Heading for disaster: Extreme work and skill mix changes in the emergency services of England

Abstract

This article examines the impact on staff of state-imposed public sector reforms alongside austerity cuts since 2010 in the emergency services of England. We discuss the contextual imperatives for change in the police, fire and ambulance services while exploring their unique labour management and industrial relations’ structures and systems. As elsewhere, the burden of cuts and reforms has fallen on the workforce managed through skill mix changes. Such site-level management responses to austerity are being implemented despite staff concerns, increased dangers to the public, and their non-sustainable nature.

Keywords

austerity emergency services labour process public sector resistance skill mix

Introduction

It is now a commonplace of day-to-day work that managers acting on behalf of employers in both the public and private sectors are using the recession and attendant austerity measures in the United Kingdom to push back the frontier of control (Goodrich 1920) and reduce workers’ and union rights and abilities to mobilise against wage cuts and deteriorating terms and conditions of service (Centre for Labour and Social Studies (CLASS) 2015). This is all part of the small state aspirations of Conservative government policy (Krugman 2015). This study examines some of those sectors with high union membership, strong formal industrial relations traditions, high public profiles, and which are part and parcel of the daily expectations of citizens being protected by the state from harm. The three emergency services (fire, police and ambulance) come into our lives when there is a crisis, protect us all from harm, and are now experiencing the same kind of labour management pressures found elsewhere in the economy (Office for Budget Responsibility (OBR) 2015). The government’s austerity policies have speeded up and enlarged those trends in emergency services management that were apparent before 2008, but only in a piecemeal and limited way.

Work is organised in ways that are supposed to ensure that those at work are set tasks to achieve in a controlled and orderly fashion explicitly linked to the service being provided to a given set of customer–users and within the context of the pro tem business priorities. This division of labour and skill mix is designed to maximise productivity and minimise labour costs within an efficient firm. Classical and neo-classical economists concern themselves with both the level of wages in exchange for labour and the use-value of that labour when managed to perform set tasks (Hicks [1932] 1963). This general position gives rise to the ceaseless set of workplace conflicts between managers acting on behalf of the employer and workers (individually and collectively through their trade unions) seeking to defend and improve their pay and conditions of service (Kelly 1999), including the use to which the employer puts their skills. This struggle over job regulation is part of the wider class struggle to recognise the nature of exploitation and the efforts to hide it from workers (Hyman 1989).

The argument is summed up, ‘as the division of labour increases, labour is simplified’ (Marx [1849] 1977: 225). This becomes the basis for two subsequent debates rooted in an increasingly instrumental view taken by workers of their work (Goldthorpe et al. 1968), namely that they work for wages and that is that (Marx [1859] 1971: 210). As labour diminishes into ever smaller skill differences (however much exaggerated), the advent of ‘generalised labour’ creates a labour market ever more flexible and mobile to suit all occasions (Marx & Engels [1846] 1976: 87). As Cohen (1988) summarises, ‘capitalism increases the number of distinct jobs involved in the production of a given product, but at the same time it decreases the specialization of the worker’ (p. 194). This lays the basis for both Braverman’s (1974) general deskilling thesis and Polanyi’s (1944) interpretation of Gramsci’s works ([1929–1935] 1971) about the socialised nature of the division of labour and its attendant consequences for the creation of a working class as a class (Burawoy 2003). This includes, though frequently in a contentious manner, workers in uniforms especially as the office holders are state employees with a distinctive employment status.

Under these long-term tendencies for the development of a generalised labour problem, senior managers devise a range of solutions for controlling worker performance within the twin pressures of internally set budgets and externally created demand for the service (Marginson 1993). In the public sector, all of this applies and at times of austerity becomes both the dominant and determinant pressure generated from the neoliberal policy programme (Krugman 2015). In the case of the three emergency services in England, their budgets have been cut in real terms (Office for National Statistics (ONS) 2015), and subsequently staff pay and pensions (Hutton 2011) have been reduced nationally by unilateral government decision. Yet, given the nature of the ‘blue light’ services provided, levels of service delivery and performance have to be seen to be maintained. The only way to try to square this circle is through changes to skill mix and division of labour. The three services, for reasons that we hope to explain, have reacted differently (Seifert & Mather 2013).

The police service has externalised the problem through the creation of a lower skilled group of workers, Police and Community Support Officers (PCSOs), who are employed as civilians doing some tasks previously performed by warranted police officers (so-called ‘civilianisation’, Merritt 2010). In the ambulance service, the new division of labour has been internalised through the split of grades into a new paramedic job with higher pay and professional aspirations and technicians with lower pay and less skilled task requirements. This parallels developments elsewhere in the health services with changes in skill definitions of nurses (Grimshaw 1999) and health-care assistants (Bach et al. 2008). All ambulance staff remain employed by National Health Service (NHS) Ambulance Trusts. This change is separate from but concerned with the increased privatisation of some non-emergency ambulance services. Third, the fire service has kept the job the same. That is, firefighters remain a single grade with general and specific skills and tasks, and there has been no further division of labour. This article draws on research findings from a larger study to examine this triptych of management responses to the twin pressures of budget cuts and the need to provide these blue light services. It provides an interesting story in terms of the three services and the staff and union experiences of these developments. We begin with a discussion of the contextual imperatives for change in these services and their unique industrial relations arrangements before moving to our research findings and concluding remarks.

