What you really need to know - your questions answered

Transparent EEAST crest

Thank you to everyone for engaging with us and sharing your questions, thoughts and concerns following the communication we released last week.

There have been a lot of questions submitted and we have done our best to answer them. Below are a number of FAQs and we have also emailed them out to all Trust email accounts. We will keep this updated as and when any further questions come in.

Please do keep any further questions coming in if your concerns have not already been answered, by emailing feedback@eastamb.nhs.uk

Thank you once again for your honesty and openness with the executive team about all these topics.

The Executive Team

Busting myths:

UNISON says: the current recognition agreement has stood the test of time ensuring the union has been able to function effectively representing the interests of its members and that there was no good reason to end the current agreement.

The existing partnership arrangements do not work in the interests of the Trust or its staff. Feedback tells us there is a clear need to change the way we work in partnership and to update existing arrangements.  We have never sought to derecognise UNISON and gave six months’ notice to negotiate a new agreement.  UNISON did not engage with the review for three months which has caused a delay and led to the potential for the current agreement to expire and UNISON to be derecognised by default.  However, the Trust extended the deadline, further demonstrating the desire to reach a new voluntary agreement, something we remain committed to.

UNISON says: a new agreement has been reached and that the Trust can now sign this but didn’t attend the meeting.

The Trust had declared a major incident requiring all meetings to be cancelled and clinical staff to make themselves available to provide patient facing services.  Both management and ACAS were affected by airport and school closures and the need to be available in the Trust to ensure staff and patients were supported.  It was for these exceptional reasons the meeting was unable to go ahead. 

UNISON has provided an updated version of the agreement but it does not address all of the Trust’s concerns and includes a commitment to three full time officials.  The Trust is not willing to agree to this full time facility time level, which costs about £140,000 per annum, until there is clear progress regarding effective use of this time to improve partnership working.  We have offered to sign a new recognition agreement with this element removed whilst maintaining the current status quo for trade union facilities including the current three full time officials, on the basis that negotiations continue about future trade union facilities and consultation and negotiation arrangements.  

UNISON claims: the Trust has set up a staff forum and handpicked people to attend to discuss late finishes.

We have received lots of feedback form staff with their views and suggestions on how we might improve late finishes. We all recognise the one absolute solution is more funding to employ more staff, something we hope to achieve very soon.  We have been working in partnership for a number of months with UNISON on this issue and still haven’t managed to find the solution.  We want to continue working with UNISON on this issue but do not feel this prevents us from listening directly to what staff think might help.  An open invitation was sent to staff to take part in late finishes workshops and will continue to do so.  No one was handpicked and all have been welcomed and will continue to be so. We would urge all staff to continue to have their voice heard through any of the methods they are most comfortable with.

We would encourage UNISON to work with us to campaign for better funding as other UNISON branches have done elsewhere to resolve this issue.

UNISON suggests a staff forum is the Trust ‘playing fast and loose’ with consultation and negotiation arrangements.

The Trust will always want to listen directly to its staff regardless of their membership of a union. That is what good employers do to ensure staff are engaged and supported and their views are valued.  To support this we are setting up an employee engagement forum based on your feedback and suggestions. This does not replace the formal processes for trade union consultation and negotiation, which will continue. 


Your latest questions:

Why do we accept urgent bookings when we are on surge black? 

When we historically tried to refuse urgent calls they often then got returned through the 999 system which caused other problems. We are working with GPs on the new surge plan and will be reviewing this along with other transport methods etc (noting we are contracted to undertake these journeys)

Can 111 be fined for putting through inappropriate calls? When will 111 calls be reviewed?

In a similar way to hospitals, 111 are commissioned by CCGs and so any contractual arrangements are their responsibility. In saying that we do highlight issues with 111 back through our commissioners and the 111 review meetings are starting again after winter. We would encourage the use of 111 review so this can be maintained. 111 providers are also now operating with an extended time to clinically triage calls before dispatching ambulance dispositions and we also expect them to increase their clinical capacity to improve triage at the point of call.

Abandoning the cross border policy has definitely increased late finishes for crews.  Why has this been done?

We reintroduced cross border procedure following feedback from staff. We don't believe it is the long-term solution though which is likely to come from a combination of increased resources (hopefully via the Independent Service Review) and different measures on out of area working.

Why cant we introduce a mileage limit for crews to safely drive under emergency conditions?

In a similar theme to the above we are looking to trial some different procedures for out of area working. We have to assume coding is correct as otherwise it presents a patient safety risk. It is obviously important we try and proactively move resources where possible to avoid long distance running.

