Trends, variations and prediction of staff sickness absence rates among NHS ambulance services in England: a time series study

Objectives Our aim was to measure ambulance sickness absence rates over time, comparing ambulance services and investigate the predictability of rates for future forecasting.

Setting All English ambulance services, UK.

Design We used a time series design analysing published monthly National Health Service staff sickness rates by gender, age, job role and region, comparing the 10 regional ambulance services in England between 2009 and 2018. Autoregressive Integrated Moving Average (ARIMA) and Seasonal ARIMA (SARIMA) models were developed using Stata V.14.2 and trends displayed graphically.

Participants Individual participant data were not available. The total number of full-time equivalent (FTE) days lost due to sickness absence (including non-working days) and total number of days available for work for each staff group and level were available. In line with The Data Protection Act, if the organisation had less than 330 FTE days available during the study period it was censored for analysis.

Results A total of 1117 months of sickness absence rate data for all English ambulance services were included in the analysis. We found considerable variation in annual sickness absence rates between ambulance services and over the 10-year duration of the study in England. Across all the ambulance services the median days available were 1 336 888 with IQR of 548 796 and 73 346 median days lost due to sickness absence, with IQR of 30 551 days. Among clinical staff sickness absence varied seasonally with peaks in winter and falls over summer. The winter increases in sickness absence were largely predictable using seasonally adjusted (SARIMA) time series models.

Conclusion Sickness rates for clinical staff were found to vary considerably over time and by ambulance trust. Statistical models had sufficient predictive capability to help forecast sickness absence, enabling services to plan human resources more effectively at times of increased demand.

University of Lincoln, College of Social Science Research

Zahid B Asghar, University of Lincoln, School of Health and Social Care

Paresh Wankhade, Edge Hill University, Business School

Fiona Bell, Yorkshire Ambulance Service NHS Trust

Kristy Sanderson, University of East Anglia, School of Health Science

Kelly Hird, Yorkshire Ambulance Service NHS Trust

Viet-Hai Phung, University of Lincoln, School of Health and Social Care

Aloysius Niroshan Siriwardena, University of Lincoln, School of Health and Social Care

Call volume, triage outcomes, and protocols during the first wave of the COVID-19 pandemic in the United Kingdom: Results of a national survey


During the first wave of the COVID-19 pandemic in the United Kingdom (UK), to describe volume and pattern of calls to emergency ambulance services, proportion of calls where an ambulance was dispatched, proportion conveyed to hospital, and features of triage used.


Semistructured electronic survey of all UK ambulance services (n = 13) and a request for routine service data on weekly call volumes for 22 weeks (February 1–July 3, 2020). Questionnaires and data request were emailed to chief executives and research leads followed by email and telephone reminders. The routine data were analyzed using descriptive statistics, and questionnaire data using thematic analysis.


Completed questionnaires were received from 12 services. Call volume varied widely between services, with a UK peak at week 7 at 13.1% above baseline (service range -0.5% to +31.4%). All services ended the study period with a lower call volume than at baseline (service range -3.7% to -25.5%). Suspected COVID-19 calls across the UK totaled 604,146 (13.5% of all calls), with wide variation between services (service range 3.7% to 25.7%), and in service peaks of 11.4% to 44.5%. Ambulances were dispatched to 478,638 (79.2%) of these calls (service range 59.0% to 100.0%), with 262,547 (43.5%) resulting in conveyance to hospital (service range 32.0% to 53.9%). Triage models varied between services and over time. Two primary call triage systems were in use across the UK. There were a large number of products and arrangements used for secondary triage, with services using paramedics, nurses, and doctors to support decision making in the call center and on scene. Frequent changes to triage processes took place.


Call volumes were highly variable. Case mix and workload changed significantly as COVID-19 calls displaced other calls. Triage models and prehospital outcomes varied between services. We urgently need to understand safety and effectiveness of triage models to inform care during further waves and pandemics.


Ambulance clinician perspectives of disparity in prehospital child pain management: A mixed methods study

When children suffer pain through medical illness or traumatic injury, they are often assessed, treated, and transported to hospital by ambulance. Prehospital pain management in children is considered poor. Within the United Kingdom (UK), a recent study showed that only 39% of children suffering acute pain achieved effective pain management (abolition or reduction of pain ≥2 out of 10). In Australia, a study showed that 55% of children suffering severe pain received no analgesics. This is despite pain management being considered an essential human right.

