AES0019 - St John Ambulance – written evidence
House of Lords inquiry into Access to emergency services
Submission from St John Ambulance
Background
As England’s leading first aid and health response charity, St John Ambulance has always supported the NHS during periods of high demand, such as winter pressures, heatwaves, flooding, and – most recently – as part of 1.6 million hours of support during the coronavirus pandemic. Our Covid-19 response (further details below) has encompassed emergency ambulance provision, alongside volunteering in hospitals, and administering vaccinations, as well as providing further community-based activities that reduce pressure on NHS services.
Our wider ambulance operations work includes paediatric transport services, neonatal transport, bariatric transfers, end of life transport, renal dialysis transport and surge support to the NHS, working under contract to many NHS hospital and ambulance trusts around the country. Partnerships include work with Great Ormond Street Hospital for Children, Birmingham Women’s and Children’s Hospitals and Midlands Critical Care Transfer Services.
St John Ambulance’s role in emergency ambulance response
Since August 1, 2022, St John Ambulance has been commissioned formally by NHS England (NHSE) to provide the nation’s ambulance auxiliary in a four-year contract to add resilience to NHS ambulance trusts – treating and transporting patients across the country.
St John is contracted to offer a minimum of 5,000 hours per month to support the NHS. Figures show that since the start of the contract in early August, St John has provided over 6,000 hours per month. This includes September, when, as the nation mourned the passing of Her Late Majesty Queen Elizabeth II, thousands of St John volunteers and staff worked in partnership with the Government and London Ambulance Service to help keep the public safe, treating over 2,000 people and avoiding unnecessary ambulance callouts and hospital admissions, during the period of mourning and state funeral.
Our charity has over 250 ambulance vehicles and more than 800 emergency ambulance crew members, who are highly skilled clinically trained volunteers and employees. St John volunteers include healthcare professionals, such as doctors, nurses, and paramedics, who gain valuable experience of treating patients in different settings by giving their time to St John in a variety of roles, including on board our ambulances.
The latest chapter in our relationship with the NHS has given both organisations solid foundations to build on for the future. St John is now able to invest in its people and fleet through long-term planning, which helps the charity to live up to its mission of being an ambulance auxiliary that can be relied upon. Meanwhile, the NHS has certainty that St John can deliver, including scaling up surge capacity during times of significant pressure.
Professor Sir Stephen Powis, NHS Medical Director said: “This new agreement with one of our longest partners is a welcome addition as the NHS does everything it can to boost capacity ahead of what is set to be another difficult winter.”
St John Ambulance’s regulated services (ambulance operations and Homeless Service in Sussex) are overseen by the Care Quality Commission (CQC). Following inspections this summer, three out of five services have been rated ‘Good, with ‘Outstanding’ features. At the time of writing, final CQC inspection reports are due for the other two, but the drafts both rate St John as ‘Good’, meaning our ambulance operations are of high quality across the country.
Supporting and additional evidence
Our Ambulance Operations
As a leading supplier of ambulance services in England, St John Ambulance transports around 100,000 people to hospital every year and responds to emergency calls, including caring for patients at home without conveying them to hospital. Our ambulance operations provide services including paediatric transport services, neonatal transport, bariatric transfers, end of life transport, renal dialysis transport and surge NHS support.
St John Ambulance crews support the NHS by:
A crucial part of delivering health resilience through the Ambulance Auxiliary is to ensure that it is appropriately reflected within the national resilience architecture, to deliver effective emergency preparedness through representation within the emergency planning of Integrated Care Boards (ICBs) and local NHS ambulance and hospital trusts. Greater integration of the Ambulance Auxiliary and voluntary sector into these structures will help contribute to NHS trusts being able to deliver necessary clinical and logistical expertise at times of crisis.
Our asks of Government
We are asking the Department of Health & Social Care and Cabinet Office to deliver:
Our Community Operations
Falls Services
St John provides two 24/7 mobile response falls services in London and Wolverhampton to support the elderly and frail in their own homes. Every year, 1 in 3 people over 65 suffer a fall, which can cause serious injury and even death. According to NHSE, the costs from hip fractures alone are £6 million a day or £2.3 billion a year.
Our falls services provide a high level of care to residents, both clinically and non-clinically. 90% of dispatches are managed by St John to discharge at scene without needing an ambulance and calls are responded to in 20 minutes. We enable NHS Trusts to focus on other urgent calls relieving pressure and providing savings in terms of time and capacity.
