GEX0004
Written evidence St John Ambulance
1.1 As England’s leading first aid and health response charity, St John Ambulance supports the NHS and local communities during periods of high demand and in response to community health emergencies such as winter pressures, heatwaves, and flooding. St John has a volunteer workforce of over 40,000 volunteers of all ages, many of them clinically trained, supported by 1,500 employed staff, including ambulance crew.
1.2 At St John Ambulance, we know Community First Aid Saves Lives. Through our services we empower communities to respond to community health emergencies, ensuring everyone gets the help they need in a health crisis.
1.3 As the Nation’s ambulance auxiliary, St John Ambulance is a key delivery partner to the NHS and local communities in enhancing first aid resilience by delivering the following services:
1.4 St John Ambulance participates in the Voluntary and Community Sector Emergencies Partnership (VCSEP) to support communities before, during or after a national or local crisis.
1.5 This submission focuses specifically on strengthening national resilience arrangements.
2.1 Since August 1, 2022, St John Ambulance has been commissioned by NHS England (NHSE) to provide the nation’s ambulance auxiliary service in a four-year contract to add resilience to NHS trusts and local communities. The contract sees St John provide:
2.2 St John co-ordinates with NHS trusts to ensure we can provide the optimal support as the Auxiliary. This ensures the NHS has certainty that St John can deliver surge capacity during times of significant pressure e.g. winter pressures, heatwaves, or extreme weather events.
2.3 St John volunteers also include healthcare professionals, such as doctors, nurses, and paramedics, who are able to bolster their experience of treating patients in different settings in the community, as well as contributing to the quality of training received by volunteers.
2.4 St John Ambulance sits on several Local Resilience Forums (LRFs), Borough Resilience Forums (BRFs) and where applicable Local Health Resilience Partnerships (LHRPS) to participate in multi-agency planning for a variety of potential incidents. Although unable to be represented in every area, we work with partners in the VCSEP on the collective coverage of the voluntary sector. As a key provider of services to the NHS, we follow NHS England Core Standards for EPRR in accordance with the Civil Contingencies Act 2004 and the Health and Social Care Act (2012).
2.5 St John engages in various risk-based programmes with LRFs, alongside developing our own adverse weather plans and mature adverse weather alerting systems to inform emergency response operations in response to extreme weather events.
3. Does the UK Government have a clear vision and well-defined roles and responsibilities to manage national risks
3.1 St John Ambulance welcomed the publication of the Cabinet Office’s National Resilience Framework in December 2022. Specifically, we welcomed the Framework’s acknowledgement of resilience as a ‘Whole of Society’ endeavor and its commitments to strengthen leadership, accountability, and transparency by:
3.2 St John believes the UK Resilience Framework is a welcome first step in defining lines of accountability for resilience arrangements at a national and local level to support a ‘whole of society’’ approach. St John agrees with the assessment of the National Audit Office report into National Resilience that the government has yet to specifically set out the roles and duties of local government, the private sector, voluntary sector and the public, leading to uncertainty on actions to take in response to weather events at a national and local level.
3.3 According to the UK Government’s national risk register, 8 of the 89 risks identified relate to extreme weather. The Cabinet Office Resilience Directorate and Local Authorities have a responsibility to ensure local actors are best equipped to perform their resilience role. That includes providing a framework of national organisations with local expertise who can best support specific needs. As the nation’s ambulance auxiliary, St John deploys volunteer and employed ambulance crews to 10 out of the 11 Ambulance Trusts, responding to Category 3 or 4 (urgent/less urgent) situations and Category 1 and 2 (life threatening/emergency) situations when necessary, delivering 8,000 hours of surge capacity support at the height of NHS winter pressures to manage demand.
3.4 St John volunteers who support first aid operations can also take on new roles, transferring the skills they already had into new settings. For example, St John Ambulance’s involvement in the Covid Vaccination programme was built on our well-established training capacity, enabling us to deploy over 26,500 volunteer vaccinators to support and administer vaccinations contributing to over 1.7 million patient facing hours support to the NHS and local communities to support the covid response. This brought into focus the contribution that trained volunteers can make to the nation in times of crisis to enhance community resilience.
3.5 As extreme weather events are forecast to become more frequent and severe, St John believes the Cabinet Office must build on the lessons of the pandemic and reiterate to local authorities and emergency services the surge capacity support and community links the voluntary sector can provide to enhance local resilience. Any guidance issued by the Cabinet Office must encourage local authorities to utilise the diversity and expertise of the sector, ensuring roles are defined to support our response to extreme weather events.
3.6 St John is asking the Cabinet Office to set out the roles and responsibilities of National and Local Government to engage with the voluntary sector and the public to deliver a ‘whole of society’ approach to national resilience.
4. How can the UK Government develop Resilience?
4.1 We believe increased efforts should be made to ensure volunteers and voluntary organisations are involved in planning and preparation for extreme weather emergencies. We 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 to inform future preparations.
4.2 There should be increased recognition of the ‘volunteer not amateur’ nature of volunteers with specific trained skillsets, such as the clinically trained volunteers of St John, 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.
4.3 St John Ambulance supports increased mapping of the local voluntary sector, its capabilities, and skillsets in each area so that statutory services and responders 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 units. We believe there should be increased involvement of organisations of volunteers in emergency preparedness, resilience, and response at local level, including within exercises and through representation within the emergency planning of Integrated Care Systems and local Ambulance and Hospital Trusts, alongside local resilience forums as recommended by the Manchester Arena Inquiry Volume 2: Emergency Response report.
4.4 At a 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 and response. Our existing ambulance auxiliary arrangement provided welcome recognition of the value of investing in the underlying capacity to respond (people, fleet, skills) as well as funding operational delivery itself. We would welcome consideration of this principle of investing in foundational capacity to respond.
4.5 We continue to recommend the UK Government implements the recommendations of the recent NHS Volunteer Taskforce Report (published in June 2023) to bring together expertise from across health, social care, and the voluntary sector to build on the achievements of volunteers who stood up to support their NHS and local communities during the pandemic and this can also be reflected in response to extreme weather events. These include:
4.6 St John was disappointed the Government’s post implementation review of the CCA in 2022 and the resilience framework concluded “there is not yet a case for expanding or changing the duties” of category 1 and 2 responders and the review did not indicate a need to strengthen duties for responder engagement with the voluntary sector beyond the current requirement to “have regard to”.
4.7 We recognise legislation is not the only vehicle for improving UK resilience and partnership working at a local level. The CCA is supported with statutory and non-statutory guidance, identifying good and leading practice for the fulfilment of the legal duties. St John is asking the UK Government to strengthen this guidance to local authorities and statutory responders to support strategic approaches to community resilience at a local level.
4.8 There is an urgent need for legislation to enable volunteer to step forward to respond at times of national crisis. An effective system would enable an employee to have a legal facility to ask their employer to sign an “emergency volunteering leave agreement” so volunteers can take a set period of unpaid leave to deploy at times of crisis with certainty for employers. The National Council of Voluntary Organisations Time Well Spent Survey 2023 funded by the Department for Culture, Media and Sport found that work and study commitments and lack of spare time remained the main barriers to volunteering.
4.9 St John proposes the UK Government develops legal mechanisms that ensure skilled volunteers are 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 schedule 7 of the Coronavirus Act 2020 but adapted for a post-pandemic world. If emergency volunteers leave were enshrined in law, it will represent a new public-voluntary sector partnership to support the NHS and local communities and could be embedded into future public sector workforce planning. This would increase the surge support capacity provided to the NHS by St John’s clinical volunteer reserve.
February 2024