If someone finishes a shift at 1700 one day and comes in the following day for a shift at 1800 thereby having 25 hours off between duties does this count as a rest day? i.e. having had 24 hours or more off.

With regards rest and the working time regulations, the requirements are as follows:

- Rest break when the working day is longer than 6 hours
- Rest period of 11 consecutive hours a day
- Minimum of an uninterrupted rest period of not less than 24 hours in each seven-day period

There is separate working time regulations for heavy goods vehicle (HGV) and public service vehicle (PSV) drivers and crew ('mobile workers').

What is the method to feedback ARP related issues? We have Datix’d call codings we feel inappropriate but have had the response that the call was coded in accordance with ARP.

You can continue to identify issues through Datix but it would also be helpful (if you are able to) to have specific examples collated as a case study so we can use for feedback. These can be sent to EOCCommunications@eastamb.nhs.uk, should not contain patient sensitive data but CAD number and date referenced so we can identify the call record.

This issue has been raised by the Trust nationally as part of the ARP review due in the spring. Once we receive feedback we will release a wider communication.

What is load levelling?
Load levelling is a system that was introduced at the recommendation and requirement of NHS England. It is a system that was agreed in an effort to reduce the hospital delays that were having such a significant impact on our handovers and ultimately our response to patients.

The ambulance service was given the autonomy to direct ambulances and patients to the most appropriate hospital which may not have necessarily been the closest. This will take into account several different factors such as capacity and handover trends etc. The regional coordination centre (RCC) have the delegated authority from our CEO Robert Morton to enact this when it is deemed necessary to try and reduce handover delays at troubled emergency departments without having to gain permission from the acute hospitals or the formal processes of a soft border divert.

Once enacted the process will be managed by your local dispatchers who will identify suitable crews and make contact with them to advise them of the most appropriate location. This may be either by radio or by MDT. This process has not gained any additional funding to be a specialist function of a dispatcher and as such there may instances where due to their significant workload they have not been able to make contact with you. In case where you are aware load levelling is occurring and you feel your patient may be suitable then please make contact with your dispatcher to discuss further.
As with all processes the safety of our patients is paramount and as such there are some exclusion criteria to the load levelling process.

When considering the potential for taking the patient to a different acute hospital (as opposed to their nearest), the following are excluded: (extracted from OI201)
• Pre-alerted patients
• Acute specialist care pathways (e.g. maternity, PPCI, trauma)
• Patients currently receiving specialist treatment at a receiving hospital (e.g. Sickle cell)
• HCP referrals with specified receiving team (and ward other than A&E)
• Patients already on a hospital trolley
• Patients with learning difficulties who are familiar with their local hospital.

This process may feel counter intuitive and result in you being requested to travel further or out of your normal area but the decision will be made with the interests of both yourselves and the patients in receiving a more timely handover with the added intention of getting you #HomeOnTime

Why can’t NQPs do bank work with the Trust? 
Newly qualified paramedics are required to complete a portfolio and it is not possible to meet the requirements of that portfolio while on a bank contract.

Has the Trust has ever considered the feasibility of joining an NHS staff car leasing schemes?
A proposal is currently being drafted for a specific salary sacrifice scheme and the financial team leading the piece of work is hoping to submit this to the executive team for consideration in the spring time. The scheme proposed is under the CPC Drive framework.

There are certain costs and risks, which are being considered in setting the specifics for the proposal. The costs to the Trust are from administrative support to set up scheme membership, managing deductions from pay and provision of tax information to HMRC.

The car salary sacrifice schemes are not sadly as tax advantageous as the cycle to work schemes and there is a need to ensure tax consequences are clearly outlines and communicated, should the Trust set up such a scheme.

Due to the financial values and lease terms associated with a car scheme there are expected to be requirements as to who can access the scheme, so that deductions don’t reduce paid earnings below national living wage, and limiting the scheme to permanent employees seeks to address risks with lease terms.  There are potential costs to employees associated with seeking to return the car mid lease term, or returning the car with excessive mileage or damage on it at the end of the term.

The Trust already severely restricts the number of staff that can take annual leave over the Christmas period (this seems to extend to almost 6 weeks), are you planning on further restrictions?
An action that came about as a result of the recent risk summit was for the Trust to consider changes to its annual leave policy to increase staff availability over the winter period.  We have committed to work with UNISON to review the policy and will feedback to staff once that work has been undertaken. 

Are there any restrictions on how many Board members can be off over the festive period? Currently road staff are only allowed a 5% maximum.
The Trust has a policy that there must be three Executive Directors on duty at any one time.  The Chief Executive and Deputy Chief executive must not be on annual leave at the same time.

