St John Ambulance – Written evidence (FFF0039)



  1. Summary: About St John Ambulance and our COVID-19 response: 


1.1 St John Ambulance’s clinically trained volunteers have provided over 1.4 million hours of patient-facing service during the COVID-19 pandemic including working in hospital emergency departments and wards, with ambulance trusts, and in communities. The surge capacity of highly skilled clinical volunteers that St John Ambulance provides increases capacity to care for patients and enables NHS clinicians to respond to other urgent health needs.


1.2 St John Ambulance is also a key delivery partner in the NHS COVID-19 vaccination programme, aimed at getting the nation through the coronavirus pandemic. We are working with NHS partners across England, delivering a local response to this national programme. In 2020-21 we recruited and trained over 26,000 vaccination volunteers, using our longstanding expertise in empowering people with lifesaving clinical skills and the confidence to use them.  St John Ambulance volunteers have delivered millions of COVID-19 and flu jabs since the start of 2021, giving a million hours of their time to support the NHS vaccination programme, to date. The emergence of the Omicron variant in late 2021 saw an urgent need for more trained vaccinators to deliver first, second and booster jabs. St John Ambulance is continuing to support the health service by re-engaging and mobilising existing volunteer vaccinators across the country, as well as recruiting 6,000 new vaccinators in 2022.


1.3 The roles and deployments of our clinically trained volunteers have been sources of major innovation during the pandemic and demonstrated that St John Ambulance’s clinically trained volunteers (those who existed before 2020 and the many thousands more who have been recruited since) are a vital resource with further potential to support the nation’s health. 


1.4 St John Ambulance has undertaken its largest peacetime mobilisation, and it was thanks to our expertise and capacity that England has been the only nation in the world to train members of the public to administer the COVID-19 vaccinations themselves.  


1.5 We believe it is important to build on the innovations developed during the pandemic, to create a lasting legacy of resilience for the NHS and communities, through greater integration of the voluntary sector in the architecture of national and local emergency planning, resilience and response, and specifically through formal recognition of St John Ambulance as the nation’s ambulance auxiliary, cementing the role we have been playing thought the pandemic and creating greater certainty for NHS ambulance trusts. We have been delighted to play a role in the HEE-led discussions on long term health workforce planning and believe a long-term, integrated approach makes the most of the strengths of partnerships between voluntary and public sector. 


Our evidence to this inquiry will focus on questions 10, 11, 12 and 13.


  1. Voluntary sector embedded within national resilience architecture


2.1 We believe increased efforts should be made to make sure volunteers and voluntary organisations are involved in planning and preparation for emergencies at both national and local level.


2.2 The support St John Ambulance’s clinically trained volunteers have given in hospital emergency departments since the start of the pandemic, and over the past year in the vaccination programme, including administering vaccinations has brought into focus the huge contribution that highly skilled volunteers, such as St John people, make to the NHS and nation in times of crisis.   We now want to ensure that they can continue to support their communities and the health service and that we build a positive legacy for the nation’s resilience from the experience of the pandemic.


2.3 There should be increased recognition of the ‘volunteer not amateur’ nature of volunteers with specific highly trained skillsets, such as the clinically trained volunteers of St John Ambulance, and a focus within emergency planning and deployment on matching cadres of volunteers with specific skillsets to relevant areas of need. This includes recognition of the ongoing training and opportunities needed to keep those skills current and ready to deploy where and when they are needed most.


2.4 We support increased mapping of the local voluntary sector, its capabilities, and skillsets in each area so that statutory services know the support the sector can provide, and can match cadres of volunteers with specific skillsets to relevant areas of need, including the local capabilities of national organisations such as St John Ambulance’s local units. We believe there should be increased involvement of organisations of skilled volunteers in emergency preparedness, resilience and response at local level, including within exercises and through representation within the emergency planning of ICSs and local Ambulance and Hospital Trusts, alongside local resilience structures.


2.5 At national level, we believe the legislative structure for resilience should enable increased involvement of organisations of skilled volunteers in emergency preparedness, resilience and response. Greater integration into the national resilience architecture, with appropriate resourcing, would give St John Ambulance the confidence to ensure we could contribute our clinical and logistical expertise to national and local emergency planning to a far greater degree. We support the work of the NHS Volunteering Taskforce to bring together expertise from across health, social care and the voluntary sector to build on the incredible achievements of people who stood up to support their NHS and local communities during the pandemic. 


2.6 The challenges and innovations in response to the pandemic have demonstrated to us that amendments could reasonably be made to schedule 1 of the Civil Contingencies Act 2004, which details Category 1 and 2 responders in emergencies, to better recognise and reflect the role of the voluntary sector in emergencies and ensure greater integration of appropriate voluntary organisations in national and local emergency preparedness, planning and response.  


