Editorial: Resilience and wellbeing—the persistent challenges for our emergency services

Introduction

All of the articles in this Public Money & Management theme, except for Lakoma and Liu-Smith’s more contemporary contribution debate article, were written on the basis of field research or databases that were compiled before, or soon after, the onset of the Covid 19 pandemic. Their publication is a sobering reminder of the persistence of the challenges around the wellbeing and resilience of our emergency services and their staff before they were compounded and exacerbated by the pandemic and subsequent economic, social and environmental disruptions. What is more alarming has been the inadequacy, or limitations, of the response from both governments and society. Despite the widespread support emergency and healthcare workers enjoyed during the pandemic, post pandemic there has generally been a return to austerity-driven leadership and management, inadequate resourcing and increased work intensification and consequent stress.

Organizational support can help improve staff motivation and effective commitment

The first two research articles in our theme look primarily at the organizational support or perceived organizational support provided to police officers and army personnel. The work these emergency workers undertake means they are demonstrably susceptible to high levels of stress and, consequently, require sensitive and appropriate organizational support. The two articles come from a very well-established researchers who have written extensively on the link between organizational support and the wellbeing of emergency service personnel and public service personnel more generally—both in this journal and elsewhere. The underpinning research for both articles used robust and well-established theories and models to explore comparative empirical evidence and provide us with interesting new insights into an increasingly international discourse. They suggest that if austerity-driven management is the cause of low organizational support, then new management models are required to ensure psychologically safe workplaces.

The first research article, from Brunetto et al. (2021), uses conservation of resources theory, which explains employee motivation, to look at the behaviour of street level bureaucrats (SLB) in Australia. Using data collected from self-completed questionnaires, they compare the impact of perceived organizational support (POS) for emergency services SLBs (police and army) to administrative SLBs (local government officials) and professional SLBs (nurses) at the ‘POS–wellbeing–engagement nexus’. They found professional and emergency services SLBs both perceive low POS and that the impact of low POS explained ‘a third of administrative SLBs’ wellbeing, a fifth for professionals, but less than 10 percent of emergency services’ wellbeing’. As such, the article provides empirical evidence of the impact of poor management on employees, as well as the increased costs to taxpayers and the communities. The authors suggest that, if short-term austerity-driven management is the cause of low POS, then more effective management models based on the principles of social exchange theory that generate mutual reciprocity and trusting relationships would be a more effective and cost-effective way forward.

The second research article, from Nelson et al. (2021), is the first study to be conducted in Brazil on the relationship between POS, work-related stress and effective commitment to the organization for military police officers. The authors cite current literature to show that organizations demonstrate how they value their employees, and care about their wellbeing, by providing physical and socio-emotional support to minimize stress and limit burnout. Employees normally reciprocate this support with increased commitment. This research analysed 296 questionnaires to test multiple hypotheses. However, in Brazil, the policing environment has been affected by increasing levels of violence due to social, economic and political upheaval. In such an environment, Brazil’s emergency service organizations, such as the military police, struggle to provide adequate support for employees and incidents of post-traumatic stress disorder are increasing but are rarely discussed. The authors demonstrate how the contemporary social, political and economic environment has negatively influenced the relationship between POS, work-related stress and organizational commitment. We now know that Brazil was the epicentre of the epidemic in Latin America and that health, economic, social and political issues effectively collapsed the already precarious public health system.

Our third research article looks at a recent initiative in UK policing that starts to address and improve organizational support from a system-wide perspective. During the pandemic, the health and wellbeing of emergency services personnel were considered essential for effective recovery. This public acknowledgement had resulted in the NHS Long Term Plan and the need to address emergency services responders’ resilience. The UK’s National Police Wellbeing Service (NPWS) was therefore created to provide increased support and guidance for police forces. Hesketh and Tehrani (2022) from the NPWS describe the Emergency Services Trauma Intervention Programme (ESTIP). This article was written after the Covid 19 pandemic when questions had already arisen about how we plan for and respond to long-term civil contingencies. The authors note that certain features of disaster response create higher threats to the psychological health and wellbeing of emergency services responders and suggest that risk areas can be divided into three main groups, relating to the nature of the disaster, personal factors and the style of leadership and support provided. The programme adopts an in-service three-stage approach, which consists of demobilizing, defusing, and EST management, before onward referral, via occupational health, to external general or specialist health services. Adopting an evidence-based approach and acknowledging existing guidance for ambulance personnel (College of Paramedics, 2020), the authors explain that ESTIP has been developed ‘for policing, by policing, in a way that meets the unique needs of police officers and staff’ and it is intended to build resilience to deal with major traumatic events as well as everyday stressors. Ultimately, however, they acknowledge that consolidated and co-ordinated multi-agency guidance and practice must be the ambition.

Cultural change needed to tackle staff welfare and wellbeing issues

The remaining three research articles in our theme relate specifically to the ambulance services.