The political economy of emergency services

There is increasing state-sponsored downward pressure on costs across all UK public services since 2010 including fire, police and ambulance, as public spending is squeezed.¹ This example of really existing austerity is a graphic reassertion of neoliberal market strategies wrapped up in the rhetoric of small state and big society (Lowndes & Pratchett 2012) and presented as achieving more for less with little democratic accountability (Chomsky 1999).

Austerity measures are then legitimised under the auspices of increased and ultra-democratic localism (Seifert 2014). The effect is to bypass locally elected representatives of citizen users, thereby skewing services towards those citizens with the loudest voices and deepest pockets. For example, the move towards directly elected USA-style Police and Crime Commissioners is now complete (Jones et al. 2012), and as local government is degraded so the political vacuum is filled either by more central government intervention (pace firefighters’ pensions) or by unaccountable self-serving senior managers (Francis 2013).

This attack on public sector employment was predicted by Hood in the 1990s as New Public Management (NPM) overtook progressive public administration as the hallmark of the reforming movement within the public services (Hood 1995).

As Bach and Kessler (2012) observe, ‘in the public services the connection between employee relations policies and practices, worker attitudes and behaviours, and organisational outcomes clearly assumes a very different form [from that in the private sector]’ (p. 2). They note the potentially disastrous outcomes that flow from problems of low morale, poor employee relations and inappropriate skill mix/workforce organisation decisions in public services. This is echoed in local government, ‘empirical findings show councillor, union and worker resistance to managerial reform. They also show job loss, work intensification, job insecurity and demoralisation of staff’ (Gill-McLure 2014: 365).

UK public services are labour intensive and function within non-market profitless organisations. That is the key feature that distinguishes this work from work in the private profit-making sectors. Public sector service managers, therefore, must seek out ways of intensifying and extensifying work as part of the process of ‘managing’ the increasingly fraught labour problem (Burchell et al.2005). As a result there have been widespread job losses across these services - 5600 police officers; 4000 firefighters; and 2000 ambulance paramedics. Senior managers, therefore, have to find ways of doing the same (or more) with less and they must find ways pf being seen to protect ‘front line provision’ in order to reassure the citizen-user that service standards are maintained. This is because there is also a close relationship between service users and front line employees such that ‘the performance of these employees will determine the efficiency and effectiveness of service delivery’ (Bach and Kessler 2012:2). This link further illustrates the special case of state employees and is acutely felt in the emergency services.

If there is an emergency, then workers expect to be called out. This is reflected in the overarching responsibility assumed by the state for such provision, and of long-standing views on how best to regulate work and wages in these monopsonistic services. There are culturally inspired state-supported images of brave ‘heroes’ protecting us all from harm which lend themselves to quasi-militaristic ways of organising these uniformed services, particularly police and fire, along command and control lines.

Our study of labour management decisions on the emergency service ‘front line’ suggests that different management ‘solutions’ to coping in times of austerity emerge and that these are best understood using the analytical device of labour process theory (Braverman 1974). However, division of labour/skill mix decisions outcomes will vary depending on specific management strategies, organised worker power and workforce disposition (Vidal 2007). This general proposition is accentuated in the case of ‘blue light’ emergency service work which is characterised by extremes of danger to staff and/or citizens’ lives. The work of emergency medical teams is ‘uncertain, unpredictable, urgent, complex, interdependent and tightly coupled’ (Klein et al. 2006: 590–591). Similarly, the work of ambulance crews involves ‘constant emotional oscillations’ as they face potential life and death situations every time they receive a 999 call (Boyle & Healy 2003: 351). Firefighters are more likely to suffer stress and stress-related injuries in their day-to-day work (Steffen et al. 2012). One result is ‘that injury often occurs when protective gear is not used properly … because of haste, cumbersome gear can sometimes interfere with performance, and cultural factors’ (Kahn et al. 2014). Research into police work concluded that

police officers face a number of challenges in their working lives that were felt more acutely by them … police officers were also less likely than the other(s) … to feel like they have control over when they work their hours … (and) police officers were found to be consistently less likely to feel consulted, fairly treated or to trust their managers … Lack of trust, in particular, stands out as a serious problem for police officers across all ranks and jurisdictions. (Jakubauskas & Wright 2012: 4)

In all of this, there is a false but widespread split as between the frontline (brave and protected) and backroom (bureaucratic and a burden). Even self-ascribed definitions of where the frontline begins and ends are variable and contradictory (O’Connor 2011). The ‘split’ does raise, however, the question of task allocation, skill mix hierarchies and labour management ways of solving the long-standing labour problem (Kaufman 1993). The fundamentals of which are rooted in deep-seated feelings of being exploited (not valued), being alienated (not in control with military-style command structures) and increasing levels of anomie (clash of culture and values). The popularity of the jobs under consideration (no recruitment problems) and the extent to which being in uniform, respected, part of teams and with a high-profile of dedicated professionalism affects levels of worker discontent and associated collective action remain elements of the labour management conundrum (Knight Review 2013).

