A report of the #ProjectA Wellbeing Collaborative Event held in London on the 5th March 2019.

1. 5th March 2018
Twitter hashtag #ProjectA
Report of the #ProjectA Wellbeing Collaborative
Accelerated Design Event
Creating ‘safe spaces’ for ambulance staff

2. The purpose of this report
What this report seeks to do:
• Provide a record of the inputs and outputs from the day
• Show what happened on the day and the energy in the room
• Document the wealth of information and experience that the attendees
brought to the day
What this report does NOT seek
to do:
• Make verbatim notes
• Analyse, synthesise or prioritise ideas
• Develop a decision document or action plan
Report compiled by Lynsey Oates and Ian Baines NHS Horizons

3. Showcase table and wall area
Share and show materials from Wellbeing
initiatives around the country – learn and
share from one another.

4. Welcome by Jason Killens CEO of Welsh
Ambulance Service.
Why today is important………
It’s really good to see every service
represented here today.
Wellbeing is a very important topic.
I’d encourage you to share your
wellbeing and safe spaces work with
one another.
Lets take this opportunity to learn
about the good practise that is in place
across all ambulance services and
explore new ideas together.
Thank you to NHS Horizons team for
planning the event and for all the
#ProjectA work.
Have a good day everyone.

5. In the room are people who
aren't ambulance staff - these
are critical friends, and who
are here to help us – embrace
them.
Helen Bevan Chief Transformation Officer
NHS Horizons set the context for the day
This is not your usual conference or
workshop, it is a specially designed
process that enables a depth and
quality of output that would usually
be unachievable in such a short
timeframe...we’ll do three months’
worth of work today.

6. The activity:
On your own, look through the
magazines and find two pictures that
symbolise for you:How the midwifery
profession is now (sometimesalways)
•How things could be different
in the future
People travelled to London from
as far afield as Northern Ireland
and Scotland to attend the
event. Every ambulance service
in the UK was represented.

7. Aims for the day
To:
• Build proposals for ‘creating a system of safe spaces
where staff can discuss emotional/psychological
aspects of their experiences and decompress’
• Consider how we link and support (not duplicate)
work of the Ambulance Staff Partnership Forum and
the existing AACE HROD Ambulance Wellbeing Group
• Create a vision for the future
• Share existing knowledge and good practice
• Identify how we can enable this to happen across the
country
• Test out the ideas and identify our next steps

8. Employee Wellbeing
Sasha Johnston, South West Ambulance
Gill Heuchan, London Ambulance
We don’t want to
see staff broken, we
want to encourage
staff to talk about
how they feel.
Sasha and Gill framed the day by
providing some powerful statistics -
if all ambulance services achieved
the sickness rate of the lowest
ambulance service it would mean
the equivalent of 1,000 extra people
in the service

9. What unites us?
• Attendees were asked to introduce
themselves to everyone else at the table
• They were then asked to find five things that
they had in common and to be prepared to
share them with the room

10. We all deal
with trauma
We all like
Yorkshire Puddings
Finding out what unites us
We all have
dogs

11. We created a symbol of safe spaces
by tying a ribbon around each of the
tables.
Each table was asked to consider
one aspect of being in a ‘safe space’
that was important for ambulance
services.

12. Creating our own safe spaces

13. Safe spaces - ribbon activity: feedback from the tables
1 – Let’s value our differences
2 – There should be no hierarchies and we are all equal
3 – We need to be able to speak openly about anything
4 – We must give people the time they need
5 – It should be “safe” to leave our safe space at any time
6 - What is said in the circle stays in the circle
7 - Listen, do not judge
8 – Let’s make the most of everyone’s experience

14. Safe spaces: now and in the future
• We asked people to look through magazines and find two
pictures - in the context of safe spaces - that symbolised:
– How ambulance services are now (sometimes/always)
– How things could be different in the future
• People were asked to share their pictures with others on
the table
• The tables then created a “collage” of now and the future
for safe spaces
#ProjectA

15. Safe Spaces
Now and in the future - teams in action

16. The collages

17. The collages

18. Feedback - Where we are now:
Each table fed back
three words that
described the
current state in
relation to finding
safe spaces for
ambulance staff to
talk and
decompress….
The three words
were entered into a
word cloud. It is
clear that things
could be improved.

