Re-imagining Ambulance Services Through Participation and Deliberation

This chapter identifies the serious issue of the mental health and wellbeing of English paramedics working in the emergency ambulance service. It identifies the case of the extant top-down performance measurement regime and the absence of indicators of wellbeing in ambulance performance reporting. The impact of such measures on frontline staff and the implications for their motivation and commitment are also documented. More decentralised, open and discursive approaches to performance management in the public sector are advocated as key methods for re-imagining ambulance and wider public services in a global context.

Drawing on relevant literature, the chapter provides the context of the English ambulance service and the challenges it faces with reference to the New Public Management (NPM) and New Public Governance (NPG). Key issues concerning performance metrics and staff wellbeing and welfare are then identified and discussed. The notions of communicative rationality, deliberative democracy and agonistic pluralism are introduced as a framework for analysing the state of both wellbeing and resilience and the performance regime within the English ambulance service. The chapter relates these themes to the re-imagining of public services internationally, proposing a more participative and discursive approach.

It is desirable for the evaluation of public services to include the wellbeing of the healthcare provider, as well as the public service recipient. Additionally, there is a case for greater participative and dialogic engagement to address the intertwined relationship of ambulance staff wellbeing and the performance management regime of the service. The process should be revised, therefore, to take into account the wellbeing of ambulance staff as an integral and intrinsic part of the delivery of the service, and it is recommended that deliberative methods of participation are deployed in reimagining ambulance services and public services more generally.

The challenges facing ambulance services and, more generally, health services globally continue to proliferate and intensify. They are exacerbated by foreseeable contextual challenges such as the demographic profile of patients and service users and budgetary cuts. Traditional and more recent NPM approaches are proving inadequate for this challenge and appear unsustainable in practice. The lack of acknowledgement of welfare indicators in the performance metrics make them unfit for purpose. Our suggested discursive approach would help to re-imagine the service by improving its sustainability and resilience in parallel with the improved wellbeing and personal resilience of the people who provide the service.