The consequences of inadequate pain management in children suffering acute pain include posttraumatic stress disorder and altered pain perception. Prehospital pain management in children is extremely complex; difficulty assessing pain and administering analgesics have been identified as key barriers to effective management. Recent efforts to improve pain management include the introduction of intranasal analgesics. Although a promising solution, there are likely to be many unrecognized barriers to prehospital pain relief in children. These require a mixed methods approach to better clarify and delineate the problems associated with effective management.

We have previously identified a number of predictors of effective pain management in children within a UK ambulance service. Children, who were younger (0‐5 years) compared to older (12‐17 years), administered analgesics, attended by a paramedic, or living in an area of medium (index of multiple deprivation [IMD] 4‐7) or low (IMD 8‐10) deprivation compared to those living in an area of high (IMD 1‐3) deprivation were more likely to achieve effective pain management. We aimed to explain these four predictors, along with two other previously identified predictors; child sex (male) and type of pain (traumatic), using the perspectives of ambulance clinicians within a mixed methods approach.

University of Lincoln, College of Social Science Research

Gregory Whitley, University of Lincoln, Community and Health Research Unit
Pippa Hemingway, University of Nottingham, Faculty of Medicine and Health Sciences
Graham Law, University of Lincoln, Community and Health Research Unit
 Niro Siriwardena, University of Lincoln, Community and Health Research Unit

COVID-19: Psychological flexibility, coping, mental health, and wellbeing in the UK during the pandemic

The COVID-19 pandemic has profoundly altered the daily lives of many people across the globe, both through the direct interpersonal cost of the disease, and the governmental restrictions imposed to mitigate its spread and impact. The UK has been particularly affected and has one of the highest mortality rates in Europe. In this paper, we examine the impact of COVID-19 on psychological health and well-being in the UK during a period of ‘lockdown’ (15th–21st May 2020) and the specific role of Psychological Flexibility as a potential mitigating process.

We observed clinically high levels of distress in our sample (N = 555). However, psychological flexibility was significantly and positively associated with greater wellbeing, and inversely related to anxiety, depression, and COVID-19-related distress. Avoidant coping behaviour was positively associated with all indices of distress and negatively associated with wellbeing, while engagement in approach coping only demonstrated weaker associations with outcomes of interest. No relationship between adherence to government guidelines and psychological flexibility was found.

In planned regression models, psychological flexibility demonstrated incremental predictive validity for all distress and wellbeing outcomes (over and above both demographic characteristics and COVID-19-specific coping responses). Furthermore, psychological flexibility and COVID-19 outcomes were only part-mediated by coping responses to COVID-19, supporting the position that psychological flexibility can be understood as an overarching response style that is distinct from established conceptualisations of coping. We conclude that psychological flexibility represents a promising candidate process for understanding and predicting how an individual may be affected by, and cope with, both the acute and longer-term challenges of the pandemic.

University of Lincoln, College of Social Science research

Dave Dawson, University of Lincoln, College of Social Science

Nima Moghaddam, University of Lincoln, College of Social Science


Collaborative partnerships between the Clinical Research Network and the University of Lincoln, School of Health and Social Care

The Clinical Research Network (CRN) National and the CRN East Midlands funded two Research Associate posts for one year in order to promote and develop research in Public Health and Social Care. Both posts are based at the University of Lincoln in the School of Health and Social Care. The social care post, held by Louise Marsh, is intended to promote the social care research agenda by raising awareness and activity within the social care sector. A previously poorly engaged and under-researched area, it comes with unique challenges but great opportunities. Drawing from established models like ENRICH, Louise, who has extensive experience in the social care sector will engage with domiciliary and day care services, charity, voluntary and faith sectors as major social care providers. The public health post, held by Sam Cooke, will aim to champion public health research across the East Midlands by promoting and engaging in research activity within the public health sector. Sam will work closely with researchers, local authority staff, and organisations to develop public health networks, facilitate shared learning, and drive areas of high research priority. This post will offer great opportunity in contributing towards building public health research capacity across the region. Our presentation today will summarise how the roles were developed, what they hope to achieve and the kinds of benefits and impact that collaborative partnerships such as this one can have on research within the University and the wider public health and social care arena.

Dr Ros Kane, School of Health and Social Care
Prof Mo Ray, School of Health and Social Care
Dr Samuel Cooke, School of Health and Social Care
Ms Louise Marsh, School of Health and Social Care


Covid-19 and Probation’s Health Related Practice

The prevalence of many health conditions is higher amongst people under probation supervision than in the general population. Probation staff work in partnership with healthcare organisations to identify health needs and improve the health of people under supervision. During the pandemic, probation adopted an Exceptional Delivery Model, replacing most face-to-face supervision with remote supervision.

