Memorandum from the Ambulance Service
The purpose of this draft paper is to proffer
a considered response as part of the Public Consultation process
for the Draft Civil Contingencies Bill. The latter document sets
out a proposal for a new framework for Civil Protection in the
United Kingdom which, if enacted will have implications both corporately
and individually for all organisations associated with the response
to an emergency situation.
The consultation document accompanying the Draft
Bill asks that responses address specifically 23 Questions.
Q1. Is the definition of emergency the right
one? If not, in what ways should it be tightened or expanded to
exclude certain classes of event or situation?
In the opinion of this organisation the definition
provides sufficient width to cover all those events which could
reasonably be foreseen. The scope of the definition does not however
clearly identify its place in the management of incidents, declared
as an emergency which result from events outside of UK borders.
It is our assumption therefore that any impact
on the health, environment or wealth of the UK resulting from
an incident or event elsewhere in the world will be declared an
emergency for the purposes of the Bill and managed accordingly.
Where no such declaration is made then the resulting impact on
the areas of activity previously noted will be dealt with under
the appropriate existing legislation.
Q2. Do you agree that the obligation imposed
on both Category 1 and 2 responders by or under the new framework
will ensure operationally effective and financially efficient
planning and response to emergencies at the local level? If not
how should these obligations be increased or reduced?
The draft Bill identifies and places a duty
on organisations to bring "civil protection into the mainstream
of each local responders organisation's functions". In this
respect Risk Assessment and Planning and Prevention should be
core activity for any of the local responding agencies and the
outcomes of these activities shared amongst the appropriate agencies
in order to inform planning in the wider geographical context.
Similarly information and advice to the public should have a common
thread with emphasis given to the necessary area of threat. In
other words a health emergency should produce guidance with health
and well being at the forefront but underpinned appropriately
by the key messages from other agencies.
Placing such duties as statutory responsibilities
is fully endorsed and supported by this organisation, however
the draft Bill alone will not ensure that more effective planning
and response results.
Overall the result is likely to vary according
to the specific function of each organisation and the degree to
which they collaborate with similar partner agencies and their
regional liaison groups. The establishment of Regional (Local)
Resilience Forums should reduce these differences but is it envisaged
that such groups will have the power to regulate and audit compliance
or will this continue to rest with existing regulatory bodies,
Commission for Health Improvement, Her Majesty's Inspectorates
It must therefore be acknowledged that in order
to fulfil these roles the Government must ensure that sufficient
resources are made available to establish and maintain these activities
for both individual organisations and those charged with co-ordinating
such works at regional level. It is not suggested that the final
Bill identifies specifically such funding streams but they must
accompany its enactment.
Q3. Do you agree that the membership of Categories
1 and 2 is right? If not, which organisations should be added,
moved or removed.
The agencies listed against Category 1 and 2
responders are broadly balanced between responding agencies and
supporting agencies however the NHS response goes beyond that
of just Ambulance Trusts (guidance notes p 35 Section iv paragraph
Indeed Schedule 1, Part 1, Category 1 Responders,
Emergency Services, para 6 states "A National Health Service
Trust established under Section 5 of the National Health Service
and Community Act 1990 (c19) the functions of which include the
provision of Ambulance Services must by default include Acute
Trusts and Primary Care Trusts as both have a responsibility to
provide Ambulance Services to their patients and the community
they serve. Critically each speciality within "health"
will, uniquely, have either a response or support role depending
on the nature and type of incident. Arguably therefore each health
agency should be considered as an individual organisation.
It is clear then that Acute Trusts, Primary
Care Trusts, the Health Protection Agency and the National Blood
Service, including their equivalents in the devolved administrations
should be included in the Category 1 and 2 list.
In a long term incident it is likely that the
powers conferred under the act may be in place beyond the 30 days
cited. As such consideration must also be given to the fact that
as an incident progresses naturally from response to consolidation
and recovery the listed support agencies may well become the responding
agencies restoring essential services and supplies.
Q4. Do you agree that the Bill gives the
Government the right balance of regulation making powers to meet
its aims of consistency and flexibility? If not, please explain
how the powers should be extended.
The draft Bill facilitates the inception and
implementation of a broad range of regulations and advice to be
put in place as appropriate to the situation.
Throughout the document it is noted that a Minister
of the Crown may invoke regulations under the Act but does not
clearly identify which Minister has the lead. The aim for consistency
may therefore be undermined if there is no clear lead across all
Judgement regarding the balance of regulation
making powers to meet the stated aims cannot be determined at
this stage. Powers can only be balanced once they have been measured
against one another. Until the event occurs on the regulations
within the draft Bill developed further we do not know whether
those powers will compliment or contradict.
