e-imagining Ambulance Services Through Participation and Deliberation Paresh Wankhade, Geoffrey Heath, Peter Murphy

This chapter identifies the serious issues of mental health and wellbeing of English paramedics working in the emergency ambulance service. It identifies the case of top-down performance measures and absence of indicators of wellbeing in ambulance performance reporting. It also documents the impact of such measures on frontline staff and its implications for their motivation and commitment. The chapter advocates a more decentralised, open and discursive approaches on performance management packages in the public sector, as key methods, for re-imagining the ambulance and wider public services in a global context. It first provides the context of the English ambulance service and the challenges it faces within the context of the New Public Management (NPM) and New Public Governance (NPG) literature. Key issues concerning performance metrics and staff wellbeing and welfare are identified and discussed. The notions of communicative rationality, deliberative democracy and agonistic pluralism are then introduced as a framework for analyses of the state of both wellbeing and resilience and the performance regime within the English ambulance service. The chapter then integrates the themes to the re-imagining of public services discourse internationally, suggesting a more participative approach. The chapter makes a case for a greater participative and dialogic engagement to address the intertwined relationship of ambulance staff wellbeing within the performance management regime of the service. We re-imagine the process to take into account the wellbeing of ambulance staff as an integral and intrinsic part of the delivery of a service and that deliberative methods of participation are deployed in the reimagining of ambulance services and the public services more generally.