Using qualitative staff surveys with a convenience sample of frontline staff (n=27) and interviews with people under supervision (n=11), we investigated perceptions of the impact of the response to covid-19 on health-related probation practice, the lived experience of seeking health support whilst under supervision, and partnership working and pathways into healthcare.

To date, we have created themes around the importance of face-to-face communication; partnerships and service access; impact on health; remote appointments; innovations; impact on staff; risk management; digital capability and access; and flexibility, discretion, trust and choice. This research will have real world benefit as findings will inform recovery planning in probation, including for the delivery of community sentence treatment requirements, and the NHS England RECONNECT project to improve continuity of care for prisoners. We will make recommendations around avoiding negative consequences of change, and spreading beneficial innovations identified in the research in future practice.

Dr Coral Sirdifield, School of Health and Social Care, University of Lincoln
Dr Helen Nichols, School of Social and Political Science, University of Lincoln
Dr Philip Mullen, Revolving Doors Agency
Revolving Doors Agency Peer Researchers

Do National and International Ethics Documents Accord With the Consent Substitute Model for Emergency Research?

In 2010 Largent, Wendler, and Emanuel proposed the “consent substitute model” for emergency research with incapacitated participants. The model provides a means to enroll participants in emergency research without consent, if five conditions are met: 1) the research addresses the patients’ urgent medical needs, 2) the risk–benefit ratio is favorable, 3) there are no known conflicts with patients’ values or interests, 4) cumulative net risk is minimal, and 5) consent is given as soon as possible. We review national and international ethics laws, regulations, and guidelines to determine 1) whether they accord with the consent substitute model’s five conditions and 2) the level of congruence across these documents. We find that only one document meets all five conditions and that there is significant disparity among the documents, particularly between national and international ones. These differences may have stymied international collaboration in emergency research. We recommend that the two international documents used most, the International Council for Harmonization’s Guideline for Good Clinical Practice and the World Medical Association’s Declaration of Helsinki, are revised to include more specific provisions on emergency medical research.

University of Lincoln, College of Social Science

Adele Langlois, University of Lincoln, School of Social and Political Sciences

Stephanie Armstrong, University of Lincoln, School of Social and Political Sciences

Niro Siriwardena, University of Lincoln, School of Social and Political Sciences

Inter-Disciplinary Student Work Placements within a Care Home Setting: Improving Student Employability and Developing Social Connections – A Qualitative Evaluation

This article reports on the development, implementation and evaluation of a project to develop students’ employability skills by involving them in work experience within a care home. The aims of this project were (1) to describe how employability skills developed during the work experience (including knowledge and values relevant to the health and social care sector) and (2) to promote social engagement for residents living within the care home. In this descriptive qualitative study, 12 students from various disciplines across social science courses volunteered to participate following an advert to all students. Alongside three key care home staff, these students participated in two information sessions prior to involving residents in individual and group activities commencing in the following week. Qualitative, semi-structured, written evaluations were collected from the students and care home staff at three time points: immediately after the information sessions, immediately following volunteering sessions and at the end of the project, five months after the project commenced. Evaluations were analysed thematically using the principles of Braun and Clarke (2006) with the identified themes demonstrating students had developed skills, knowledge and understanding in the context of caring for older adults through their planning and implementation of activities, engaging and communicating with the residents, and working alongside care home staff. They reported benefiting from working as a team and commented on their perceived benefits to the residents. Students were able to build transferable skills which they felt would benefit them in future employment. Their participation resulted in a greater understanding of caring for older adults which students stated they can apply both in their working and social lives. The project provided an opportunity for peer education and experience of inter-disciplinary teamwork. The perceived benefits to residents included a positive impact on social engagement, communication and well-being.

University of Lincoln, College of Social Science

Rachael Mason, University of Lincoln, School of Health and Social Care

Rachael Hunt, University of Lincoln, School of Health and Social Care

Ros Kane, University of Lincoln, School of Health and Social Care

Has a child you care for been in an ambulance with a painful condition? – Call for Participants

Has a child you care for been in an ambulance with a painful condition?  If so we would really like to hear from you.  We are designing a research project that aims to improve pain management in children and young people treated by the ambulance service.  We are looking for parents/carers of children, or children and young people along with their parents/carers, who have been attended by an ambulance in the UK for a painful condition.

Research created with patients and the public is more likely to benefit patients, therefore you would part of a Patient and Public Involvement and Engagement (PPIE) group.  To take part, you do not need any research experience, and it would involve a short discussion, by telephone or videoconference, lasting no more than 60 minutes.  You would receive compensation for your time in the form of a £20 voucher per participant.  If you would like to find out more, please contact Dr Gregory Whitley at: