A truly toxic British ambulance bureaucracy

Woman left to die by the roadside after ambulance bosses refused to let crew cross a county boundary

A student was left dying by the side of a road after an air ambulance 20 miles away was refused permission to cross a county boundary, it has been revealed. Rebecca Wedd, 23, had to wait 42 minutes for medical help after she was hit by a car as she walked with a group of college friends to a summer ball. Police arrived in seven minutes, but it was almost three quarters of an hour after the 999 call when paramedics finally appeared. The national target for answering such a call is eight minutes. Miss Wedd was eventually flown to a nearby hospital but died of her injuries the following day.

It has emerged that an air ambulance crew three minutes away from the scene of the accident was initially refused permission to answer the call from the A433 in Gloucestershire, because it meant crossing a county boundary from Wiltshire. The emergency controller contacted the Wiltshire Air Ambulance after the accident but was told the helicopter could not fly outside the county at night. This was said to be part of a pre-existing arrangement between WAA and Wiltshire Police, which shared the helicopter. The controller then contacted Wiltshire Police directly and persuaded them to bend the rule because of the emergency. Permission was given and the aircraft was finally dispatched at 12.02pm, and arrived at the scene at 12.05am - 43 minutes after the initial 999 call.

Only a minute beforehand, the student graduate was being tended by a paramedic whose ambulance had been flagged down by police. Miss Wedd eventually arrived at hospital an hour and 18 minutes after the accident, and died of her injuries the next day.

The shocking delay in flying the air ambulance was revealed after an internal investigation into the tragedy was made public under the Freedom of Information Act. Miss Wedd's father said he believed his daughter might have been saved but for the delay. Peter Wedd, of Harston, Cambridgeshire, 53, said: 'I cannot understand why that rule applies and why that air ambulance could not fly. 'The bureaucracy that stopped the helicopter from flying that night is unbelievable. Why are these rules there when someone's life is in severe danger? 'The report is a catalogue of disasters. The resources available were not properly managed and someone could have attended to my daughter far, far quicker. 'It's hard to know if that would have made a difference. In my heart of hearts I believe it would.'

The report also highlighted other failings by the Great Western Ambulance Service that night. A nearby ambulance dealing with a less urgent call was not diverted to Rebecca's aid and no ambulances were available in nearby Cirencester because of staff sickness.

At the time Rebecca was killed, Mr Wedd had been rebuilding his life after his wife Carol, 46, died of breast cancer. He has one other daughter Caroline, 22. Rebecca was on her way to the ball at the Royal Agricultural College in Cirencester in May last year when she was struck.

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A truly toxic Australian ambulance bureaucracy

After a decade of wall-to-wall inquiries, the NSW Ambulance Service still fails its noble undertaking on care, at least to its own workers. As health mottos go, the NSW Ambulance Service's Excellence in Care is an efficient mantra. But once the service had loftier ambitions. "Together," said its old motto, "we will be the world leader in ambulance services, providing a shield of protection to our community." Now its ability to deliver excellence and protection has been questioned. How can it deliver to the community, when it cannot guarantee a protective work culture for its employees?

The ambulance service has been the subject of 11 inquiries since 2001; the latest, expected to hand down its findings on Monday, has been inundated with hundreds of disturbing stories of abuse, bullying and harassment. Barely 24 hours before the NSW upper house inquiry began in July, a Premier's Department review of the service concluded serious operational and workforce issues were harming the welfare of ambulance officers.

In opening the upper house inquiry, the chairwoman Robyn Parker said it was called in response to concerns "raised by ambulance officers and the community with members of Parliament and in the public domain regarding, in particular, bullying, harassment, intimidation and occupational health and safety issues". Parker said this week that a decade of ignoring the issue had to stop. "I guess what I really feel personally now is that I see an ambulance officer and I want to go up and hug them . We call triple-0 and we expect them to turn up and we don't expect that they're not treated well. "The community holds them in such high regard yet the services and the structure and the government is not matching that with the resources they need to do the job. The ambulance service has got to breaking point."

The inquiry heard tales of officers unable to endure the lengthy complaints management system - criticised by the Health Services Union as being so aggressive it was a form of bullying in itself - who gave up and went on stress leave.Others obtained apprehended violence orders against officers; some committed suicide. For too many officers, management's repeated failure to even address their problems exacerbated their pain.

The service has responded. A harassment taskforce was set up last year, and a healthy workforce summit was held last May. Still, ambulance service research shows 75 per cent of the 3105 paramedics are unhappy and the rate of sick leave outstrips the average for other health department employees, including nurses.

Officers have inquiry fatigue and say significant cultural change in dealing with bullying and harassment will not occur without an overhaul of the executive. They are also critical of the union for apparent inaction. They hold out some hope this inquiry will be different, given its independence from ministers and ambulance bureaucrats, but acknowledge implementation of recommendations depends on government.

Carlo Caponecchia, a University of NSW psychologist, told the inquiry that bullying and harassment were unsurprising, given the stress in ambulance officers' jobs. "Things like fatigue, rostering, being stationed in the country without ever knowing when you are going to leave, lack of career progression - all these kinds of things . need to be dealt with." Caponecchia said there was no evidence to suggest bullying and harassment in the ambulance service was worse than elsewhere. But workers' health and wellbeing were affected, regardless of the individual's personality.

The director-general of NSW Health, Professor Debora Picone, told the inquiry the ambulance service tended to operate on an old-fashioned "command and control type structure from the military" that was at the root of some of its bullying and harassment problems. Picone believes that bullying and harassment are "in pockets rather than widespread". Bullying and harassment are compounded by workplace and operational problems. Officers complained of the difficulty of getting holidays or transfers approved, of the lack of counselling after traumatic events, and how overtime was essential to a satisfactory wage, yet it caused fatigue.

Face-to-face counselling was used 544 times in the past 12 months, but Picone told the inquiry post-traumatic support was employed only once. This raises questions about the adequacy of "debriefing" services, particularly as international research shows stress is one factor increasing the likelihood of workplace bullying.

The ambulance service's chief executive, Greg Rochford, concedes that officers have traditionally been promoted to management without being trained in people skills or conflict resolution. And Picone says it is planned to have all 400 operational managers trained in complaints handling by the end of the year.

But Dennis Ravlich, a Health Services Union official, was scathing at the inquiry about the service's inability to turn things around. "The Premier's Department review and a number of reviews that we have participated in over the previous eight or nine years consistently identify issues that the service needs to do better. Yet no one is accountable, 10 or eight years later." He said that in investigating complaints or disciplinary matters the service's professional standards and conduct unit "has almost institutionalised a rather aggressive approach to staff - indeed, almost to the point of being harassing in itself", and that reports on bullying allegations "drop into a big black abyss".

Parker told the Herald on Thursday: "This has gone for so long, and the chief executive officer [Greg Rochford] and the Government has been clearly aware of this issue for more than 10 years now, and a broom needs to be swept through the service, starting at the top. "Ambulance officers painted a bleak picture of their workplace. It was just so dysfunctional, the morale so low. There was so much unresolved conflict and time and time again we heard about this nepotistic old boys' club; it just has to change."

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