Industrial relations and the new division of labour

All three staff sets are highly organised: firefighters in the Fire Brigades Union (FBU), ambulance staff in UNISON, UNITE and the GMB, police civilians in UNISON and the PCS in London and police in the Police Federation of England and Wales (PFEW).² All groups function within a national collective bargaining forum mediated by specific institutional variations. Firefighters’ pay was indexed to the upper quartile of male manual workers as part of the settlement of the 1977 strike, but ended after the 2002–2004 dispute (Seifert & Sibley 2011). The system has reverted to a Whitley-style National Joint Council (Grey Book) and is under the zero-pay policy.

Ambulance staff come under the NHS Pay Review Body following on from the Agenda for Change (AfC) Job Evaluation exercise in which they were up-rated from old manual grades to a mix of old APT&C grades, with paramedics and technicians emerging into the daylight from the previous skill mix muddle. This resulted in considerable pay uplift for paramedics. Even though ambulance staff are under the 2010 pay freeze, the main issues are pensions, conditions of service (especially with regard to workload) and management attacks on trade union rights.

Since 1919, the police have been unable to strike and so do not enjoy free collective bargaining, although they all belong to a post-entry closed shop federation. Nationally, pay is decided in an indexation format through the Police Negotiating Board (PNB) (Hunter 2003; Winsor 2011), which morphed into a form of Pay Review in 2014. Locally, the PFEW is active in representation and bargaining with Chief Constables along horizontal lines (constables, sergeants and inspectors) with some joint board activity. PCSOs are employed on local authority pay and conditions and have the right to strike.

Firefighters in England are involved in a long-running dispute that has included strike action over changes to their pension arrangements.³ The police marched (in 2013) against their pay settlement, and PCSOs have been involved in general local government strikes over pay.⁴ The ambulance staff have been in dispute with their employers over workload, privatisation and pay.⁵ Thus, cuts and the management recreation of the division of labour are located within a generally hostile industrial relations’ setting.

In the context of austerity measures, there is a need to push down on unit labour costs as the only viable way to make savings and maintain standards. The emphasis will be on how managers pass on the cuts. One aspect of this is an intensification of current trends around task reallocation rooted in Taylor’s nostrums as explained by Braverman and concerned with decisions about division of labour ‘which add to the productivity of labor’ (Babbage in Braverman 1974: 55).

Braverman’s analysis of the division of labour underlines the centrality of decisions about task allocation to an understanding of the labour processes of any occupation. While task reallocation may deliver cost savings, the conundrum for managers is to cut costs while responding positively to the political and service imperative to protect the emergency service frontline. Division of labour and task allocation decisions therefore need to marry the twin concerns of cost cutting and service standards. This means some engagement with the nature of the tasks involved and level of skill required to perform the task so that citizen users are reassured. For the workers, this may spill over into more collective bargaining leverage and the ability to resist imposed changes. The relationship between skill and what this infers about competence to do the job is equally problematic. Gallie (1994) uses a range of measures for determining the skill embodied in work such as length of training and time taken to learn to do the work well. But training and qualification do not in themselves provide a clear indication of role content or competence to undertake different tasks (Neyroud 2011). Our point is that division of labour and task allocation decisions are not about improving competence and service per se, but rather, they provide opportunities for cost savings as ‘separating simple from complex tasks permits economies in training and recruitment’ (Rueschemeyer 1986: 18).

These debates require special attention when applied to emergency service workers because public service professionals, ‘as holders of specialist expertise, expect to exercise a degree of autonomy over their work and their work processes’ (Ferlie et al. 1996: 168). In the case of emergency service workers, the degree of autonomy is often confined to professional decisions in immediate situations and within a group-based decision-making mechanism. Autonomy is also circumscribed by the scrutiny of external observers.

Conceptualised in this way, skill and competence in these services are bound up with training, the materials and knowledge to do the job, tacit know-how based on experience and some control over the immediate work situation. The team analogy is to some extent related to the military-style command hierarchies, the heroic nature of the labour process and a shared ‘special’ function that saves lives, prevents crimes and deals with injuries and illness.

One feature of division of labour decisions in the public sector has been the use of cheaper, ‘assistant’ roles ‘including the expansion of community-support officers in the police service and a variety of assistant roles established in health and social care’ (Bach et al. 2006: 2). Such analysis highlights the ways in which new job boundaries and attendant task allocation decisions are intertwined with broader debates about ‘eligibility rules’, who may be employed in a category, how many, training requirements, and ‘performance rules’, defining the tasks undertaken and the ways in which they are performed. More recent studies include new division of labour arrangements in the UK probation service (Gale 2012), in the English Further Education sector (Mather & Seifert 2014) and in nursing (Bach et al. 2012). All highlight a tendency for service managers to reallocate tasks where possible to carefully delineated groups of workers with differentiated job roles and on different levels of pay.

Methods

The focus of the fieldwork was to reveal the experiences of emergency service front line workers and their union representatives (FBU, PFEW, GMB and UNISON) to managerial efforts to reform skill mix arrangements. The design of the larger research project, although essentially mixed-method in its approach at discrete stages, is rooted in qualitative traditions that allows for access to the ‘multi-layered and textured social world … based on methods of analysis, explanation and argument building which involve understandings of complexity, detail and context’ (Mason 2009: 3).