Will the Trust take serious and meaningful steps to tackle the problem with the 111 service, whose risk averse algorithms and approach put such a massive strain on us? Personally I probably leave at least 70% of the Category 2 (the old Red 2) calls they send through to us, at home, indicating there is something seriously wrong if these are all meant to be potentially life-threatening.
There was a specific actions following on from the risk summit regarding 111 particularly focusing on clinical triage and demand management. We have also re-established the 111 review meetings via the clinical teams and so would encourage continued feedback via that route. We continue to manage calls via ECAT from 111 where appropriate.


ECPs have traditionally been forgotten about. The last year we have put ECPs back on the map in the west division. Staff can access us for advice and support in treating people at home. It's been so successful it's evidenced to avoid 500 admissions a year to a+e. The CCG are now funding a year's trial to assess acute GP home visits. What is the service view of ECPs? Are we going to get supported by the trust? Will will be involved in see and treat lower equity calls and paid an uplift to band 7 to reflect our qualification? Emergency Care Practitioners have always been valued by EEAST and will continue to play an important role as we move forward into the next phases of the Ambulance Response Programme. The work you are doing in the west sector is great for your colleagues, patients and the Trust providing effective and collective clinical leadership. We are working hard at the moment on the Specialist and Advanced Paramedic governance framework which will look to provide clear direction on roles, continuous professional development and formal education with associated reward. The dispatching of the Specialist and Advanced roles is also being worked through by all directorates and external stakeholders to ensure effective utilisation and best patient care. There will be more specific detail released soon and you will be updated when these decisions have been finalised.

Why can't we access East24 from home?
As the Trust intranet, East24, sits behind the secure Trust firewall it is available remotely but is only accessible on Trust devices. The decision was upheld for this situation to remain as East24 provides gateway access to further Trust secure systems, such as Portal. It also holds our response plans and procedures which cannot be made available outside the Trust network. Need to Know was designed as an unlisted website for staff to be able to access remotely on mobile devices.  It is a rolling news site and is there to work with East24. However to allow access on personal devices it is understood that although a hidden site and not for sharing outside the Trust, any and all content is deemed as in the 'public forum' when posted on Need to Know. As part of being and open and transparent organisation, we post as much information as we can publicly available. Trust policies are available to staff (and the public) on our website, under our governance and policies section - https://www.eastamb.nhs.uk/policy-library.htm

 Has there been an update on the WTD policy surrounding late finishes? Also we are constantly told that we can not claim twice, i.e. for the overtime worked and then come in late as per WTD regulations. My argument is and always has been that these are two separate issues and should be treated as such.
The Trust cannot pay you for work that has not been done, which would be the case if staff claimed twice. The key issue here is the focus on reducing late finishes so that the issue of compensatory time next shift is significantly reduced.

Can you please tell me how many full time UNISON personal there are? It seems that £140,000 is a lot of money for 2 or 3 people.
There are three full time UNISON officials. The £140,000 cost includes vehicles and overtime costs.

Would now not be a good time for the Trust to work stronger with additional unions such as GMB? Is this something that the Board could consider? Is the Trust already working stronger with GMB?
UNISON remains the only recognised trade union and the Trust is not engaging in collective bargaining with any other trade union.

When will relief be addressed?
When we understand rostering requirement from the ISR we will be working with staff on the appropriate roster requirements to match demand. When the rosters are consulted on we would urge you to share your views to get a better local arrangement. We would also encourage you ask your staff partnership representatives to bring forward a proposal on this matter to the staff partnership forum.

Will the annual leave limit be set to the amount of new staff employed for each station instead of the old leave limits with the old numbers for staffing? Is the trust going to remove the 50 per cent limit at Christmas at any point in the future?
We are currently working with UNISON via the policy group to review the annual leave policy. If we see growth, as we expect, from the ISR it would be reasonable to expect a change as people fill the vacancies.

New staff are being told there are too many people on family friendly hours already so they cannot be considered for a family friendly roster. When will a full review take place to enable family friendly rosters to be considered for all staff with ever changing family circumstances?

The right to request flexible working is open to anyone, even those without children or dependents, and anyone working flexibly should have regular reviews to ensure the arrangements work for the individual and the Trust. The process for rota reviews under the delivery of ARP will start to happen at the start of next year (2018) and can take up to one year to complete. This has the potential to offer more flexible working patterns and making those opportunities available will be a key principle of that review.

What is the future of the Norwich site? As our colleagues in other areas in the build already know, when will we be told the future and what will be offered to staff?

