Yesterday afternoon your bargaining representatives met with St John to discuss our claim regarding our proposal to introduce a clause which would define acceptable ‘Metropolitan Crew Formation’, thereby addressing both AO/AO crewing and safe restrictions on Single Officer clinical duties.
Why is this important?
The obvious concern here is that if not restricted, Ambulance Officer crewing can develop into a rebranded ‘Clinical Appropriate Model of Care’. This CAMC model was universally rejected by bargaining groups over 12 months ago as a model which would devalue the profession of Paramedicine and put significant downward pressure on Paramedic wages. Once established, both the CAMC and/or AO-AO crewing could rapidly become the normal crew mix which would grow to overtake Paramedic crewed ambulances. It’s no secret that St John think the Ambulance Paramedic classification is too expensive. The CAMC model wanted to limit the wage to the AO Grade 2 salary bracket. No surprise then that the AO model will see 000 calls responded by employees on AO wages. It is our position that the profession of Paramedicine is more than just the qualification. It is a combination of tertiary clinical education coupled with practical hands on experience and the honing of clinical decision ability, gained while working in a supervised environment with an experienced Ambulance Paramedic. Under the AO-AO model, St John insist that they can send (on paper at least) a ‘Registered Paramedic’ to a job, but earning AO wages.
St John were informed that we will not accept the long term use of AO-AO crew mix. The AEAWA are aware that the east coast has seen a variety of ‘surge’ staff measures and crew variation implemented as COVID surges occur. We are also aware that St John have recruited heavily in the last 12 months and have a current imbalance of staff. With this in mind, we have indicated to St John that we would consider, cautiously, discussions regarding safe TEMPORARY, time limited crewing measures that may be required for the impending COVID-19 surge. But like our Victorian Ambulance colleagues with whom we work closely, we want concrete, indisputable written assurance that any COVID surge measures will be unwound as soon as possible. We also insist on an appropriate clause that defines acceptable crew mix going forward, and will not move on that.
In respect to single officer clinical duties, all Ambulance Officers within St John undergo a standard training package which is entirely oriented around and focused upon ‘crew’ based ambulance duties. Everything from reversing a vehicle, to medication checks to operating a Ferno stretcher is defined in terms of a crew, and typically specifies two employees. Most SOP’s within St John make specific instructions which cannot be safely complied with, as a single officer (i.e. ‘the patient must not be left unattended’).
Despite this, St John have responded to pressures within the system by seeking to extract ever more productivity from employees, and have decided that single officers can now perform a range of duties that had previously been considered unsafe.
At each time we have challenged the safety of such deployments, or other violations of their own Ramping and Patient Flow SOP, St John have re-written the SOP to retrospectively permit their actions. We have continually argued that it is unsafe for a single officer to care for patients who may be unpredictable, violent, or confused. Frail and elderly patients often need frequent toileting, and can pose a falls risk and constitute a lifting hazard to a single officer. Hospital staff have a range of systems and other health professionals nearby to assist with managing things like breaks and patient toileting. St John employees do not have easy access to these systems, and may be left on their own for hours.
We have continually requested that St John confirm if a risk assessment for single officer clinical ramping duties has been done, and to disclose any guidance from Clinical Governance in respect to the clinical management of ramped patients by a single officer. None of these requests has ever been forthcoming. There have been instances where two officers of compatible makeup to form an ambulance crew (and respond to patients in the community), have been instead tasked to work in two separate emergency departments to care for patients in the department.
Sometimes our work in the community is delayed as we progress through the ED. St John call this ‘delayed transfer of care’. Despite this fact, and it’s increasing frequency, it is our view that the primary role of ‘Ambulance Paramedics’ and ‘Ambulance Officers’ is in ambulances, not in hospital corridors. Having your ‘community based’ ambulance work ‘delayed’ in the ED is, in our opinion, entirely different to being sent to work in an ED at the start of your shift. That is a different job than what we applied for, and that kind of change in role must be voluntary.
The move towards the normalisation of single officer clinical duties has been gradual, with the boundaries of what is safe and what is ‘acceptable’ being pushed further with each revision of SOP. Such incremental change can seem inconsequential at the time, but over many years we may find ourselves working an entirely different job. Our argument is this; working a role which is different to the role to which you applied for and where trained for (that of a ambulance crew member) should be optional, and compensated by, at the very least, an ‘extra duties allowance’. In our opinion it constitutes a change of job description. If working alone in an emergency department is expected of an employee, they should be provided with appropriate training to conduct hospital based care, but also should be provided with appropriate clinical guidance, appropriate equipment, appropriate risk assessments, and appropriate breaks.
We have put this idea forward to St John, and explained that such a model involving an EOI for such duties, would be the only ‘single officer usage’ we would accept, and only if followed by appropriate training and support via policy/guideline/equipment. Surprisingly, St John have indicated interest with this concept and are willing to move forward to consider developing an EOI for single officer clinical duties. We have also encouraged St John to utilise after hours ICB requests to better utilise single officers,. which we hope will have the added benefit of supporting the 224 crews at night.
Discussions only briefly touched upon this issue, but we have reaffirmed that our claim is for either 15 minutes double time payment or an allowance equivalent. We have insisted that this is payable regardless of any allocation of a job, and regardless of ‘log in time’ so long as the officer is at work, and performing the critical checks required to start work.
The next meeting is on Thursday 10th March and will cover Meal Breaks.