The research project involved participants from across England and included 27 in-depth interviews, six discussion groups with representatives and meetings with 10 key informants from each emergency service. Data were also drawn from secondary sources including government, service and union websites/blogs and documents. The particular focus of this article emerged from interviews with national and regional (Sergeants’ and Constables’ Branch Board representatives) PFEW representatives (excluding Metropolitan Police), FBU regional and branch officials, UNISON and GMB regional and branch officials representing ambulance staff. The interviews were based on semi-structured questions about the nature of the service, the nature and understanding of what constituted frontline work, views on spending cuts, skills mix and division of labour, current workplace issues and union responses. Within this general framework, each interview unfolded in different ways, with interviewees providing detailed commentaries around core labour management matters as they saw them. The data therefore provided a rich and detailed insight into aspects of work in these services. Each interview, discussion and meeting lasted for approximately 1 hour 30 minutes.

Findings

Externalising jobs in the police

Successive governments have long been concerned with the costs of maintaining a police force. This has meant control over pay costs, changes in conditions of service including pensions and hours worked, more powers to senior managers and a cheapening of provision through outsourcing and skill mix changes. In 2002, the Police Reform Act introduced PCSOs as cheaper labour to replace the work of the more expensive and less tractable police officer. The political imperative rested on having ‘bobbies on the beat’, irrespective of actual police effectiveness. This was delivered at least-cost under the auspices of ‘Neighbourhood policing’ which is ‘the presence of visible, accessible and locally known figures in neighbourhoods’ (Turley et al. 2012: 2). By 2014, with cutbacks and increased pressures on the service, the role of PSCOs was less clear cut as there had been some blurring of the boundaries with the office of constable. A plea to save PSCOs from cuts argued,

PCSOs should not be viewed as expendable in times of austerity. They have a vital role in neighbourhood policing, which is in turn important for police legitimacy. This in fact makes them crucial to police forces trying to save money. (O’Neill 2014: 265)

Police officers were less enthusiastic about the benefits of PCSOs. Key themes that emerged through much of the interview and meetings data were uncertainty and feeling let down (‘betrayed’) by government policy. An important aspect of this betrayal related to the introduction of PCSOs which, they felt, sometimes had the effect of undermining ‘the police job’. While PFEW representatives noted the importance of the PCSO role, they remained sceptical about its contribution to the police ‘family’. Some expressed the view that urban policing, in particular, did not lend itself to this division of labour decision so as one put it, ‘PCSOs tend to be used more outside the big cities … the experiment isn’t sustainable’. Another noted the limitations in that ‘off duty police officers come in during a crisis, but CSOs don’t volunteer. They’re not part of the police family’. If there is an incident police constables usually stay at work whereas PCSOs ‘are straight out of the door at the end of their shift. They increase our workload because they don’t deal properly with incidents and they are the first port of call’.

The PFEW representatives suggested that this division of labour is a false economy. More fundamentally, it appeared to be the opinion among police sergeants, in particular, that reliance on PCSOs in the neighbourhood effectively severed or severely weakened the links between the community and their police officers. They were disparaging about the role, suggesting that they should be ‘given more power or got rid of altogether’.

There was also a view that as budgetary pressures continue, then service managers will inevitably pursue further workforce and task allocation changes – shorter shifts (to avoid overtime payments), curbs on 24/7 availability and narrowing down police activity from ‘nice to have’ to ‘essential to have’. Police officers reported that ‘you have to cover yourself in case’. A senior figure noted that ‘it is better to have fewer, better people than more who are no good’. This comment suggests that the PCSO role is undervalued, although this division of labour was seen as politically expedient as a means for ‘simply being visible on the streets’ at lowest possible cost. Others were critical of the focus of the sustained budget cuts, commenting that ‘cuts should start with the senior managers … the front line must be saved’. Underpinning this were deeper concerns about the ramifications of job cuts for the age profile and loss of senior (older) staff who have ‘trodden the beat’. Implied within this is the relative importance of tacit skill and job know-how that is assimilated over time within the labour process.

Interviewees also reported pressure to move to one officer on the beat rather than two, and they also raised questions over access to training. PFEW representatives were particularly critical of this development, suggesting that police resourcing needed to relate to the role and function of the job – and for the most part, there was a need for two officers. As one commented, ‘they (government ministers) simply don’t understand the nature of frontline policing’. The official line on service websites is an increased emphasis on training and career progression, but this, according to the PFEW is for the smaller number of warranted officers.

According to government websites, the priority policing areas are sex offences, organised crime and neighbourhood policing. While interviewees did not disagree with these broad commitments, they felt that such definitions further blurred the front-line/backroom split that drives managerial (and political rhetoric) about a new, more efficient division of labour that protects the frontline while cutting the backroom. As one PFEW representative explained, ‘being on the street stops crime and disorder, but looking for a sex offender is not front line is it?’ Similarly, another noted the importance of ‘the presence of the bobby on the beat … cops that can be trusted … But this tradition is changing and really, proper neighbourhood policing is being lost’.

Underlying all of this are the twin pressures of balancing the needs of the public and the workload of the police officers. The organisation and deployment of staff are therefore crucially important both through skill mix arrangements and through shift working and rosters. PCSOs are argued by service managers to provide the requisite flexibility, but this is contested by police officers. One PFEW regional representative emphasised that ‘PCSOs are not flexible but we are’. Nevertheless, revised recruitment and selection strategies for the service highlight that entry routes into the police service have been changed, with graduate entry now posited as the way to revitalise policing. This move continues to be resisted by the PFEW as, according to them ‘experience counts’. Their argument is that this development diversifies the skills and experience in the service, buttressed by the commonly held view among serving officers that all recruits should do time ‘on the beat’.

The squeeze on pay exacerbates workload pressures and poor morale, so as another commented ‘a lot of officers are in debt and I’m worried about a return to corruption’. This has implications for service standards. All PFEW interviewees reported police officers having to do ‘more for less’, with one explaining, ‘when I started there were four sergeants but now there’s one and all their work’s been bumped down to us’. Another noted that ‘acting sergeants are on the increase but they lack the experience in the role, plus they then leave gaps for other police officers’. The general picture that emerged was of pressurised police officers on the frontline (constables and sergeants) and then gaps as inspectors were perceived to have ‘moved away’ from the frontline. One commented that ‘the inspector hides from issues and for that matter, so does the management’. He went on to explain that there were no senior staff around after 5 pm, so the work then falls on the sergeant (e.g. handling complaints). Those interviewed reported being overloaded with work – they could not ‘get annual leave in’, they were expected to deal with duty changes at short notice and were constantly working late to fill in paperwork or to cope with shortages. These pressures have consequences in terms of commitment to the service as was widely expressed, ‘I don’t want to leave but the goodwill’s gone’.

An additional aspect of police work organisation is the creeping privatisation, for example, private security companies are taking control of custody suites, traffic offices and highway agencies. As one optimistic company head put it, ‘Private companies will be running large parts of the UK’s police service within five years’ (Guardian 20/6/12). These are very real concerns:

over the past few years, the police have been thinking the unthinkable. Faced with a 20 per cent budget cut courtesy of the coalition’s severe post-financial crisis ‘comprehensive spending review’, many forces have been toying with the policy of privatising front-line services to save money. (White 2014 at http://blogs.lse.ac.uk/politicsandpolicy/five-reasons-why-its-difficult-to-privatise-the-police/)

White’s (2014) published research identifies the five reasons why this policy has been so difficult to implement: media scaremongering, public fear, lack of support from senior officers, inexperience in contracting out and problems in staffing the contract.

All these changes in skill mix, recruitment and training have been contested by the PFEW, but this has proved less problematic for managers than having to deal with an independent trade union with full industrial rights. Some aspects of the changes appear to have triggered mixed responses from the PFEW. For example, it was difficult for them to argue against the case for better training and promotion opportunities, although they did oppose more direct entry to senior ranks and other ‘managerial’ solutions to skill shortages (Neyroud 2011; PFEW 2011).

The division of labour decisions in the police service has therefore been made on the basis of externalising key aspects of the policing role to civilian staff who are cheaper, and the substitution of cheaper for more expensive staff, broadly in line with Gale’s (2012) findings for the UK probation service. This was an imposed change rather than the outcome of a negotiated settlement with the PFEW.

Splitting jobs inside the ambulance service

The labour management solution in the case of the ambulance service has been the creation of a new internal division of labour including senior paramedics, paramedics, emergency care assistants (previously technicians) and ambulance care assistants and drivers who staff the Passenger Transport Services (PTS). This new division of labour was created within the AfC⁶ agreement, thereby representing the outcome of extensive consultation and negotiation around a detailed job evaluation exercise that underpins the NHS job categories. Prior to AfC, the nature of ambulance work was perceived to be qualitatively different: ‘a scoop and run service’ which aimed to get the patient to hospital as quickly as possible. The scope of ambulance worker involvement at the scene was circumscribed since they only required the limited Miller Certificate which provided for little engagement in pre-hospital care. AfC effectively triggered a range of training and skills mix changes that reconfigured the nature of ambulance work along ‘professional’ lines.

The job evaluation process enabled ambulance work to be broken down into its constituent tasks and among different categories of workers. PTS relies primarily on driving skills. The allocation of this part of the job to cheaper staff has enabled much of this work to be privatised, leaving emergency care assistants and paramedics to deal with medical emergencies and call-outs. There are also essential ‘backroom staff’ in this service, with mechanics that make ready the ambulance fleet. The ambulance service was also offered the prospect of the acquisition of additional skills through government-funded training with the requirement on paramedics to register with the Health Professionals Council (HPC).

The focus of the paramedic job is with providing essential pre-hospital care. Some paramedics undertake additional, advanced training to equip them for lone, rapid response work. One such paramedic, also a UNISON representative, explained how she had undertaken extensive training to enable her to perform this role, such that she was effectively ‘better qualified than some senior nursing staff, but on lower pay’. The detail of the job meant that she could be faced with life and death decisions ‘at the scene’ and she was expected to act autonomously. As she explained,

We have to be autonomous. We have to make that quick decision there and then. We don’t have the luxury of even picking up a phone and saying, I need to speak to Dr. Such and Such. This is what I’ve got. What do you think? We don’t have that.

This autonomy carries particular pressures associated with working alone and in sometimes highly traumatic circumstances. A UNISON representative noted, ‘this is a difficult group to work with, because of their regular proximity to trauma’. He observed that in any other sphere of work, this would attract lots of counselling support but that these workers ‘get on with it’.

Another UNISON representative commented, their ‘professionalism is now comparable to nurses’ and as such there are minimum standards of competence and ‘fitness to practice’. While registration with the HPC confers some degree of ‘professional comparability’, it also allows for a paramedic to be struck off. Furthermore, there appeared to be a greater willingness among senior managers to trigger formal disciplinary measures as they seek to avoid ‘bad press’.