Absolutely no decisions have been made with regards any of the EOC sites to date. We recognise the current EOC sites are not fit for purpose and do not provide the best working environment for our staff.  Our estates strategy states the Trust will review the current three sites and consider what might be better options for the future.  However, this is a long term plan and will take a number of years. 

This is a question about last hour calls since the introduction of ARP. There didn't appear to be any concerns over the old system impacting on patient care from the Board so why hasn't this been adopted on the introduction of ARP?

We have adopted an end of shift approach which we believe is as close to others nationally as we can, and as close as we can to the pre-ARP changes we put in place that protect patient safety.  We have to balance the need to get staff off shift on time with patient safety risks, and with increasing demand and a known funded capacity gap, we continue to find this very difficult.  We are early into ARP but are experiencing more C1 and C2 calls than expected, which we have fed back to NHS England ARP working group. We are reviewing what impact ARP changes may have had and will be seeking individual staff experiences to inform that review. In the meantime, we encourage you to request the use of IX where this would apply.

Where has all this trouble come from? As a now ex-unison member, I heard nothing about all this until the Trust decided to send out lots of emails. Could you just tell me in brief what has caused this to all come about?

Partnership working relationships became increasingly strained in recent years and made working together to reach agreements for the benefit of staff difficult. There has been lots of negative campaigning and public messaging from UNISON via the newsletter, website, campaign pages and social media.  We have also seen negative media coverage and direct contact to regulators. Staff have been asking us to provide the Trust’s view of this messaging and we believe now is the time to make sure our staff and the public we serve get the facts.

Can the trust work with Unison, GMB, Unite come together and make a EEAST forum that represents all staff? It seems to me that Unison have taken all the negotiations and we as an organization seem to have gone backwards not forwards. This reflects on the leadership team of Unison and not the members. Should GMB be the leading union that EEAST negotiates with? Is there a national agreement that all Trust's must negotiate with Unison?

There is no national agreement that ambulance trusts have to recognise UNISON. The Trust voluntarily recognises UNISON for collective bargaining purposes and has done for many years. Some other ambulance trusts do recognise a range of other trade unions including GMB. We have had a request from GMB for recognition and have publicly acknowledged that although we haven’t progressed any further at this stage.  We are establishing an employee engagement forum, which will not replace trade union arrangements on things like negotiations on policies or staff terms and conditions, but will offer another opportunity for all staff regardless of trade union membership to contribute views and ideas and help ensure we focus on the things that matter most to staff. 

Hot topics for staff:

Is the Trust worsening the position for staff on late finishes and missed meal breaks?
The Trust is not seeking to worsen the situation for staff and we recognise the impact this issue has. Initiatives have been trialled but ultimately we know, as do our staff, that funding to provide more frontline staff is the one thing that will allow us to improve the situation.

Changes were made when ARP was introduced to limit meal break interruptions and call allocations towards the end of shifts. We need some time to understand the consequences of these changes to see if they are having an impact.

Has the Trust not been working with UNISON about late finishes and missed meal breaks?
The Trust has been working with UNISON for months about late finishes and missed meal breaks. We would like to continue to work with UNISON to develop initiatives further to alleviate this issue, including ways to help staff get off shift on time and get their breaks.

The Trust needs UNISON to compromise and accept that we cannot introduce initiatives that have the potential to impact on patient safety – and we don’t think our staff would want us to do that either.

Technician crews need to ring CAL if they want to be relieved on scene by an oncoming crew. However, I'm not aware of crews being phoned at the beginning or middle of their shift asking why their lights aren't on or checking if their patient is time critical. Why is their judgement deemed less valid at the end of the shift?

The process of changeover described was strengthened off the back of a pattern of adverse incidents - the alternative was to withdraw it - which showed a risk to patients based on decisions being taken.

Why it is not IX Zero or possibly IX -15? Would it be appropriate to put mileage or travel time restrictions in place for the last hour (as an example)?

We think it is time to move beyond IX and find a new way forward, which is why we’re asking for help from staff in the form of workshops and feedback. .  Staff tell us that the issues are far broader than the last hour tasking and need to be looked at together rather than just this one aspect. We felt that if, for example, we took a principle of Home On Time (HOT) tasking on from a beyond the last hour it may be a new opportunity for solution. The belief is that the end of the shift starts from the beginning of it and not the last hour, and that continuing to focus on that aspect is not the solution.

Can you clarify the current IX agreement and explain what changes are likely to be made and when?
We haven’t stopped IX. The previous IX code set has been superseded by the C1 category. A resource can still be placed in intelligent x-ray status when the travel time back to base is expected to result in a late finish in excess of 15 minutes. The EOC dispatch teams can also consider placing crews operating outside of their local area in IX if they are a significant distance from their base station.