19. Feedback - Where we want to be, future:
Each table fed back
three words that
described how they
wanted things to be in
the future in relation
to finding safe spaces
for ambulance staff to
talk and
decompress….
The three words were
entered into a word
cloud. People want to
be engaged, confident
and supported.

20. Three approaches to improving
wellbeing
#ProjectA
Anu Mitra
(Imperial College
Healthcare NHS Trust)
Introduction of Schwartz
Rounds
Esther Murray
Chartered and Registered Health
Psychologist
Addressing moral injury
Fiona Meechan
(College of Policing)
Compassion at work toolkit

21. Anu Mitra shared his experience as a resus
consultant at St Mary’s Hospital.
Anu spoke about the Grenfell Tower tragedy and
how the hospital had responded to it.
Anu explained about how important it is to
understand how harrowing events can impact
staff.
St Mary’s has introduced Schwartz Rounds to
help staff decompress and talk about stressful,
emotional and traumatic experiences.
These have been a great success with 97% of
attendees recommending Schwartz Rounds to
other health care workers.
Anu Mitra
(St. Mary’s Hospital - Imperial College
Healthcare NHS Trust)
Introduction of Schwartz Rounds
“It’s important to look after ourselves so that
we can be more effective, compassionate
carers for our patients. Well-being, self-
compassion, compassion for colleagues, is
intimately tied up with compassion for
patients”

22. Fiona spoke about the importance of
wellbeing and compassion in the workplace.
Fiona described how compassion increases
resilience, outcomes, collaborations, trust,
effectiveness and job satisfaction.
In essence compassion is the key to
improved wellbeing and productivity.
Fiona explained how small acts can make a
big impact.
Those who witness compassionate acts also
feel better - it’s a contagious effect we pay
compassion forward.
Fiona Meechan
(College of Policing)
Compassion at work toolkit “Compassion is a
fundamental human value”

23. Esther presented Moral Injury and how important
it is to recognise our need for wellbeing.
Moral injury occurs after exposure to traumatic
unjust or amoral incidents. Frontline ambulance
staff can witness a variety of emotional and
difficult situations on a daily basis.
Witnessing a number of unsettling events can lead
to individuals displaying similar symptoms of PTSD.
Esther explained that this is a human response, we
are designed to have morals and exposure to
horrific events triggers psychological unrest.
Esther advised all staff in ambulance services to
take time to recognise what constitutes a safe
space. It will vary what works for some may not
work for others. Flexibility and variety are key.
Esther Murray
(Queen Mary University of London)
Addressing moral injury
“Everyone has the capacity to be
kind to ourselves - liken it to
brushing our teeth - just do it,
don’t think about why you are
doing it, just do it”

24. The table feedback from the speakers

25. The table feedback from the speakers

26. Feedback from the speakers- teams in action

27. Approaches to improving wellbeing: Key theme feedback from the tables
1 – What are our questions and issues in relation to what we have just heard?
• How do we normalise it?
• How do we create the space?
• How do you scale it?
• How do you get the leadership behind it?
2 -What are the uniting principles we can extract and use in ambulance ‘safe spaces’?
• It’s ok to not be ok
• Trust
• Compassion
• Passionate Leaders
3 - What barriers may we have to overcome to enact these principles?
• Time
• Resources
• Culture
• Leadership
• ‘Here we go again’
4 - If there was one reflection your table could summarise what would it be?
• No shame or blame
• Variety
• We need to be more compassionate

28. Market place – 2 minute pitch
• Dr Jennifer Wild - PTSD Prevention
• Scottish Ambulance Service – RUOK?
• South West Ambulance Service – Supervision
• East of England Ambulance Service – Digital
interventions on health
• Yorkshire ambulance service – Schwartz rounds in
111
• Welsh Ambulance Service – Implementation of
TRIM
• London ambulance service – Peer support network
#ProjectA

29. Market Place
A table was hosted by each service that
had come forward
We asked participants to choose the table
they wanted to start with
We had 3 rotations around different
subjects

30. Market Place Session

31. Feedback from
the Market Place

32. Market Place: Key theme feedback from the tables
1 - PTSD Prevention
• We need to ask the right questions
• We want to take the model forwards
• We need to engage student paramedics
• We need to broaden, sign post and enable
• What are the barriers? - Bullying
2 – Scottish Ambulance Service: RUOK?
• Lifesaving commonalities that can be applied across all services.
• Any of the first responders fire, police, ambulance can be affected by stress
• Signposting internal or external, enabling approach, no formal training- RUOK?
• Simple to do, but some barriers - resources, time and money. Also reliant on volunteering CPD
events.
• Potential to expand, back in ambulance or control room or office, not about a separate section
humans can ask RUOK?
3 – South West Ambulance Service: Clinical Supervision
• Supervision important H&WB, can be applied to all ambulances, clinical supervision
• CS framework applied to many different settings, can discuss what they want to, staff enthusiastic
about it, virial methods can work.
• Barriers time and demands and understanding what CS is- creating a safe space
• Potential for nationwide it’s a framework, place to talk, ground rules and a safeguarding policy.