The dispatching of ambulances to patients is managed by control rooms staffed by emergency call handlers. Technology therefore plays an important part in matching emergency calls made to the service with the dispatching of an ambulance within prescribed target times. As one representative explained, the quality of information from control can be variable as the call handling protocol is ‘scripted’. She reflected on ‘getting “psyched up” for emergency’ that can sometimes turn out to be the ‘panic of an elderly patient who doesn’t want to be on his [sic] own’. The problem is that other emergency situations cannot be attended to until the ambulance is formally dispatched. This can act to close down the professional discretion of the paramedic who must wait for the call. The technology is also being used as a form of surveillance to monitor call times, so as an emergency care assistant, also a UNISON representative explained, ‘we’re followed and we’re tracked, we’re GPS-tracked, so at every point … every second of every day they know exactly where I am’. This has the effect of increasing the intensity of the labour process.

Demand for the ambulance service has increased since 2006 and the increased workload pressure that flows from this is unrelenting (Incomes Data Services (IDS) 2014; Mather 2014). One representative noted that ‘calls have doubled – demand has gone through the roof’. He attributed this to two main developments: first, the emergence of the general practitioner (GP) out-of-hours service and the fact that people do not like call centres so they call 999 for the ambulance when they cannot contact their GP and second, the impact of an increase in TV exposure to the service (programmes such as Casualty). As a result, ambulance crews were increasingly complaining that calls were ‘coming in that aren’t our responsibility’. Another noted that the failures in 111 have also triggered major upward demand on Accident and Emergency in general and ambulance services in particular.

There are no recruitment difficulties in the ambulance service below the level of paramedic, but there is a problem with the ability of NHS Trusts to recruit and retain qualified paramedic staff (UNISON 2014). While one UNISON representative commented, ‘it’s now seen as a career choice – it’s seen as a professional service’, another representative (also a paramedic) explained,

It takes three years to get a paramedic through their training now. … the pressure’s on in all the other trusts, country-wide, to get paramedics who are already qualified. It’s not happening. There’s no quick fix. And unfortunately, because of getting rid of so many staff, or as people left … because the job’s not as enjoyable as it was, then it’s hard for them to get qualified staff in.

One consequence of this shortage is an increased reliance on the lower paid, but less qualified emergency care assistants/support workers, so

it’s regularly two support workers that turn up on an ambulance … They’re qualified to sort of assist a paramedic, but they’re not qualified to work autonomously when treating the patients … it’s horrendous, you know. It’s more and more with the lack of paramedics as well … They’re into that sort of stage where they have to put unqualified staff on an ambulance.

Another made similar observations:

We’re short staffed so we’ve got not enough paramedics, … But the person that I’m working with there … is an ECSW as well, so they’ve doubled us up, so we do an awful lot of double ECSW crews … Now, then, we’re not qualified and we can’t assess a patient, we’re just there as a support.

Evidence from the 2012 NHS Survey raised similar concerns, revealing management-led restructuring and workforce reorganisations, whereby ambulances were staffed with one paramedic and one driver, instead of a fully qualified (and more expensive) crew. The report cited one paramedic who explained that this put both workers under ‘more pressure and stress’ as one had to attend to patients while the other had to cope with driving constantly in a blue light situation. The downside risk is clear: ‘patients have less qualified staff attending. This is risky if there is more than one patient e.g. in a road traffic accident’ (IDS 2013: 139).

The emergency care assistant role (replaced the previous technician role, although there are still technicians working in this role) attracts less pay and is therefore cheaper, so in many respects, this mirrors the substitution of cheaper for more expensive staff that is a feature of the police division of labour. It is also the case that part of the management solution relies on the privatisation of some work that had belonged with the ambulance service – the entire PTS is now delivered in the private sector by passenger transport drivers or ambulance care assistants (also known as emergency care support workers). A representative explained the more routinised nature of this work:

The ambulance care assistants work … primarily patient transport services. Obviously, the training isn’t as in-depth as the likes of paramedic or technician. Obviously, we do get training on things like oxygen therapy and that sort of thing, but mainly it’s more routine. Sometimes urgent jobs but obviously we don’t respond to, like, red calls and things like that, … it’s more routine.

Another (himself an emergency care support worker) elaborated on the boundaries of his job:

So what the Emergency Care Support Worker does is works with a qualified, either a paramedic or a technician, and my role is to support them … … I’m not just a driver, some people think ECSWs are just drivers, but we have the vehicle, so we check the vehicle in the morning and make sure it’s all stocked up for the paramedics.

The 2012 NHS survey indicates that one-third of ambulance staff report always working in excess of their contracted hours, and although they were paid overtime for these extra hours they were concerned about the negative consequences of this ‘substantial increase in their workload’ (IDS 2013: 37). Blaming pressure to meet government targets plus the additional duties and responsibilities that now fall within their roles, ambulance staff reported low levels of morale, feeling stressed and under-valued by their managers. The same report highlights a related development in workforce reorganisation in what amounts to a departure from job profiles in AfC bands, whereby service managers down-band some ambulance workers’ jobs so workers do the same jobs but on lower pay. The managerial solution to cost-cutting pressures in the ambulance service therefore appears to have rested on a newly devised internal division of labour that is the outcome of a joint agreement between the relevant unions and service managers. One consequence appears to be the more intensive use of labour working in this part of the emergency services.

