In every crisis, there is also opportunity

Garrett Emmerson, Chief Executive Officer of the London Ambulance Service NHS Trust, writes about the work to keep providing critical life-saving services during the pandemic.

Garrett Emmerson standing in front of ambulances

The COVID-19 coronavirus pandemic is arguably the greatest public healthcare challenge faced by the NHS since it came into being in 1948.

Due to its pivotal position as the UK’s primary international transport hub, the virus spread rapidly across London, several weeks in advance of the rest of the country. The London Ambulance Service, as London’s primary provider and coordinator of urgent and emergency care, was therefore at the forefront of the nation’s response.

In the early weeks of March 2020, calls for 999 ambulance services rapidly doubled, and trebled for 111 urgent care services. At the same time, in common with many other employers, we were losing up to 20% of our workforce to COVID-related sickness and self-isolation.

These circumstances placed an unprecedented level of pressure on the Service and its ability to keep Londoners safe. With the service at real risk of being overwhelmed, it was clear that we needed to implement a rapid ‘whole organisation’ response, starting with the leadership of the Trust.

A firefighter (standing on the left) and paramedic (standing on the right) in front of ambulances

Three big challenges

A simplified, operationally focused, temporary executive leadership structure was put in place, with duplicate appointees to allow for possible sickness absence and to enable 7 day a week working. This included my own role as CEO, which I effectively shared turn and turn-about with my Deputy CEO, over the 3 month period of the first wave of the pandemic. Non-operational ‘business as usual’ activities were shut down, corporate governance systems and processes were simplified and focused on operational priorities. Our challenges were essentially threefold: 

  • to develop and maintain the capability to answer and clinically triage a hugely increased number of 999 and 111 calls;
  • to find enough additional vehicles, keep them on the road 24/7 and enable us to double our patient facing ambulance resources, and;
  • to find enough clinical and other operational staff to operate these vehicles, answer the calls and perform the myriad of other vehicle maintenance, logistics, IT, HR, finance and other activities necessary to respond to this massively increased demand.

This was something that we recognised from the outset that we couldn’t do alone: system working, not only across the healthcare sector, but also with the transport industry, other emergency services and elsewhere, was going to be crucial. To me, one of the most heart-warming reflections I have of this incredibly challenging, and often tragic, time is the way that the whole nation pulled together to support the NHS, both corporately and individually. The list of all those who we reached out to, and who universally went the extra mile to help us, is too long to repeat here. However, here is a flavour of what this involved.

Extending the team with the help of partners

In rapidly increasing our numbers of 999 and 111 call handlers, we reached out to 1st and 2nd year university student paramedics who, with their prior clinical training, could be rapidly trained to safely triage COVID-related 999 calls. With the support of several major airlines (including British Airways, Virgin and EasyJet), over 100 furloughed airline staff were trained to support 111 call handling. To support this, we literally had to design, build and bring into operation a brand new additional COVID-specific 999 call handling facility over the course of just a single weekend!

To increase our numbers of operational ambulances, our existing supply chain rapidly mobilised additional resources, often from normally competitor organisations, to commission an additional 60 new and 50 second-hand ambulances into service within 3 weeks (a process that would normally have taken over 5 months!).

With the help of Transport for London and Stagecoach Buses, West Ham Bus Garage was temporarily transformed into a massive ambulance commissioning facility. To support this and keep these vehicles running 24/7, taking advantage of the massive down-turn in traffic levels during the first national lockdown, the AA made more than 170 vehicle technicians available to us across London.

A firefighter helping a paramedic load equipment into an ambulance.

Blue-light drivers

To supplement our clinical crews on the road, the London Fire Brigade made available over 300 ‘blue-light drivers’. London firefighters are also routinely trained by ourselves in basic emergency urgent care skills and so were ideal partners to support our front-line crews. Wembley Stadium made their facilities available for vehicle familiarisation training to get these colleagues (who were later joined by 75 Metropolitan Police officers) on the road with our crews within 3 days.

Other additional clinical resources deployed included around 150 volunteer Emergency Responders who normally work alongside our regular crews on first response cars; 90 3rd year student paramedics, who are experienced enough to work alongside a fully qualified paramedic; and over 100 former/retired staff who answered a call to temporarily return to the front line.

Overall, the organisation ‘on-boarded’ over 1000 additional staff, and grew the scale of its overall operations by about 20% within a matter of weeks – a truly heroic achievement by all concerned.

A police officer and LAS paramedic standing in front of an ambulance.

The whole organisation

This brings me naturally back to our own substantive full-time workforce of around 6,500 people. Without exception, over the last 12 months, they have faced incredible pressures, repeatedly having to deal with heartache, tragedy and trauma in both professional and personal capacities, whilst continuing to respond to patients and keep Londoners safe. They are tired, they are in many ways exhausted, but they have been truly heroic – not just in frontline patient facing and clinical roles, but throughout the organisation.

Our logistics teams had to completely re-engineer the way we distributed vital clinical and personal protective equipment (PPE) to ensure that our clinicians were able to treat patients and stay safe themselves. Our IT teams had to re-engineer our operational ways of work to massively increase our remote working capabilities, whilst keeping patient information safe and secure. Our frontline staff had to adapt to new and rapidly changing working practices, clinical guidance, often working in new roles and/or different geographical locations. Our project management and estates teams have delivered our biggest ever capital infrastructure programme… I could go on!

The result of all of this rapid change is that we have become, I think, a far more innovative and ‘can do’ organisation. We have massively accelerated many long-planned initiatives that have undoubtedly improved the care we provide for our patients. The result is that we have, more than ever, been able to play our part in coordinating and integrating access to NHS urgent and emergency care for the 4.5 million plus patients that call 999 or 111 in London every year. In all of that, I am immensely proud.

Read the full Public Leaders Report: Supporting the NHS in its hour of need · Collaborating places · Extraordinary resilience and service · What do we know about public sector leaders · Looking ahead to 2022