33. Market Place: Key theme feedback from the tables
4 – East of England Ambulance Service: Digital Interventions on health
• Alertness at work, long shifts things that can make you tired, enablers research communication,
people buying in.
• Barriers are the lack of research
• Potential for this intervention, would it work might not work etc. Interventions that can be realistic
5 - Yorkshire Ambulance Service: Schwartz rounds in 111
• Schwartz rounds comparison between acute and an ambulance sector, peer to peer support.
• Open to all staff, need to talk about our problems
• Costs money, but have buy in from staff and management, have facilitators in organisation.
• Barriers releasing of staff, confidentiality, how we build trust
• Potential for this intervention, Schwartz round based facilitators others doing something similar- we
do have facilitators at station and we will look at trialling at the station
6 - Welsh Ambulance Service: Implementation of TRIM
• Important, evidence based, care about each other, peer led 24/7 service
• Embedded in services, enablers, learn from each other, want to know more - positive feedback,
resources in place
• It has been accepted as senior level
• Barriers- time and money
• Potential for rolling this out, currently have space at the station encouraging staff, newsletter share
experiences and positivity.
• We are learning every day

34. Market Place: Key theme feedback from the tables
7 - London Ambulance Service: Peer Support network
• It helps stop little things becoming big things
• It’s for staff, evolved from the staff survey
• We incorporate trim into peer support model
• Focus on networking events and #ProjectA
• Barriers: the cost, expertise training and evaluation - how do we quantify - what’s the best model,
time, stigma and mandate on mental health first aid.
• Potential for peer support approach, first and biggest step if you can get people to care about each
other – in society we have stopped, we need to start caring, we have to care
• Compassionate leadership: if all ambulance services had the lowest average sickness rate, it would
equate to 1000 extra staff a year.

35. What I have found from today is
that there are similar wellbeing
issues across the country that
we can all tackle.
We need to take forward an
offer to AACE and put a plan
together to support and improve
Ambulance staff wellbeing. The
Chiefs are committed to this.
Thank you all for your
contributions.
Jason Killens, CEO Sponsor
Thinking through next steps

36. It’s been a great and hugely
thought provoking.
We need to be mindful of
support and remember our
staffs’s needs. We will need
different resources for different
people.
At present there is no national
work on safe spaces, this is an
area that #ProjectA can really
develop and work with.
We are very keen to support this
agenda along with the CEO’s.
Anna Parry, AACE
Thinking through next steps

37. Action Planning

38. Action
Planning

39. Today has been great to be
with likeminded people.
Our passion should be that
we care for each other and
that you have time to care
for yourself.
Compassionate leadership,
self-compassion, we owe it
to staff to provide the
support.
Thanks everyone for a great
day.
Final thoughts
John Isaac, Paramedic
and Locality Manager
Yorkshire Ambulance

40. Developing the outputs post ADE
Jason Killens
Chief Executive
Welsh Ambulance
Service
During the falls ADE Jason Killens (one of #ProjectA’s sponsoring CEOs) expressed a desire to
move the wellbeing ADE outputs forward across all CEOs. Specifically arising from the ADE will be
a number of suggestions for CEOs to consider .These include:
• The introduction of a well being pledge that all ambulance services sign up to.
• The introduction of a prevention strategy for ambulance services with regard to post
traumatic stress disorder (PTSD) – that is embedded in an evidence-based model
commissioned through #ProjectA
• Providing appropriate on going 1:1 support (One example at the ADE being the RUOK model
of the Scottish Ambulance Service).
• Setting up a virtual learning group of colleagues to explore potential for the introduction of
Schwartz rounds nationally across all ambulance services for winter 2020.
All the above have been included in the proposed workplan for #ProjectA in 2019/20. This
workplan will be presented to the AACE Council in April