Plus ça change in the fire service

Solutions to the labour problem in the fire service have surfaced rather differently. The potential for creating a new division of labour through the breaking down of the firefighter role is not feasible – there is no scope for externalising parts of the job to other, less-qualified workers. This is where an understanding of the real nature of ‘emergency work’ becomes clearer and more significant. In a genuine emergency, all firefighters have to be comfortable operating within the command and control environment that characterises a 999 fire situation. It is simply too dangerous to have in place sub-categories of workers who are part-qualified to deal only with parts of the job.

Analysis of resourcing decisions reveals a division of labour based on whole-time and retained duty firefighters, although these arrangements tend to be confined to shire, rather than metropolitan brigades. For example, in one shire service, the staff mix is based on a 40:60 whole-time to retained ratio. The attraction of using retained firefighters is the potential cost saving – they earn 10% of whole-time salary plus payments to attend training and incidents. There is growing pressure, notably triggered by the Knight Review (2013) for managers to increase reliance on these on-call firefighters as they are cheaper, the implication being that they would displace some of the more expensive whole-time staff. This represents the more intensive use of both categories of worker. This is in the context of job losses which amount to a 9% reduction (5,000) in the number of firefighters since 2010 (FBU 2014). While these job losses have been delivered primarily through a policy of non-replacement of staff, an FBU representative pointed out that this still meant ‘a loss of firefighters in real terms, no matter how you cut it’.

The whole-time/retained duty mix is also important for a range of other reasons – the need for sufficient crewing levels, coverage and response times and minimum number of crewing levels. This is particularly evident in rural fire stations which tend to be staffed by retained or ‘on-call’ firefighters where there are recruitment difficulties and where it takes longer for on-call workers to get to the fire station and mobilise. While retained firefighters therefore offer managers a degree of flexibility in resourcing decisions, the downside is the labour turnover problem among this group of workers. As one FBU representative explained,

Turnover in the retained is really high. Some people just don’t hack it because it asks a lot of people to give up, or to ask employers to give up people to fight fires in their local area. And people give up their own time and families in the middle of the night. It asks a lot for very little reward and they’re very poorly paid for what they do.

This indicates some constraints on labour management decisions with regard to extending reliance on retained crews. The balance between retained and full-time firefighters may vary, although in reality many retained firefighters are involved in highly specialised tasks and they are all ‘competent’ to deal with fire and rescue incidents. However, this masks important variations in access to training – retained firefighters are paid to undertake 2 hours training per week to maintain operational competence, whereas whole-time firefighters work 42 hours per week and much emphasis is placed on training during these hours. FBU representatives emphasised the crucially important role of training in order to keep up to date with firefighting skills and the use of an increasingly complex array of equipment. The costs of training and the importance of public safety and the perception of public safety means that externalising such tasks and jobs therefore remains on management wish-lists only. Importantly, any skill differences between whole-time and retained are not seen by the public or indeed the service managers. For example, specialist response can be provided by retained stations in the areas of flood response and water rescue.

While 999 response is an important aspect of the firefighter’s job, a major emphasis across the service is the increasing focus on fire and accident prevention work. This means that firefighters are expected to engage in community-based initiatives such as fitting smoke alarms and talking to community groups. Uniformed firefighters are perceived to add credibility to the prevention message and whole-time firefighters undertake this as part of their whole-time duties. The retained duty workforce is by its nature far more limited in its availability to undertake such work. There has been an associated reduction in the number of fires since 2010, so according to Sir Ken Knight Review (2013),

in the case of fire and rescue services there remains a significant decrease in demand for its operational response … Differences in operational practices, including minimum crewing levels and the ratio of senior managers to firefighters further show that there are savings to be made without reducing the quality of outcomes for the public. (pp. 4–5)

But this is disputed by the FBU (2013): ‘The improving statistics show that the fire and rescue service is more productive than it has ever been in the past’ (p. 4). Matt Wrack, FBU General Secretary argues against reducing the risk of fire to market forces supply and demand style arguments,

It takes the same number of firefighters and fire engines to safely and efficiently extinguish a house fire whether a town has ten house fires per week or one per month. Fire and rescue service ‘supply’ cannot simply be scaled up or down in response to ‘demand’. (FBU 2013: 3)

He goes on to explain that the public expect an effective, timely response in the event of an emergency, and this cannot be delivered with reduced fire service capability. This argument draws out the potentially dangerous nature of the job that cannot be hived off to another category of worker. As one FBU representative put it, ‘you only need one fire’.

There is more use being made of technology in the fire service, but firefighters do not regard this as a threat to their jobs. More training to use technological innovations is seen to enhance the skill content of the job and so ‘our jobs are safe’. However, innovations in fire appliances, rapid deployment requirements and moves to reduce minimum crew sizes create major pressures for those on the frontline. This is a major point of contestation for FBU representatives. One explained, ‘We used to ride with five and now it can be down to three’. He linked this to firefighter safety concerns and noted that managers would not be able to go further without compromising firefighter safety.

