No confidence in National Director

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Between Tuesday, April 29th, and Monday, May 12th, the ISP conducted an anonymous poll to assess attitudes towards the leadership of the NAS amongst its members. The poll consisted of three questions:

1. Are you a member of the National Ambulance Service (NAS)?

2. Do you have confidence in the National Director of the NAS?

3. Do you feel that the leadership of the NAS is acting in the best interests of staff and the public?

The vote was designed to be anonymous, but also for the results to be validated. To achieve this, a voting register was created from the ISP membership. Each voter was issued with a unique, random voter ID which was used to validate their vote. A link between registered voters and their voter IDs was kept for the duration of the poll and then deleted, ensuring that no link remains between each voter and the vote that they cast. Votes cast were checked against the list of voter IDs to ensure their validity, and voter IDs were counted to ensure each voter cast only one vote.

There were 915 registered voters, all of whom are, or were, operational, front-line ambulance staff. There were 624 unique votes cast. Therefore, the turnout was 68.2%. Question one was included to determine what percentage of respondents currently work for the NAS, as opposed to former staff who have retired or resigned. Five respondents (0.8%) indicated that they have retired or resigned and 99.2% indicated that they currently work for the NAS. Questions two and three had two possible answers: yes or no. A vast majority (98.6%) of respondents indicated that they do not have confidence in the National Director of the NAS. An even higher percentage (99.5%) of respondents feel that the leadership of the NAS is not acting in the best interests of staff and the public.

To summarise, an overwhelming majority of current, operational ambulance staff have indicated that they do not have confidence in the National Director, and they feel that the leadership of the NAS is not acting in the best interests of staff and the public. It is the view of the ISP that this, alone, indicates that the National Director's position is untenable.

We would also like to bring to your attention item NSASNAS3 from the HSE National Services and Schemes Risk Register. NSASNAS3 identifies risks to service delivery and staff wellbeing caused by ineffective leadership. The risk rating given to NSASNAS3 has remained high since it was added to the risk register on October 22nd, 2021. The risk status is listed as open and it was last reviewed on September 24th, 2024. The risk description is as follows:

SR1 Risk Acute Hosp RR 1306

There is a significant risk that effective leadership, governance and assurance structures and processes are not in place.

Key drivers of this risk are delays in the senior management approval process, the recent recruitment pause, poor staff to manager ratios, lack of supervisory positions and sub optimal core technocratic and business support structures.

Ineffective leadership and governance presents risks to the governance of service delivery to patients, the management of staff wellbeing and the potential for psychosocial harm

The current National Director was in the position for over two years when the risk was documented, having taken up the position in February, 2019. It appears – as evidenced by the ISP vote of no confidence – that front-line ambulance staff feel that the National Director has not been effective in addressing this risk during his time in the position. The risk owner for all NAS-related risks in the HSE National Services and Schemes Risk Register is the National Director. It follows that, in the face of an evident dearth of confidence, questions must be asked about the ability of the National Director to manage risks related to ineffective leadership in the NAS.

Questions have been asked about decisions and policy of the National Director for some time now. Recent revelations in the media suggest that the directorship of the NAS is not in keeping with the HSE's core values: care, compassion, trust, and learning. Our members feel that recent media coverage serves to validate and underscore the doubt that exists as to the ability of the National Director to carry out his role. The ISP has written to the Minister for Health calling for an investigation into the running of the NAS by the current National Director.