fill areas. 

NWAS added that it has a good history of working with Health Education North West and higher education institutes to develop existing staff to paramedic status. Places on those courses have been increased from 84 to 150 for the 2015-16 intake and these staff will qualify in 2016.  

Student paramedics 

In 2014-15 at the East of England Ambulance Service NHS Trust (EEAST) a programme to recruit 400 student paramedics was launched. 

“We successfully completed this recruitment and the student paramedics are progressing on their education pathway,” an EEAST spokesperson told NHE. “To further increase frontline staffing we are looking to recruit another 400 student paramedics in 2015-16.” 

They added that the trust continues to advertise for qualified and graduate paramedics and is looking at packages such as golden hellos, C1 training and relocation assistance. “We also have a new career pathway in place for paramedics, who can now progress to become a senior paramedic.” 

Discussing the student paramedic recruitment approach, Webber told us there has been a move from in-house to higher academic training. “East of England have done a good job in that they run a sort of hybrid house,” he said. “The staff will go off to do a university programme in year two or three. 

“But it goes back to the lack of workforce planning and upgrading of staff. There wasn’t enough planning done: ‘here’s the number of people we’ve got and we need x number more’.” 

At South Central Ambulance Service NHS Foundation Trust (SCAS) five paramedics have been recruited from overseas. However, the trust has seen its vacancy count increase from 220 in 2014 to 277 in 2015. 

As of March 2015, the trust had 603 staff working primarily as paramedics, but wants more. It will do this via a UCAS student paramedic partnership with four universities; internal growth, with sponsored placements at university for 90 SCAS staff; and international recruitment. 

In the North East, the ambulance trust says it has over a 93% occupancy rate across all its services, and its vacancy rate has reduced to 89.09. In the CfWI evidence it had been reported that there was 131 vacancies at the trust. 

North East Ambulance Service NHS Foundation Trust (NEAS) says it knows it needs to address both the immediate workforce shortfalls and to have a longer-term strategy, such as engaging with third party voluntary ambulance service providers and bringing back ex-NEAS paramedics to carry out bank work for the trust. 

There are also 96.47 wte student paramedics in post with the trust. A relocation package ‘tax free’ has also been agreed for potential candidates who live 50 or more miles away. 

NEAS has also developed a proposed strategy for engaging with universities north of Birmingham so that the trust can “sell itself” to the new three-year BSc student paramedics. This has included incentives as well as selling the benefits of working for NEAS and living in the north east of England. 

Career progression 

In the opposite corner of England, South Western Ambulance Service NHS Foundation Trust (SWASFT) revealed that 134.4 (wte) vacancies remain unfilled at the trust. 

A spokesperson said the shortage is a national problem and SWASFT is working hard to minimise the impact that this is having on its day-to-day operations. 

SWASFT said it is “growing our own” by building a Clinical Workforce Development Strategy and offering access, support and funding for staff to complete the required qualification to become registered clinicians. 

On top of this, the trust is retaining staff by ensuring career development and progression, offering leadership training and developing paramedics to become specialist paramedics. This is something that has been lacking nationwide, the College of Paramedics noted. 

In England’s largest county, Yorkshire, the ambulance trust has reported 46.93 wte vacancies. However, like its counterparts across the country, Yorkshire Ambulance Service NHS Trust (YAS) is continuing to work with universities offering paramedic courses. The trust is also making conditional offers of work with universities offering paramedic courses. 

The remaining two ambulance trusts – East Midlands Ambulance Service NHS Trust (EMAS) and West Midlands Ambulance Service NHS Foundation Trust (WMAS) – have also been able to reduce their vacancy rates. 

At EMAS the number of unfilled vacancies has fallen from 58 in 2010-11 to 20 in 2014-15, with one Polish paramedic recruited during this time. 

“We are building strong relationships with universities, encouraging internal development of staff to paramedic level and considering how we can expand recruitment from within the EU,” a spokesperson told us. 

At WMAS, there are now no unfilled vacancies and no paramedics have been brought into the trust from other countries be it inside or outside the EU. The trust is working with three local universities – Wolverhampton, Stafford and Coventry – to support paramedic training and recruitment into the trust.  

WMAS told NHE: “The trust has also encouraged internal staff career progression to paramedic levels. The trust has also held a number of regional recruitment campaigns over the past 18 months to encourage paramedics to join WMAS. 

“In addition, we have taken on a large number of student paramedics on a 30-month contract that sees them fully trained to paramedic level, including completion of their university degree, in the same way as those completing their direct-entry degree courses.” 

Having discussed the approaches of all England’s ambulance trusts in tackling the shortfall, Webber said he believes they are now in a position to tackle the issue. 

“There are more places being funded and more coming online but I think it will be another two to three years until we’re back at the right levels,” he said. “It is solvable, but there are still a lot of questions up in the air.”

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