The experiences and perceptions of wellbeing provision among English ambulance services staff: a multi-method qualitative study.

BACKGROUND: NHS ambulance service staff are at risk of poor physical and mental wellbeing because of the likelihood of encountering stressful and traumatic incidents. While reducing sickness absence and improving wellbeing support to ambulance staff is a key NHS priority, few studies have empirically documented a national picture to inform policy and service re-design. The study aimed to understand how ambulance service trusts in England deal with staff health and wellbeing, as well as how the staff perceive and use wellbeing services. METHODS: To achieve our aim, we undertook semi-structured telephone interviews with health and wellbeing leads and patient-facing ambulance staff, as well as undertaking documentary analysis of ambulance trust policies on wellbeing. The study was conducted both before and during the UK first COVID-19 pandemic wave. The University of Lincoln ethics committee and the Health Research Authority (HRA) granted ethical approval. Overall, we analysed 57 staff wellbeing policy documents across all Trusts. Additionally, we interviewed a Health and Wellbeing Lead in eight Trusts as well as 25 ambulance and control room staff across three Trusts. RESULTS: The study highlighted clear variations between organisational and individual actions to support wellbeing across Trust policies. Wellbeing leads acknowledged real 'tensions' between individual and organisational responsibility for wellbeing. Behaviour changes around diet and exercise were perceived to have a positive effect on the overall mental health of their workforce. Wellbeing leads generally agreed that mental health was given primacy over other wellbeing initiatives. Variable experiences of health and wellbeing support were partly contingent on the levels of management support, impacted by organisational culture and service delivery challenges for staff. CONCLUSION: Ambulance service work can impact upon physical and mental health, which necessitates effective support for staff mental health and wellbeing. Increasing the knowledge of line managers around the availability of services could improve engagement.

Perceptions and experiences of wellbeing provision for NHS ambulance staff: a qualitative interview study of wellbeing leads and frontline staff

BackgroundThe wellbeing of ambulance staff is critical to their safety and safe care delivery. This study examined the perceptions of English NHS ambulance Trust health and wellbeing leads, and the experiences of UK ambulance staff of workplace wellbeing culture and provision.MethodsSemi-structured telephone interviews were undertaken with staff wellbeing leads for eight NHS ambulance trusts in England and with ambulance staff from three NHS ambulance trusts in England, selected to represent services with high, medium or low relative sickness absence rates. Interviews were subsequently transcribed, coded and analysed using Framework Analysis (FA).ResultsWe interviewed eight wellbeing leads and 25 frontline ambulance staff from April-November 2020. Decisions around what was included in or omitted from wellbeing policies sometimes led to conflict between wellbeing leads and their superiors. Ambulance work was perceived as inherently unhealthy because of work stress and the risk of encountering traumatic incidents. Well-being leads understood the adverse impacts of work on mental health for some staff. Ambulance staff wanted empathy, understanding and practical support from managers, but the reality did not always match these needs, because of variability in provision and experiences of health and wellbeing services, poor behaviours or attitudes from line managers, and a stigmatising rather than open organisational culture. COVID-19 not only impacted significantly on staff health and wellbeing, but also challenged how ambulance trusts support them.ConclusionsThe importance of an open organisational culture and the variable availability and experiences of interventions to support staff to stay well at work means that improvements are needed in both to ensure positive staff mental health and wellbeing. Early interventions, improved training for line managers to support staff at work, bespoke wellbeing services and an open culture are key to delivering effective support to ambulance staff, especially in the light of the COVID-19 pandemic.