Q5. Do you agree that consistent arrangements
for multi-agency working should be established through the creation
of Local Resilience Teams? If not how else should consistency
Where such arrangements exist there is clear
evidence to support this assertion and therefore it is agreed
that the aim would be achieved. But clarity is needed around the
role the forum would play. Is it just a co-ordinating centre or
does it facilitate locally focussed policy regarding responses
within its area and do they have a function regarding audit and
compliance with the duties outlined in the draft Bill (see also
reply to Q2).
Q6. Do you agree that the partial Regulatory
Impact Assessment accurately reflects the cost benefits of the
Bill's proposals? If not, how should it be changed?
The enhancement of UK resilience to an event
of a significant scale both locally and nationally is the stated
aim of the draft Bill. Option 1 is essentially a "do nothing"
option which leaves current arrangements in place. Although as
noted previously where collaborative groups exist it is arguable
that resilience is satisfactory, however this is not replicated
across the country and it is desirable therefore to formalise
these ad hoc arrangements.
Option 2 attempts that formalisation in part
and weighs the costs against the achievement of the stated objectives.
Option 3 increases the range of functions to be undertaken and
requires that co-operation is enforced as a statutory function.
Option 1 is discarded because it is likely to
exacerbate existing failings. Option 2 appears to provide the
best way forward due to its attempt to establish equilibrium between
accomplishing the aim of the policy and the financial impact resulting
from formalising these activities. This option also allows for
other organisations, the voluntary sector for example, to be brought
under the umbrella of this Bill. The contribution and development
of the voluntary "health" sector, eg St John and the
British Red Cross Society is inconsistent across the country and
as such a key resource has in some circumstances been marginalised.
Option 3 is not fully discounted as it places
a duty on all involved to establish and maintain partnerships
and look beyond their normal function and core activity when planning
and undertaking risk assessments.
The latter would ultimately be the ideal because,
despite being obligatory, it promulgates a much broader based
integrated approach for both Category 1 and 2 organisations, however
it is agreed that ensuring consistency across the UK and the costs
involved could negate the operational gains realised from improved
Option 2 is therefore supported but as the products
of this legislation mature Option 3 should remain the goal.
Q7. Do you agree that funding for Category
1 Local Authorities should be transferred from the specific grant
(Civil Defence Grant) to the Revenue Support Grant?
The emergency services identified in Category
1 do not receive funding in the manner prescribed, so to comment
in detail would be inappropriate. Even so the additional duties
and responsibilities placed on such organisations will have a
financial burden, accordingly the necessary funding must accompany
Q8. Do you agree that the level of funding
to support the Bill is sufficient? If not, please explain why
you believe it to be too high or too low?
The Government is of the opinion that there
is sufficient funding to support Local Authorities in executing
their responsibilities under the terms of this Bill. Whether this
is or is not true is a matter for discussion within the appropriate
forum, what is clear is that to effectively discharge the responsibilities
outlined it will be necessary to allocate specified resources
to the task. In realising the aims and objectives of the draft
Bill the barriers to funding must be removed.
Q9. Do you agree that performance should
be audited through existing mechanisms? If not, what mechanisms
would you like to see established?
Performance Management and audit are key parts
of core activity, however where it is not then Clause 8 states
that a Minister of State may require a person or body listed in
Part 1 or 2 of Schedule 1 to provide information regarding compliance
and action taken to fulfil the requirements of the Act. Our contention
is then that the question is not whether existing mechanisms can
be used but whether such existing processes are appropriate. What
are the performance measures? Without such information it is difficult
to agree or disagree with this question.
Whatever the outcome performance monitoring
and audit requires additional resources both monetary and human,
the necessary financial support must therefore be provided.
Q10. Do you agree with the role of the Regional
Nominated Co-ordinator? If not, who should take responsibility
at the Regional level, and with what responsibilities?
The proposal is supported, but it is stressed
that the individual(s) must have previously established and test
links with the relevant Local Resilience Forum and moreover must
have a specialist background appropriate to the task/incident.
Q11. Do you agree with the principle of applying
special legislation measures on a regional basis? Please explain
The principle enshrined in the draft Bill is
welcomed as localised declaration provides scope for a specifically
targeted response appropriate to the needs of the region, locality
What is not clear is who has responsibility
for initiating the declaration from regional, locality level to
the Secretary of State and beyond. Is it envisaged that the local
Commanders ask for Catastrophic Incident to be declared and COBR
take the decision to invoke regulations?
