I've worked in the Ambulance Service in Glasgow for 6 years and I have to say that everything we are struggling with in our local services was predicted and already taking effect before I started.
I'm only a lowly clinician so I can only speak of what I encounter on a daily basis and as much as I'd love to have solutions for the problems, some are well above my pay grade but I can touch on some popular points from my point of view and I suspect some of the madness is reflected elsewhere in the system.
Managers- We (and the rest of the NHS here) appear very management heavy with a "jobs for the boys" culture that sees people who are part of a certain clique retire on very generous pensions only to come back weeks later in a band 8+ post which appears to the rest of us to have been specifically created for those people. Some of those in mid/senior positions having made almighty errors when they were on the road and seemingly promoted and placed in positions to get them out the way or who are regarded by those who worked with them as pretty s**** medics/line Managers who constantly float between different management roles. Then there are the non clinical managers who are given input to things which will effect patient care nationally, and challenge clinicians protests about it despite never having worked on the road. Accountants and physiotherapists can make good managers I'm sure but IMHO have no place in leading a blue light organisation where they fail to take on board the troops ideas or concerns.
Response times- You all have stories either first hand or from the media of long waits for 999 responses and there are multiple issues at play which cov only expidated and brought to public attention. On my patch the Gov closed or downsized 3 local hospitals (ED's and primary care) and replaced them with one huge ego project "super hospital" against warnings by medics that it takes a day to cut beds and years to create them. As a result one ED now covers an area which was once served by 3 and doesn't have the capacity to do so. It was designed with patient flow in mind but when they simultaneously also closed several smaller cottage hospitals and rehab units, the backlog of "blockers" began (several years ago). Social care services dont have the capacity to put safe discharge plans in place for the elderly and frail, or the morbidly unwell who do nothing to care for themselves and so these people remain in hospital beds or they are discharged into unsuitable surroundings and so end up falling again or remaining unwell, just to be taken straight back to the ED days after discharge. Our service response to the at times 6+ hours wait at ED has been to employ several new managers to hang around hospital on band 7 all day and update crews about tea and coffee facilities available.
The response model used by our control staff has been unfit for purpose since I started and several adjustments to it have just made it worse. We often get diverted from genuine calls to drunk people lying in the street who then gob off or try to assault you (often a fun little distraction), or from emergencies to chronic conditions that a person has been having for a week and done sod all about. ;Have you called the GP?......Can't get a GP.....Have you taken your meds?.....Don't have my meds.....Let's call your GP......sorted......But I'm really sore I want to go to hospital can you ring my social worker/housing officer/support worker to tell them I'm going, can you put those crisps in my bag etc.
Example: Yesterday we book on at 0700 and are sent to an Amber call (non ilt but requires a timely response) for an 84 yo gentleman recently discharged who has fallen and is trapped behind his bathroom door, query hip fracture. The job has been sitting since 0345 and nobody has been able to get access to the property to see him. He has spoken to someone via his falls alert system but is difficult to make out so his condition is unknown but he is breathing so hes an Amber. We make every effort to make progress to this gentleman and get within 500m of his address when we are diverted to a Red call (ILT) 12 miles away for a 24 year old female who is not conscious with difficulty breathing. We arrive and her man answers the door quite intoxicated to tell us they were on a bender and she collapsed and now won't wake up. She wakes up no bother with some gentle but firm encouragement and precedes to tell me she can't breathe. They had a barney and she has had an anxiety attack and went on to (I suspect) pretend she is unconscious presumably to arouse sympathy from her man. I'm not taking her to hospital so we spend an hour and a half on scene while she unloads on us about her poor MH. She then kicks off as we cannot refer her to the MH team because A)she's not a danger to herself and B)she's pished. She already had a MH worker but hasnt engaged with her because she says theres no point. She then pretends to have some sort of strange seizure where she can't open her eyes and her hands twitch for a minute or two. Her clinical obs were better than mines. We find out later that she is a regular caller and due in court for assaulting a female collegue last year.
Our shift continues with much of the same until lunchtime when we get our first patient genuinely in need of an Ambulance who has COPD but despite struggling to breathe for 2 days has managed to smoke 2 fags that morning, her son pointing out he knows she's really unwell as she would normally have smoked 5 by now. We treat her and contact her GP (to avoid using the ED and to arrange some antibiotics and a steroid) who tells us she isn't complying with her own treatment plan or collecting her meds and so the best option is hospital for an assessment. Ultimately we end up finishing 2 hours past our shift in another health board area with a dementia patient who is an ex bootneck and has phoned the police because he thinks he's being held prisoner in his flat. He gets carers in twice a day and his evening meal consists of some sandwiches and his family (who live down south) have been told he doesn't qualify for further home support and will just need to be put into a home. We end up taking him to the toilet, washing him as this hasn't been done that morning and making him some scoff and a brew while he goes through his photos and tells us about the time he got lost in weymouth and pumped a lassie who worked on the buses just for a bed that night. Most genuine and rewarding patient of the shift and a delight for me personally and why I go to work, but certainly not an ambulance job.
Staff- We have issues with staff absence largely with stress and msk injuries rather than covid and the service response has been to take on more students without putting in place any support for the mentors of these students to get them qualified and on the road. If you take on a student you are expected to do all your face time and course work with them in your own time unpaid after your 14 hour shift ends or on rest days. The goodwill to do that was there before but is now lost as you give enough of your time to the job at the cost of your family. The ability of new folk coming in to finish their course work seems to be getting lower as we go and several don't even last 12 months before jacking it in for something without the stress, abuse and demands from a very demanding public and inconsistent management.
Paramedic students who tend to be about 19 with no life experience have often fallen for the TV stuff or notions of being a hero for their social media profiles and many of them lose interest in the job quickly and see opportunities to take their degree elsewhere but the Gov are relying on them being the solution to our staffing issues. I personally worry about their MH in the long run as I was fortunate to already be a nutter before I joined and I'm sure many will take the opportunity to prosper elsewhere when GPs start taking on more paramedics to take up the slack there.
The longer term staff who book off with stress after say a traumatic pediatric job or being assaulted have had the TRIM pilot removed and many have had funding for councilling removed as well. Thats something I hope to work on personally when I've the time as I know how effective intervention can be with trauma and you can definatelty go back to work if you have the support in place. Peer support is great but the employer has to step up and put their money into their people when it's needed, the Army learned this and now the MH support is improving and starts in training to build resilience in people, something the NHS does not do or encourage. The absence process effectively punishes you for returning to work early and encourages you to take 6 months on the biff instead leaving others to pick up the workload.
I'll leave it there as a wee snapshot of things as I could go on but as I said much is above my paygrade and I don't have the statistics to back anything up. Fwiw for those who have been failed by the Ambulance Service and lost loved ones please understand we share your anger and as I said, we've been warning about it for years but the ones who make the noise don't get into the positions to change anything and suggestions are usually forgotten or aren't heard unless they come from management or an outsourced data company.
for calmness under pressure and you deserve a 
for not bothering her the rest of the night with urgent follow up questions. Hope you are both fully recovered now 
.