We will review IX arrangements after the winter pressure period.

There was an agreement under the previous system regarding late finishes. With staff now much more likely to find themselves out of area does the Trust accept this is a negative step and what does the Trust intend to do about it?
We recognise the issue but in the short term and we are looking at how to address this.

We have a challenge with changeovers coinciding with increased call demand and will address this when we undertake roster reviews. 

In the meantime we have increased overtime available across winter and are focussing additional capacity toward shift changeover times, which support both demand and resource available.

We will also be proactively supporting colleagues in dispatch who have an incredibly difficult challenge of held calls.  

There was no mention from the Trust about changes to IX or last hour calls on the introduction of ARP. Can that agreement be reintroduced?
As stated above, IX is being maintained in a very similar manner to before.

We moved the last hour deployment arrangements to C1, C2 and Hot 1 back up requests as the closest alignment to the previous arrangements.

Is there likely to be a review of the break policy for being out of area?
We have reviewed break arrangements to align them with ARP.

We have made changes to improve chances of an uninterrupted break and we have had feedback that more crews are seeing this benefit.

Is there a reason ARP seems to have resulted in crews spending all their time out of area?
ARP should not have any direct correlation to this. The root of the problem is the lack of funded capacity the Trust has and the significant loss of time at hospitals that displaces staff.

As we move our operating model further and get additional funding, the need to travel further should reduce. 

We will review how we can make better dispatch decisions under the new ARP model.

Has it already been decided which stations are to lose RRV's? The stations which now have limited RRV manning, there seems to be a higher than normal level of general broadcasts for these areas, with vehicles assigned from long distance, is this being monitored?

We are working with UNISON to look at modelling data to make decisions around our future operational model which will include more DSA’s and fewer RRV’s. The independent service review also includes independent modelling of what resources are needed when and where to meet the commissioned standards.  We also need to take an evidenced based decision on the car models we use, as we have ECPs, CCP, falls cars and potentially low acuity cars – all of which can be tasked to an immediately life threatened call. We are working with UNISON on longer term changes, but currently (December 2017) there is no change. Any changes will take time and will be made in full consultation with staff. 

Will you force people to move from RRV’s to DSAs?
We will have to move some people from RRVs as we will have many fewer cars in future in favour of ambulance cover.  This is not an overnight change, but one that has to be balanced with the context of patient safety across winter, increased funded capacity to achieve the total changes and working through the right change management process for staff. We have already achieved some of this through voluntary arrangements and ending of secondments.

Will the Trust force rota changes as a result of ARP?
There will need to be rota changes made over time. We will work with staff to develop new rota patterns in consultation with them and supported by experts to achieve the best possible outcomes for staff and patients.

Each staff member will be consulted with if there are any changes to their vehicle.

No staff who are permanently rostered onto RRVs will be asked to change those lines for permanent ambulance lines until we have agreed the change management process and gone through the right consultation with staff affected.

Why hasn’t UNISON been involved in the change management process for RRVs?
The Trust met with UNISON on 9th October to discuss how to approach the change management process and aid early communication with affected staff. The Trust is now actively trying to meet with UNISON again to move this forward and a further date has been offered to UNISON to meet in December. No one has been required to move off a line who is contracted to work on it.

What are the deployment arrangements for ECPs already on RRVs following ARP? What percentage of ECPs can expect to remain on RRVs?
ECP on cars remain on cars until we have agreed on the consultation process. No changes have been made to ECPs as part of ARP implementation. We do not know what percentage of ECPs can expect to remain on RRVs until the outcome of the independent service review.

We are looking at how we can more effectively deploy cars, which will include ECPs, to a range of lower acuity calls.

Will ECPs be given priority over RRV positions or will they be forced on to DSAs?
When we have agreed in partnership the approach to this change, we will be better placed to give an answer to this. This is a work in progress and we will work with each individual. An ECP’s skills may not be best placed on an RRV focussed on Category 1 but more around the lower acuity, where we can bring the ECP’s skills to provide care and treatment closer to home.

When will ECP pay banding be reviewed?
The Trust is reviewing its approach to job evaluation with UNISON.  We have trained many more job evaluators both in management and staff side and will be developing a plan for which roles will be subject to job evaluation and in which priority order.  This will be communicated in the new year.

Why not replace call handlers with clinicians to reduce the number of calls we attend?