A related development was the move towards co-responding, with firefighters being asked to undertake emergency first aid work. For firefighters, the view is that ‘it is not in the interests of the public to displace the ambulance service, nor to believe that firefighters can provide a medical service on the cheap’ (FBU 2013: 17). When interviewed, one FBU representative explained that he had been ‘on a job’ the previous week, and was ‘relieved when the paramedic arrived’ because ‘he’s the expert, not me’. He went on to comment in detail about the boundaries, as he saw them, between a firefighter’s job and those of a paramedic, noting that he was not a qualified medical person, ‘but the paramedic wouldn’t be expected to rush into the burning building, would he? Nor would he cut the roof off in an RTA (road traffic accident)’.

One development that emerged in the interviews was a reported increase in the use of disciplinary measures. An FBU representative noted an increasing willingness on the part of managers to widen the scope of disciplinary matters to encompass issues arising outside of the workplace under the general heading of ‘bringing the service into disrepute’. He cited examples of where disciplinary action had been triggered at times on the basis of very limited evidence. He also mentioned that the ‘fear factor’ was part of the problem: the fire service had become fearful of ‘bad press’, underlining the importance of maintaining public ‘confidence’.

As part of the broader picture, at the time of the research there was an ongoing national industrial dispute over firefighters’ pensions. The attack on firefighters’ pensions was deeply felt by firefighters and added to their sense of ‘being betrayed’. An FBU regional official noted that ‘it’s a bit like being in a boxing match – like being punched into submission’. He went on to explain that firefighters ‘put their lives on the line’, but they felt undervalued and demonised. He suggested that this sense of betrayal provided a focal point around which firefighters could be galvanised to resist management and ministerial pressures to further reduce costs.

Some fire authorities, as part of the business continuity case, were contemplating the use of ‘volunteer’ civilians and private security companies to provide emergency cover in the event of continued strikes. The fire authorities are obliged by the government to provide the service. The problem for the government is that this service is highly unionised and the FBU is seen to present major obstacle to reforming the way the fire service is delivered. As Knight (2013) notes, ‘The Grey Book can lead to some self-limitation by leaders not to introduce change that would require lengthy negotiation. It should be reviewed’ (p. 8).

All this suggests that despite increasing ministerial and management pressures, there is limited scope for further division of labour in the fire service over the short term. The reasons for this relate partly to the nature of the labour process itself as there is no obvious scope for externalising parts of the job to other, less qualified workers. Even the non-emergency prevention activities still necessitate the involvement of firefighters if this work is to have credibility and impact in the wider community.

Conclusion

The main political imperative that drives management strategies across the English emergency services is to cut costs while at the same time protecting or being seen to protect standards and ‘reach’ of service provision. The political consequences of any mistakes are significant. Our research highlights that the underlying thrust of management strategies relies on the mantra of doing the same (or more) with less. This translates into work intensification as spending is cut but with the work still to be done.

The common downward budgetary pressures have therefore been tackled in a different way in each of the three services through careful attention to labour process changes, viewed here through task allocation and skill mix changes and how these processes may be understood to impact on the ‘professional’ labour process of those working on the emergency service frontline. The ‘civilianisation’ programme has been intensified in the police service and, although contested, has gathered pace in the absence of an independent trade union with full industrial rights. It was possible through close analysis of the police task for managers to identify those parts of the job that could be hived off and allocated to cheaper PCSOs, ‘freeing up’ over-worked warranted officers to focus on the core policing task. In the ambulance service, the increased division of labour accepted after AfC has been further developed through staff cuts. There are limits to this as paramedics are quitting and proving increasingly difficult to replace. Staff shortages are being managed by the use of cheaper, less qualified ambulance staff. In fire, the status quo ante prevails but with increasing pressures for skill changes. Our findings suggest the scope to enact skill mix changes is significantly restricted by a complex mix of factors that present a major barrier to management-led reforms: the highly unionised nature of the workforce, the nature of the task itself and, in particular, the need for all firefighters to be able to deal with emergencies in a command and control environment, public and firefighter safety arguments and high training costs.

One aspect of the research as presented here was to highlight how workers’ representatives viewed these new pressures to solve the long-standing labour problem. In so doing, we have drawn on Braverman’s analysis while also reflecting on mediating factors such as ‘risk’, the available technology and the modern-day application of Taylor’s management control through increased division of labour. However, in line with Vidal (2007), our findings suggest that different managerial solutions are emerging in each of the three emergency services as management decision-making is mediated by a complex dialectic of a range of factors that play out rather differently in each service.

In conclusion, this article fills in a knowledge gap and allows emergency services to be discussed within a framework of a new division of labour settlement that substitutes more management, more technology and more outsourced work for traditional service standards. This, we argue, risks both the further alienation of frontline staff and the provision of a variable and more selective service to the public.

Footnotes

Notes

Author biographies

Kim Mather is a lecturer in HRM and Industrial Relations at Keele University. Her research focuses on changes in the labour management and labour processes of front-line public sector workers, and their resistance to these changes. Her current research activity is concerned with discrete parts of the public sector including education (schools, further education) and the emergency services (fire, police, ambulance). Recent publications have appeared in the Industrial Relations Journal, in Work Employment and Society, and in Review of Radical Political Economics.

Roger Seifert read PPE at Oxford University, then an MBA from London Business School, and PhD from London School of Economics. He worked for Incomes Data Services, and was appointed professor of industrial relations at Keele in 1993. Since 2008 he has been professor of industrial relations at Wolverhampton University. He specialises in trade unions, strikes, and the public sector.

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