Perceiving a gap in the knowledge of paramedics’ personality traits considered against paramedics’ own perceptions of a relative absence of organizational support, Lockhart and Perrott (2022) explore personality characteristics associated with paramedics, in comparison to normative samples, to find out which personality styles predispose emergency responders to be more or less resilient to stress and also whether normative personality characteristics can be proxies for resilience in the stressor–stress process. Their case study surveyed paramedics registered with the College of Paramedics of Nova Scotia; 344, out of 1348, members completed their questionnaire. Although current psychopathology-focused personality tests may function adequately for screening out troubled applicants, the authors question whether measures of normal personality may hold greater promise for identifying optimal candidates. To their surprise, both emotion-focused and less-useful strategies mitigated against perceived stress, but the problem-focused strategies did not and perceptions of the support provided to enhance paramedics resilience who saw the support as inadequate. This suggests that healthcare policy-makers in Nova Scotia may have a problem if this article’s findings are replicated by further research.

Next, Constantine Manolchev and Lewis (2021) investigate bullying and negative behaviours in two UK ambulance services as ambulance personnel continue to report higher rates of bullying compared to other NHS workers in the annual NHS staff surveys. Stress and mental health issues are greater than in any other occupation and this suggests that ambulance trusts are ‘struggling to implement the Health and Safety at Work Act 1974 which specifically places requirements on UK employers to mitigate risks of stress at work’. They focused on two trusts with a history of reported bullying. They collected their data in 2017 and 2018 and investigated the ‘double-whammy of high job demands through ambulance target pressures (National Audit Office, 2017) and limited resources due to the proliferation of ill-treatment behaviours in the wider social care sector (Kline & Lewis, 2018)’. Both of these issues have clearly exacerbated during the pandemic and have persevered post-pandemic (The King’s Fund, 2023). Retrospectively, we can see that Manolchev and Lewis correctly predicted that increased demand, combined with resources pressures, did cause staff to either leave the NHS or ‘seek to resolve tensions through counter-organizational means’. As we now know, increasing vacancies, staff turnover, recruitment challenges and unprecedented strikes in the service have followed. Manolchev and Lewis also maintain that ‘in a caring-led environment, such as emergency care provision, it is fundamental that the embedded and historical inappropriate behaviours are recognized, named and openly addressed’ and, although they focus on operational team meetings, in our view, staff mistreatment within poor organizational cultures has become so pervasive that it needs to be addressed systematically at both strategic and operational levels.

Our final research article, from Heath et al. (2021), also addresses growing concerns about the welfare of ambulance staff in the UK. They take the view that caring for the patient requires caring for the provider and that this should become one of the ‘quadruple’, rather than triple, aims of the NHS Long Term Plan: ‘The changing role and evolving, if somewhat contested, professionalization of the ambulance paramedic, emotional labour, work intensification, the increase proportion of mundane cases which may seem less worthwhile, the resistant sub-cultures and the reinforcing emphasis on response times in performance management all contribute to the problematic nature of wellbeing in emergency ambulance services’. They point to the revival of interest in PV and NPG approaches and note that public health (and we would say emergency services generally) have been areas of theory and practice that have historically been resistant to interpretation and understanding solely based on NPM approaches and individualistic models of analysis. When prime minister, Margaret Thatcher was similarly faced with independent reviews of public health and rising health inequality (Black, 1980; Acheson, 1988) but effectively ignored the evidence and shelved the reports—not unlike the political leadership of Boris Johnson and Matt Hancock during the pandemic. Like Manolchev and Lewis, and Brunetto at al., Heath et al. suggest that cultural change in healthcare services may be required and suggest an approach to leadership and management based on the creation of PV and the measurement and management of health outcomes.

Debate piece

In their debate article, Lakoma and Liu-Smith (2024) eloquently capture the unprecedented disruption caused by Covid 19 and the huge additional burden placed on already stretched emergency services. In the face of these challenges, ambulance, police and the fire and rescue services performed admirably. Collaboration between emergency services in the UK was a strong positive characteristic of the response to Covid 19. The authors, rightly in our view, argue that the problems facing the emergency services in England have been years in the making and stem from long-term underfunding and poor political decision-making. They advocate that an alternative approach based on distributed decision-making, subsidiarity and NPG, assimilating notions of PV creation and a strengthened public health infrastructure, would almost certainly have resulted in better outcomes. These findings are consistent with some of the recent investigations by the UK parliamentary bodies (House of Lords, 2023; Public Accounts Committee, 2023).

Conclusion

In a recent review of Covid 19 in Brazil, Sott et al. (2022) found that the pandemic significantly affected the country, exacerbating issues that were already serious: ‘Brazilian health problems were worsened during the pandemic due to disbelief in science, lack of investment, and overcrowding of hospitals, causing the death of thousands of people. Political dilemmas put the country on a tightrope, leaving the population at the mercy of the virus, and the economic problems, which were fostered by the previous two issues, caused thousands of cases of unemployment, and increased the number of people living in extreme poverty’.

We will not be surprised if Baroness Hallett, chair of the current UK Covid 19 Inquiry, comes to some similar conclusions.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Paresh Wankhade

Paresh Wankhade is Professor of Leadership and Management at Edgehill University Business School, UK. He is the Editor-in-Chief of the International Journal of Emergency Services and is an internationally recognized expert in the field of emergency services management. He has recently been elected as a Fellow of the Academy of Social Sciences (FAcSS).

Peter Murphy

Peter Murphy is Professor of Public Policy and Management at Nottingham Business School, Nottingham Trent University, UK. He was previously the chief executive of a local authority and a senior civil servant. His most recent book, ‘Emergency services management: a research overview’ (Wankhade & Murphy, 2023), provides analysis of emergency services management research.