An international triage system is used. Call handlers follow these scripts and reach the right determinants a very high percentage of the time.  We have a clinical hub and, where advanced triage is appropriate, paramedics deal with this. We know other Trusts have tried this method and there is no tangible difference between who triages using MPDS. We have excellent clinicians and clinical support who support patients they see with self-care or pathways and we are a leading Trust in our triage, hear and treat and see and treat. At times of significant pressure additional clinical input at despatch point could help and this is something that was discussed at a recent staff workshop and will be further explored.

Communications between EOC and road staff can be challenging. Can we have a closed Facebook group for EOC and road staff that are dispatched from the same locations to support staff relations?

Improving our engagement between staff and teams is really important and that is why we will be setting up a staff engagement forum. This could be a really good topic for that forum to look at and we would welcome you joining the group when it launches.  We will also be looking at how we can better utilise technology and apps to improve communication and engagement.

What is the Trust doing to address the current problem of the “funded capacity gap” that seems to be the root of all the Trust’s problems and when should we be expected to see any positive changes?

The Trust has repeatedly provided evidence to commissioners that the solution to late finishes is to get more staff, for which more funded is needed.  This year as part of contract negotiations, regulators agreed to look at this independently to identify whether we have the funding and therefore staffing we need to provide patient care.  The independent service review is due to be finalised in the New Year and the CCGs commissioning the service will making informed decisions around our funding from it.  We are working hard to ensure we can close the capacity gap for the good of staff and patients.  The investment required is expected to be significant and whilst some positive changes will be seen immediately the need to recruit and train more staff will take time.

Can we have new Munro jackets?
We are willing to consider new uniform and have been working with UNISON on this via the Health and Safety Group. We believe that a uniform working group being reinstated could also be a good forum to review uniform suggestions and consider the implications and we will look to do this. 

EEAST is committed to the procurement of a single national uniform specification through a national framework which is focused on achieving best value for money.

It has been stated that if the item is adopted as uniform as part of a national incentive then EEAST will provide them. When will that decision will be made? Has anyone factored in supply timelines if you agree to provide the jackets? 

As mentioned above, we are willing to consider new uniform through the proper processes. The Trust buys uniform as part of a national contract with other ambulance Trusts. Any change in uniform will not happen overnight owing to tender processes, consultation and implementation regardless of if it adopted as part of the national framework or a local agreement.

If we are going to have new jackets, will options other than Munro jackets be looked at before changes are made?
We would of course consider other options as part of a uniform review and fair tender process and a risk assessment process is being adopted in partnership with UNISON.

Did the Trust ignore a request by UNISON for new Munro jackets?
Some weeks ago we informed UNISON that we would be pleased to support a proposal for the replacement of existing jackets with Munro jackets, to put forward to the national ambulance procurement group. If ambulance trusts in the national framework agree to adopt this change to the national uniform specification, then EEAST will be in a position to adopt these jackets as part of our uniform replacement process.  We are actively working with UNISON to review uniform provision.

What is the situation with blue light lease cars?
We are seeking to establish an updated business travel policy: one that reduces our spend on lease cars but gives those entitled to a lease car the right vehicle for their role.

The current policy was agreed with UNISON and the previous Chief Executive Officer. We have involved UNISON throughout this ongoing policy review.

Managers provide hundreds of patient and incident responses every year and are central to our resilience arrangements.

To be clear, our managers have done nothing outside the agreed Trust policy, so it is unacceptable that colleagues using lease cars continue to be targeted individually – let us please respect one another.

I would have come in on my day off to support the major incident at the weekend but did not know about it. Could the Trust not have rung staff on landlines at their homes?

We are always overwhelmed by the dedication shown by staff and thank those involved on the day at work as volunteers or who responded to our declaration. With a workforce of hundreds of people it is not possible to phone everyone. We recently released QR codes that link to a hidden page on the main Trust website that gives information for off-duty staff about attending major incidents and this page had more than 400 hits during the major incident period (9th December). If you haven’t already, collect your QR code sticker from your manager and attach it to the back of your ID card. For more information see here: http://ntk.eastamb.nhs.uk/news/major-incidents-would-you-know-where-to-find.htm

FAQs regarding UNISON:

Is the Trust derecognising UNISON?
To be absolutely clear, we wish to continue to voluntarily recognise UNISON. Our view is that UNISON is a valued, trusted and respected trade union in the health sector.

We therefore agreed to extend the existing recognition agreement until 31st December 2017 to allow time to finalise agreement on a new voluntary trade union agreement.

In return, UNISON had committed to desist from negative campaigning against the Trust, particularly directed towards individuals.

