Select Committee on Defence Minutes of Evidence

Memorandum submitted by the Ambulance Service Association (March 2002)


  1.  The Ambulance Service Association is the representative body of the NHS Ambulance Service. Its members include all 32 ambulance trusts in England together with the national services in Scotland, Wales and Northern Ireland. Public ambulance services in Guernsey, Jersey and the Isle of Man are also members.

  2.  Ambulance services are an integral part of the National Health Service and represent its front line response to any terrorist incident. This "public safety" role as one of the three principal emergency services is widely recognised and they make a vital contribution to local emergency preparedness.

  3.  They have also been regularly called upon to respond to a range of major incidents so liaison and co-operation with other agencies at local level is generally excellent. The local approach to emergency planning remains an important foundation, but the type of events seen on 11 September and immediately thereafter clearly calls for greater emphasis on a national approach. The Association has some real concerns regarding the existing co-ordinating mechanisms at a national and cross government level.


  4.  In recent years emergency planning in the NHS has increasingly become a public health responsibility. Whilst that has a number of obvious advantages—particularly in respect of biological issues—the public health function is not particularly well connected on a day to day basis to those more operational parts of the NHS—such as ambulance services—which are responsible for front line delivery.

  5.  Although unintended, we believe events since 11 September highlighted a significant failure within the NHS to rapidly involve the Service at national level or provide it with the kind of timely and specific information and national guidance that were clearly needed by front line crews.

  6.  The Association's members are not arguing that ambulance services should not be included in the NHS's emergency planning system. But the very nature of their front line position, operational role and well defined links to other emergency partners needs to be better recognised within the Government's planning for terrorist threats and the specific issues related to the initial response and pre-hospital care better addressed.


  7.  The Association welcomes the fact that the London Ambulance Service—an active member of the ASA—was involved in some of the wider and more strategic cross-government discussions from the outset. That is fully justified given that the particular threats and operational requirement in London are not typical. But for that very reason the views and issues of all ambulance services need to be better represented and capability outside the capital also assessed.

  8.  Health, Home Office and DTLR Ministers have recently confirmed their expectation that all three "blue light" emergency services must develop more common approaches, joint training and operational procedures. The ASA fully supports that view and will be working as an equal partner with the Association of Chief Police Officers and the Chief and Assistant Chief Fire Officers Association to develop and maintain that capability. In return it would expect equal representation on all relevant committees and national working groups so that our views can be put directly and considered in the same way as those of our partners.


  9.  A major area of continuing operational concern is around staff protection and Personal Protective Equipment. Delays in producing a national specification for PPE meant that most Services had very little available and few if any staff trained to operate in hazardous environments in the immediate aftermath of 11 September. Some of those deficiencies are slowly being remedied but from the Association's point of view those who are actually going to be the most at risk must have more involvement in the discussion and choice of equipment. As a result there is a lack of operational confidence amongst staff and comparatively little real capability outside those few areas that had received funding, training or equipment from earlier initiatives.

  10.  The same situation applies in respect of decontamination capability and in both areas it is critical that national programmes of training and national operational procedures are developed to ensure a safe and consistent response. Joint command training, to ensure effective joint working between the police, fire and ambulance services, is also of paramount importance.

  11.  The ASA welcomes the recently agreed Memorandum of Understanding between the Department of Health and the DTLR to facilitate effective co-operation between the fire and health services in dealing with incidents where mass decontamination may be required. But the triage and treatment of those who are ill or injured remains a health responsibility and the capability to deal with smaller numbers needs to be developed and maintained.


  12.  ASA believes that events since 11 September have shown the need for improved high-level information sharing and national co-ordination amongst the various agencies and organisations. This is critical to our ability to provide an adequate local response. We are aware of outline proposals to develop improved co-ordinating mechanisms and as a front line responder believe that ambulance services should play a direct and integral part in developing those arrangements.


  13.  In common with other parts of the health service, ambulance services face competing priorities and limited resources. The ability to organise and then maintain the capability to respond to such incidents will require initial and on-going investment, particularly in staff training. Given day-to-day financial pressures that must be recognised at national level and specific investment should be made available to achieve and maintain preparedness.


  14.  ASA believes that more specific ambulance involvement at national level is essential if the UK is to be and how that contribution might benefit the whole system. This Association and its individual Ambulance Trust members are ready and willing to play a full and equal part but can only do so if we are properly involved, consulted and funded for what are clearly additional responsibilities.

  15.  The Association would be pleased to clarify or expand upon these points if the Committee would find it helpful.

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