Q12. Do you agree that current emergency
powers framework is outdated and needs to be replaced? If you
do not think it should be replaced, please explain why?
When the existing legislation was enacted its
intention was to facilitate the management natural disasters,
wide scale industrial unrest, civil disorder and other incidents
commensurate with the threat at that time. It has until now stood
us in good stead however in light of recent events, domestic and
international terrorist activity, fuel crisis etc the need to
update Emergency powers legislation is clear.
The draft Bill accommodates that need and as
such is supported fully by this organisation.
Q13. Do you agree that the circumstances
in which special legislative measures may be taken should be widened
from the limited threats to public welfare to include threats
to the environment, to the political, administrative and economic
stability of the UK and to threats to its security resulting from
war or terrorism? If not, how would you like to see the circumstances
narrowed or extended?
The scope of the powers outlined is fully supported.
Q14. Do you agree that the use of special
legislative powers should be possible on a sub-UK basis? If not,
The pan UK Emergency Powers Act is no longer
seen as appropriate to either the actual or the perceived threats
which we face as a sovereign state or as part of a larger geographical
alliance. The provisions of the draft Bill enabling sub-UK powers
Q15. Do you agree that authority to declare
that special legislative measures are necessary should remain
with the Queen as Head of State, acting on the advice of Ministers?
If not, who should this sit with?
The premise upon which the draft Bill builds
is one of improvement in the ability of this country to prevent
or mitigate the impact of an event or incident which affects the
welfare or economic stability of the UK. Whilst the Queen, as
Head of State must retain the power to formally declare "Emergency
Powers" it is necessary, in our view for Ministers and representatives
of the devolved administrations to have the ability and authority
to invoke such measures before such a formal declaration is received.
This appears to be the position of this draft Bill and is supported.
Q16. Do you agree that in the event of the
process of making a Royal Proclamation would cause a delay which
might result in significant damage or harm; a Secretary of State
should be able to make the declaration in place of the Queen,
as Head of State acting on the advice of Ministers? If not, is
it acceptable or is there another alternative mechanism.
The answer to question 15 refers.
Q17. Do you agree that the emergency regulations
should act as primary legislation for the purposes of the Human
Rights Act? If not, please explain why?
The draft Bill strives to maintain a balance
between the immediate needs of managing the event and the rights
of those affected directly or indirectly by the incident. As primary
legislation the draft Bill still allows the freedom to challenge
its powers but not at the expense of the task. In other words,
where action is needed it can be taken without let or hindrance
but such action is still subject to challenge and scrutiny as
and when it is appropriate. As such this position is supported.
Q18. Do you agree that the arrangements proposed
for Scotland strike the right balance between reflecting the devolution
settlement and ensuring consistency across the UK? If not, what
changes are necessary?
In its current formulation the local responders,
as listed are not consistent, therefore that section of the draft
Bill will not apply whilst the "Emergency Powers" element
will. Where this framework suits the needs of Scotland then it
should be adopted. That not withstanding, the issue remains in
respect of who has the right within the devolved administration
to invoke the powers contained within the draft Bill.
Q19. Do you agree that the arrangements proposed
for Wales strike the right balance between reflecting the devolution
settlement and ensuring consistency across the UK? If not, what
changes are necessary?
The structure within Wales is already similar
to that proposed by the draft Bill. It is believed therefore that
the Welsh Assembly should have the ability to and be accountable
for using the powers contained within the draft Act.
Q20. Do you agree that the arrangements proposed
for Northern Ireland strike the right balance between reflecting
the devolution settlement and ensuring consistency across the
UK? If not, what changes are necessary?
The answers to Questions 19 and 20 apply.
Q21. Do you agree that the role and accountability
of the Emergency Co-ordinator in a devolved country should be
flexible to reflect different types of emergency? If not, what
alternative role should the Emergency Co-ordinator have?
The draft Bill sees the post holder as the conduit
between the local incident management group and the appropriate
central Government body. He/she will have to have the ability
to enforce/enact powers at a local level in a manner consistent
with need. By definition therefore they must have the flexibility
required to effectively and efficiently deal with the incident
irrespective of its origin.
Q22. Do you agree that the devolved administrations
should be able to declare that special legislative measures are
necessary and take action accordingly? If not, please explain
The draft Bill proffers arguments both for and
against the ability to declare and invoke emergency powers and
control the resources necessary to mitigate the impact of the
If a key area of the Bill is to assess, identify
and mitigate local risk then the ability to declare the need for
emergency power and manage the event must rest entirely with the
devolved administration unless the incident is of such magnitude
that the administration is incapable of making that decision.