What does the Trust want?
The Trust hopes that UNISON will agree to develop a new voluntary recognition agreement so we can get partnership working arrangements working effectively for the good of staff.

We want the UNISON branch to work with us on a partnership agreement that puts staff and the real issues first.

How much does the Trust really value trade union relations?
We spend in the region of £140,000 a year on full-time UNISON officials and about £85,000 for the paid facilities time provided for other UNISON officials.

What is the partnership review?
Current working arrangements with UNISON have proved ineffective and we agreed with the local branch that we will both participate in a partnership review, facilitated by ACAS.

The aim is to put in place a better partnership agreement between UNISON and the Trust.

Six months’ notice was served to UNISON in April on the existing trade union recognition agreement – a step required under our current agreement.

This was done with the agreement that UNISON would work with the Trust, supported by ACAS, to develop a new agreement and supportive arrangements for consultation and negotiation.

The current agreement was due to expire on November 6th and has now been extended.

Who is taking part in the review?
The Trust’s leadership representatives, UNISON EEAST branch representatives and regional UNISON representatives and it is facilitated by independent representatives from ACAS (Advisory, Conciliation and Arbitration Service).

Where is the evidence about what has been said between UNISON and the Trust?
In the interests of openness and transparency we have published the letters we have shared with UNISON about the existing partnership arrangement. They can be found on the website: http://www.eastamb.nhs.uk/about-us/transparency.htm

If the Trust derecognises UNISON, can it force through negative changes to terms and conditions?
No. Even without a trade union recognition agreement the Trust has a requirement to consult on change with staff.

We want to continue to recognise UNISON and work in partnership to deliver the changes that will be needed to deliver the full implementation of the Ambulance Response Programme. The move to fewer RRV’s and more DSA’s is something UNISON has been calling for so the Trust does not understand why UNISON is now actively resisting these changes.

Will the Trust continue to recognise UNISON?
The Trust has always said it wants to voluntarily recognise UNISON and recognises many of our staff are UNISON members.  The Trust is working on a new voluntary recognition agreement with UNISON which is based on the National UNISON Model recognition agreement.

So what happens if a new recognition agreement isn’t reached?
The current voluntary recognition agreement will cease on 31st December 2017 in accordance with the notice which has been issued and the extension then agreed.  After this date, should no new agreement be reached, UNISON will no longer be a recognised trade union with the East of England Ambulance Service NHS Trust.

UNISON will therefore cease to benefit from the usual statutory information and consultation rights after 31st December 2017, and until a new recognition agreement is put into place. This is a scenario we want to avoid.

Will trade union officials get time off if UNISON does not agree a new recognition agreement?
The statutory right to time off for specified trade union duties and activities is limited to officials and members of recognised independent trade unions.  This means that until a new recognition agreement is put into place UNISON representatives will only be entitled to take time off if this is for the purpose of accompanying fellow workers at a disciplinary or grievance hearing. 

The Trust currently provides resource for three full time trade union officials under the current voluntary recognition agreement at a cost of £140,000 per year. 

How will I get my voice heard?
An employee engagement forum will be set up as part of our employee engagement strategy. We had held back on doing this at the request of UNISON but feel this offers a real opportunity for staff to be kept informed of what is going on in the Trust and to offer us feedback and suggestions for improvement. 

The first meeting of the employee engagement forum will be held at the start of 2018 to agree how it might work in future.  You can still contact your line manager, HR or our Freedom to Speak Up Guardians if there are any issues you feel you need to raise.

We will continue to work with ACAS to resolve these issues and we will continue to encourage EEAS UNISON branch to work with us in a genuine spirit of partnership working.

Is the Trust refusing to share data with UNISON under FOI?
The Trust has been in dialogue with UNISON for more than 12 months to try and understand exactly what information UNISON would like so we can get this prepared and reported regularly without the need for FOI requests.

UNISON submits a huge range of FOI requests, which is placing a disproportionate burden on the FOI team and other departments and is impacting on our ability to deliver service development work.

We are happy to manage FOI-type requests from UNISON through internal mechanisms, like the staff partnership forum, but we have refused to respond to a number of FOIs from EEAST UNISON branch. This is because of the huge amount of time pressure these requests are putting on the FOI team’s workload month on month.

The Trust applies exemptions under FOI very carefully and only does so when absolutely necessary.

Why are we as a Trust paying hundreds of thousands of pounds for a union which is already paid for by its members?
Whilst trade unions are funded by member subscriptions it is not unusual for large public sector organisations to allow some paid time off for trade union duties. EEAST provides a generous amount of facility time both in terms of full time officials and the ad hoc time claimed by other UNISON representatives. We value the role of unions and want to continue to contribute paid facility time within a local agreement as to how this is managed.  The amount of time is still subject to negotiation under the partnership review and the Trust must be satisfied that the provision of facility time is proportionate and offers value for money. 