2.7 For example, during the COVID-19 pandemic, St John Ambulance has provided over 196,000 hours of ambulance support (predominantly via trained emergency ambulance volunteers, but also including professional and specialist services provided by the charity’s paid ambulance crews, under contract to the NHS and other healthcare providers), responding to thousands of emergency calls on behalf of every Ambulance Trusts in England. The tasks we supported with include: responding to Category 3 or 4 (urgent/ less urgent) situations to perform initial assessments and provide treatment, discharge on scene with appropriate support; provide onward referrals, and give the relevant advice and information to the patient; providing non-emergency transfer to hospital or another health care setting, or between hospital sites; and at times of high demand, St John Ambulance crews were also used to respond to Category 1 and 2 (life threatening/emergency) situations, adding clinical support to existing crews on scene or providing the initial response to 999 calls, backed up by a resource from the local Ambulance Trust where necessary.               


2.8 Our experiences supporting the health service during the pandemic and winter pressures have shown us how much St John Ambulance is needed as an auxiliary ambulance service. Our internal evaluation has found that Ambulance Trusts welcomed the additional capacity provided by volunteers and that this helped trusts to respond to as many patients as quickly as possible. Ambulance Trusts would welcome the opportunity to work closely with St John to develop a strong longer-term partnership and use the learning to date to tailor a model in line with their local circumstances and St John’s strategic objectives.  


2.9 We believe the best way to do this is national recognition for St John as the ambulance auxiliary, including specific recognition of St John Ambulance as England’s ambulance auxiliary within the Civil Contingencies Act 2004 and clear references within any updated guidance accompanying the Civil Contingencies Act 2004, that NHS organisations, not only Ambulances Trusts, may be able to call on St John’s clinically trained volunteers. This would allow us to cement and expand our emergency ambulance operations to the levels that have been needed during this pandemic as preparation for any future national crisis and to support the NHS deal with surges and give local ambulance organisations confidence in the scale of support we can provide, support long-range planning and ensure efficiency. It would also represent an example of the type of public-voluntary sector partnership that we believe should be central to future public sector workforce planning, especially for times of surge and emergency.


  1. Emergency Volunteering Leave (EVL)


3.1 The Coronavirus Act 2020 makes provision, in Schedule 7, for Emergency Volunteering Leave. However, this provision was not triggered and used during the pandemic.


3.2 Whilst the furlough scheme meant that volunteers were able to deploy in large numbers during the pandemic, especially during lockdowns, as this has wound down there has been a reduction in volunteer availability. Our own internal survey of volunteers during the pandemic found that work, and the financial need to work, remained the main restraint on volunteers giving more time to our pandemic response. 


3.3 There is a need for legislation to enable volunteer release from employment to respond in a crisis. We propose that Government develops legal mechanisms that ensure skilled volunteers are effectively supported to take time out from their employment to deploy in a crisis where their skills and experience are needed - building on the provisions set out in the Coronavirus Act 2020 but adapted for a post-pandemic world. 


3.4 The rapid way in which St John Ambulance has been able to surge volunteers during the COVID-19 pandemic is down to our reserve of clinically trained volunteers, ready-trained in skills needed, that we have been able to re-deploy and get vaccinating much more quickly than if we had had to reach out to and train new volunteers. This is supported by the breadth of our award-winning training capability, able to upskill for specific circumstances or needs at short notice.


3.5 We believe that sustaining this model and embedding the existing infrastructure of St John in future planning will be vital in ensuring clinically trained volunteer support ready to surge to support the NHS in time of crisis. To that end, we are building the St John Reserve, a group of people with at least a base level of training and interested in volunteering with St John and the NHS in a crisis or for large events. 


3.6 If Emergency Volunteering Leave were enshrined in law, the surge support capacity provided to the NHS by clinical volunteer reserves such as the St John reserve, would be far greater. 


  1. St John Ambulance youth programmes, including NHS Cadets


4.1 St John Ambulance has more than 9,000 volunteers aged 5 to 18 and aims to more than double its reach in 2022. After 100 years of supporting young people to learn and use health skills in their communities, St John Ambulance is expanding its programmes to reach a more diverse range of young people, teaching them valuable first aid skills and encouraging and supporting many of them to pursue healthcare careers. Among the new initiatives is NHS Cadets, developed from the knowledge that the majority of existing St John Cadets expressed an interest in pursuing careers in healthcare.


4.2 Announced in 2020, our partnership with NHS England focuses on supporting young people to consider volunteering and careers in the NHS. The NHS Cadets programme aims to attract young people who may be undecided on their career path and particularly those from marginalised backgrounds and others who might not have previously considered a career in the health service.


4.3 In September 2021, over 40 groups opened in new locations with over 100 groups opening in new locations in 2022. Supporting volunteering and careers in the NHS are key parts of the programme. For example, we know that each trust and NHS region has its own workforce needs, so where possible we aim to tailor the experiences of NHS Cadets to give them exposure to the career areas where there is a particular local need for more staff.


4.4 Even if they choose a different career path, we hope NHS Cadets will choose to continue to volunteer with St John or the NHS after the programme. On top of this, we know that the lifesaving first aid skills and life experiences they have gained will benefit them and their communities in the long-term. We are also developing apprenticeship pathways that take advantage of the diverse case mix that St John people are exposed to. Continuing to invest in programmes like NHS Cadets and taking a longer-term view to the development of the health workforce of the future are, we believe, critical parts of developing a diverse public sector workforce that is fit for the future and best represents the communities it serves.


February 2022