Our falls service reflects the power of local partnerships to deliver improved patient outcomes and its vital local health providers work collaboratively to put patients first. We believe Integrated Care Boards must establish clear onward referral processes into existing support pathways utilising community first responders in line with guidance underpinning NHSE Winter Resilience plans, and the Department for Health & Social Care ‘Plan for Patients’ and forthcoming workforce plan.
As noted in the Fuller Stocktake Report, the introduction of ICBs represents a welcome opportunity to build on the outreach model that underpinned the COVID vaccination programme. This includes developing relationships within communities, utilising expertise, resources, and relationships held by the NHS, local government, voluntary sector, and community leaders.
To strengthen collaboration between emergency services, St John is asking to be added to the Directory of Services within NHS Pathways as an end-point provider to ensure falls calls are handed on by ambulance services to St John where our services operate to boost local NHS capacity, avoid unnecessary callouts and enable providers to expand falls services.
Night-Time Economy support
Our Night-time economy (NTE) provision offers safe spaces in town and city centres, focused on Friday and Saturday nights including London, Birmingham, and Newcastle. These are times when alcohol intoxication and related issues are at their most prevalent and increase pressure on emergency services.
Our teams ensure patients receive prompt care and treatment under the supervision of a qualified healthcare professional. Where a patient does need to go to hospital, St John will take them and where 999 calls are received St John can attend. The greatest impact is on ambulance services, where that can be up to 13% reduction in calls and 19% reduction in ambulance responses required where these services are active. Research carried out by St John revealed that 67% would seek help from the NHS first. The public is becoming increasingly aware of St John’s support for NTE with 68% mentioning St John services.
Our NTE provision covers 20 locations, commissioned variously by local authorities, NHS ambulance trusts, Police & Crime Commissioners, and other stakeholders, including businesses. In all cases, we work in partnership to provide healthcare professionals to support NTE operations enabling us to expand training and recruitment of volunteers. Strengthening collaboration between NHS Trusts and the voluntary sector will ensure local organisations can contribute clinical expertise to reduce pressures on the local NHS whilst maximising provision to support pre-hospital care.
Covid- 19 Response
St John Ambulance stepped forward to serve in the biggest peacetime deployment of our- almost 150-year history. Our volunteers have delivered over 1.6 million hours of service to support local communities and the NHS, this includes:
St John was approached by NHSE in March 2020, to support the NHS through a range of activities. Included in these activities was the need to support NHS ambulance trust partners via the deployment of St John ambulance crews from our network of 38 ambulance hubs.
As the only ambulance provider with a national presence, St John Ambulance’s capability of deploying the most advanced ambulances, equipment, and medications with fully trained ambulance crew, resulted in a full national mobilisation within 24 hours of the initial request, with support sustained through the pandemic.
Professor Anthony Marsh, National Strategic Advisor for Ambulance Services said:
“Without your volunteers and staff, the country would not have been able increase the number of resources that we have been able to deploy. This has undoubtedly relieved pressure on the 999 services and ensured we have been able to save as many lives as possible”
St John continues to 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.
We believe it is important to build on the innovations developed during the pandemic, to create a legacy of resilience for the NHS and communities, through greater integration of the voluntary sector into the architecture of national and local emergency planning, resilience, and response. This would deliver a public-voluntary sector partnership that should be central to future public sector workforce planning to help improve outcomes for patients.
October 2022
Additional Information:
St John Ambulance’s 2021 Impact Report & Annual Report
Video: https://www.youtube.com/watch?v=E9RoG1jQA4o&t=8s
Care Quality Commission reports:
https://www.cqc.org.uk/location/1-9475977147
https://www.cqc.org.uk/location/1-211025821
NB Draft reports for the remaining two St John Ambulance operations regions (London and the South) also rate our services as Good.
https://www.cqc.org.uk/location/1-7920985955
House of Lords Public Services Committee Inquiry ‘Designing a public services workforce fit for the future’ St John Ambulance Written evidence:
https://committees.parliament.uk/writtenevidence/106721/html/
Home Affairs Select Committee evidence on St John Ambulance’s night-time economy support (written and transcript of oral): https://committees.parliament.uk/oralevidence/3295/html/