Of the £140,000 per annum the Trust provides for UNISON officials, does this include the use of Trust vehicles or are these additional costs and benefits the Trust supplied to UNISON full-time officials?
The Trust provides fully funded lease vehicles to each of the full time UNISON officials. The costs of these are included in the £140,000 figure. 

As far as I remember there was already a trade union recognition and facilities agreement. If that is the case why has it been necessary to issue a new one?
Current partnership documents and processes have been developed at different times and this has resulted in contradiction and confusion. This does not support positive partnership working so it was important to start with a blank sheet of paper to help us get a strong set of processes for the future. The aim is to put in place a better partnership agreement between UNISON and the Trust and because the current working arrangements with UNISON have proved ineffective, we agreed with the local branch that we will both participate in a partnership review, facilitated by ACAS.

Does the Trust deny refusing to hear grievances from Unison recently?
The Trust’s Collective Grievance Policy, which was agreed with UNISON, is clear that there are occasions where the policy will not apply. For instance when another Trust policy applies or where the matter is related to national terms and conditions. These are detailed in the policy at section 2. The Trust has refused to accept collective grievances through the correct application of the policy. One of the reasons for the partnership review was to develop a collective disputes process so that matters which were collective in nature could be more appropriately addressed between management and staff side without staff having to raise formal grievances which we know is a difficult step to take.

Can you clarify what negative campaigning is? Would this be campaigning that portrays EEAST in a negative light to the public?  Is the Trust asserting that UNISON is negative campaigning on these matters, are these false accusations made by UNISON and general media? How can the trust say that stating the facts in these matters is negative campaigning?
The Trust recognises the legitimate role of a trade union in campaigning, challenging and sometimes even openly criticising senior leadership. However, in the spirit of partnership working there is also a responsibility for unions to engage with the Trust to try to resolve issues before moving into negative campaigning. This is not currently happening. 

Whilst we welcome challenge and feedback we do not accept personal campaigns or those targeted at individuals that are against our values.



Why can’t NQPs do bank work with the Trust?
Newly qualified paramedics are required to complete a portfolio and it is not possible to meet the requirements of that portfolio while on a bank contract.


Bank paramedics are regularly told there are no shifts. If you need more staff, why are there no shifts available?

We do offer bank shifts and overtime, however, we can only offer shifts that are available within budget in each area. We need more staff to deliver the best service to patients whilst ensuring our staff are well supported. Current staffing levels aren’t enough but we only have so much money available.  This is why we are working to secure more resources so in future we have the staffing levels we need.

We hear that people aren’t happy and are leaving or going sick as a result, what is the Trust doing about that?
The Trust has made good progress to better things for staff whilst we recognise there are still improvements to make. In the past two years the Trust has gone from having the second highest turnover of staff in the sector, to the second lowest, and turnover remains on a downward turn.  This shows more staff are choosing to stay and have faith in the Trust as a good employer.

We have seen average sickness levels reduce from just under 8 per cent in 2012/13 to just over 6 per cent in 2017/18 year to date.

The drop in average sickness in A&E is even greater as it peaked at just over 9 per cent in 2012/13 and this year to date is just under 6 per cent.  We know our shortage of staff puts great pressure on our people and we want to address this, which is why we are calling for additional resources to provide the best services to patients and a safe and supportive environment for staff. 

Should the Trust not be asking current staff what they would like to see as an improvement or incentive to stay?
Yes, we want to hear from all of our staff and encourage them to feedback through the variety of channels the Trust has. The annual NHS staff survey, which everyone has been invited to take part in, also allows all staff to give feedback anonymously.

The Trust has an engagement strategy, which includes a range of ways in which staff can make suggestions for improvements and incentives. We had put off launching the staff engagement forum at the request of UNISON under the partnership review but based on staff feedback we will now go ahead and hold our first engagement forum in the New Year and will be offering an open invitation to staff from across the whole Trust.  In the meantime, we also have feedback from the cultural audit, which is now being acted upon.

Why are EOC staff being offered enhanced payments to come in on overtime when this is not offered to road staff?
We are offering supportive measures to ensure we can continue to answer calls quickly at a time of increasing demand. Frontline overtime continues to be available, increased and will further increase substantially over winter.

We have experienced a number of employment offers in EOC not translating into new staff starting. We have taken additional recruitment steps but it will take time to turn this into people answering emergency calls. 

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