If this is not to be the case as implied by
the content of the draft Bill then the system as proposed could
be argued as unequal. This organisation contends therefore that
the advantage of empowering devolved administrations to seek and
control local solutions to local dilemmas far exceeds any argument
to the contrary.
Q23. Do you agree that London should have
different arrangements for co-operation, and that the proposals
set out are the right way to deliver this? If not, what arrangements
should be put in place?
It is a widely held view that London, as capital,
centre of international trade and a key part of the UK and Global
economy is a prime target for terrorism and moreover could be
significantly affected by any national or international event.
The draft Bill acknowledges this in so far as it states that the
city has "a unique challenge within the resilience agenda"
but it also notes that it has historically prevented and dealt
with a large number of emergencies. Much of the latter activity
has been the result of close collaboration between the "blue
light" services and their counterparts in the Local Authorities
and other partner organisations under the umbrella of London Emergency
Services Liaison Panel.
Specifically in relation to the provision of
Ambulance Services the London Ambulance Service and the London
(Prince of Wales) District of St John Ambulance have developed
a close working relationship the productivity of which must not
be underestimated. It is acknowledged that this relationship may
not be reflected across the country however Part 1 of the draft
Bill seeks to ensure collaboration between partner agencies. As
such it is not, we would suggest beyond the realms of possibility
that under the aegis of the local resilience forums such relationships
could be developed elsewhere.
The recent creation of the London Resilience
Forum and Team has seen further developments in collaborative
working and broadened the range of organisations engaged in incident/emergency
management and contingency planning. The proposed structure therefore
must be accepted as "right" for ensuring the resilience
of the capital but it must not be assumed that the capital's capability
is founded on equitable or freely available funding. Each organisation
has its own unique funding streams out of which it must finance
If the capital's organisations as listed in
Category 1 and 2 are to comply with the provisions of the draft
Bill then the funding for such activities must support that aim.
How that is achieved is a matter for discussion outwith the remit
of this consultation process however it is a critical element
in the successful execution of the duties contained within the
Many of the concerns raised by this draft Bill
will manifest themselves at the tactical and operational level
once the powers are invoked but it is our belief that highlighting
some of these points at this consultation stage may enable the
necessary actions to be put in train to alleviate these anxieties.
The draft Bill proposes that organisations will
be required to work outside their normal scope and function. This
raises the prospect of key emergency workers being diverted to
other work for which they are not trained or equipped. Whilst
the logic is understandable there is a concern that such action
could severely impact on the core activities of the Emergency
Also working outside the norm may involve Ambulance
Staff being asked to undertake clinical interventions for which
they are not authorised. The question here is not one of capability
but one of governance and accountability. Will there be a need
to ask the professional bodies who govern practice to suspend
their Codes of Conduct? The draft Bill also raises issues around
the assessment of competence by staff not trained to make such
judgments. This is especially relevant where the evaluation of
that competence could result in patients receiving treatment against
The draft Bill places duties on the listed organisations
to undertake pre-planning and risk assessments to deal with and
mitigate the effects of an incident. Although this is in some
part already a core activity it is clear that this function will
have to expand.
There is no issue with this increased scope
of responsibility however some of the activities necessary may
require supporting legislation. For example in respect of Ambulance
Trusts we will have to enter into detailed discussions regarding
the availability of suitable alternatives to transport patients.
Private Ambulance companies are an obvious choice but these are
unregulated bodies and NHS Ambulances Trusts have no legal power
to inspect or assess the levels of competence of their staff.
Equally there is no requirement for Private Ambulance Services
to equip their vehicles to the same standards as NHS Vehicles.
The contingency plan could therefore be weakened from the outset.
The inclusion of Ambulance Trusts as Category
1 responders is welcomed, however as noted in the core text of
the answers given previously the Ambulance Service is but one
part of the initial response by Health. There is an absolute need
therefore to include those other NHS bodies within the cadre of
The strategic aim of the draft Bill is acknowledged
but there are a number of key operational and tactical aspects
of its implementation that will need further debate. Critically
this legislation must rationalise existing practice without compromising
Overall the framework proposed in the draft
Bill is supported but funding will be key to the achievement of
its aims. The commitment to the latter must be clear and the inclusion
of a bland statement regarding consideration of extra funding
in the context of the wider resilience agenda does little to inspire
Assistant Chief Ambulance Officer
Chair, Civil Emergencies Committee
4 September 2003