NHS 999 staff are quitting and suffering burnout due to the relentless pressure of calls, sometimes involving suicides, stabbings, shootings and patients dying before ambulances can reach them, says UNISON today (Tuesday).
Figures obtained by the union from UK ambulance services* show high turnover rates among call handlers, which staff say are often due to a lack of support and the non-stop, often distressing, calls that force many to take sick leave.
A report launched at the union’s annual conference in Liverpool today shows the toll taken on the workforce, with more than a quarter (27%) of NHS ambulance control room staff quitting their jobs over the past three years.
According to the research, more than half a million days were lost to call handler illness in the three years from April 2021. The figure for 2023/24 alone was 166,940 – the equivalent of more than a month of sick leave for each 999 call handler. This compares with just four days on average for UK workers**.
The union says high staff turnover and increased sickness absences are having a negative impact on patients. It often means people are having to wait longer for 999 staff to answer calls or for their emergency to be properly assessed and dealt with.
UNISON interviewed emergency call handlers for the report, who described the psychological toll of taking call after call. They often do a 12-hour stretch with limited breaks while dealing with complex emergencies such as mental health crises.
One 999 worker said she had been unable to forget the panic in the voice of a distressed mother whose daughter suffered life-changing burns to her face and body.
Another said she had to take time off sick after dealing with four suicide calls in a single shift, an issue that had affected her personally in the past.
Others talked about occasions where supervisors had failed to check whether staff needed time to recover. This is despite 999 call handlers having to make life and death decisions for hours on end.
The report is based on data from Freedom of Information (FoI) requests submitted to NHS ambulance trusts across the UK.
Trusts were asked to supply data on 999 control room worker numbers, call handler turnover and days lost to sickness from April 2021 to April 2024.
Last year, South East Coast Ambulance Service had the highest staff turnover (80%) followed by North East (33%), Yorkshire (31%), and South Central (28%).
At least 510,254 days were lost to sickness in 999 control rooms across the UK from April 2021 to March 2024, according to the data.
South East Coast had the highest average number of sick days per person in 2023/24. Figures provided by the trust show 19,319 were recorded that year, the equivalent of more than 54 days per call handler.
UNISON is calling for better training, regular breaks during shifts and improved emotional support. Call handlers should also be regraded, says the union, from band 3 to a band 4 on the NHS pay scale. That would mean a starting salary of £26,530 a year, which would give staff more of a financial incentive to stay and better reflect the work they do, says the union.
Commenting on the figures, UNISON general secretary Christina McAnea said: “These findings paint a bleak picture of the conditions faced by 999 control room staff.
“TV programmes about ambulance services don’t show things as they really are. Call handlers are under immense pressure, making split-second decisions that directly affect lives.
“They handle relentless calls, often from people in distress, while dealing with complex emergencies and with limited resources. Despite their crucial role, 999 call handlers frequently face emotional strain and operate in an environment where support is sometimes lacking.
“The job is rewarding, but the challenges behind the scenes are far greater than most people realise. It’s bad for morale and for patients when so many staff quit or are burnt out. Callers who dial 999 need to know the person picking up the phone is ready to deal with their crisis.
“Ambulance employers must do more to protect the health and wellbeing of staff who provide such high stakes support. This would help create a more stable emergency service that can retain the skills and experience of emergency call handlers, and persuade people to stay in the job for longer.”
Notes to editors:
–*UNISON received full or almost complete data from 11 of the 13 UK NHS ambulance trusts as follows: East Midlands, London, North East, North West, South Central, South East Coast, South Western, West Midlands, Yorkshire, Scottish and Welsh. Click here for the full report. The Northern Ireland Ambulance Service provided only partial data and the request to the East of England trust was not submitted in time for its data to be included in the report.
–**Office for National Statistics data.
– ***Workforce data from NHS England.
– UNISON’s annual delegate conferences starts today and is taking place until Friday this week (20 June) at the ACC Liverpool. Further details can be found here. Among the issues being discussed throughout the week include the employment rights bill, apprenticeships and migrant workers. Christina McAnea’s speech to the conference is at noon on Wednesday.
– Case studies:
A 999 call handler and staff trainer said: “There’s no consistency in the support given to staff after a difficult or deeply upsetting call. And we often don’t have as many call handlers as we need. While staff are trained to handle difficult calls, they’re still human. The lack of down time affects people. I’ve had to take a few days off sick, especially after handling multiple calls about an issue that had personally affected me in the past. Some colleagues have required months off due to stress and the often toxic work environment.”
A 999 call handler said: “One of the biggest challenges is the lack of support for call handlers. It’s also one of the main reasons why so many leave. Supervisors rarely check in to see if we’re okay or need a moment to recover. Instead, the expectation is simply to carry on. It’s hard to feel valued when support is minimal. It’s relentless. You log in, take emotionally intense calls for 12 hours straight, and then go home. Certain calls stay with you. I once spoke to a distressed mother whose daughter had life-changing burns to her face and body. The panic in her voice is something I’ll never forget.”
– UNISON is the UK’s largest union with more than 1.3 million members providing public services in education, local government, the NHS, police service and energy. They are employed in the public, voluntary and private sectors.
Media contacts:
Fatima Ayad M: 07508 080383 E: f.ayad@unison.co.uk
Anthony Barnes M: 07834 864794 E: a.barnes@unison.co.uk