Response to the Health and Social Care Committee’s inquiry on workforce burnout and resilience in the NHS and social care from St John Ambulance
St John Ambulance welcomes the opportunity to respond to the Health and Social Care Select Committee’s inquiry on workforce burnout and resilience in the NHS and social care. Our response is in relation to the following questions, which are relevant to our experience of supporting the NHS during the COVID-19 pandemic:
St John Ambulance is the UK’s auxiliary ambulance service and leading health and first aid charity. We have stepped forward at times of national crisis throughout our 140-year history, as well as providing seasonal support to the NHS during times of high demand through the winter months.
At St John Ambulance we have transformed our entire delivery to meet the needs of the National Health Service during the COVID-19 pandemic, placing our clinically trained volunteers and additional ambulance crews into communities and Emergency Departments nationwide. The ability of the NHS to respond to coronavirus has rested on having the staff and the facilities to care for patients; St John has liaised with NHS England and NHS Improvement from the very start of the crisis in order to support this.
We believe the NHS crisis support function that St John Ambulance has been providing throughout the pandemic should not be lost. Formalising St John Ambulance as the National Health Reserve would ensure that our clinically trained volunteers are ready and able to step up and support our health service in times of crisis now, and in the future. With a built-in expectation of support and proper resourcing, such a system would:
Policy Recommendation: St John Ambulance formalised and resourced to provide the National Health Reserve
In our response we outline the support St John Ambulance volunteers have given the health service in response to the pandemic so far; why a National Health Reserve is crucial to supporting NHS staff, both now and in the future; what we propose to deliver; and the mechanisms that need to be put in place to achieve this.
St John Ambulance COVID-19 Support to the NHS and communities
The clinical skillset of St John volunteers, unique within the voluntary sector, has enabled us to step forward to support the national COVID-19 effort and improve the life chances of the sick and vulnerable.
Despite the loss of our normal commercial revenue from first aid training and event cover, St John Ambulance has been able to refocus service delivery to assist the national effort with the backing of a £6.8 million grant from Government, via the £750 million charity support package. This supported the organisation’s core functions for 12 weeks in the immediate crisis period, for which we are immensely grateful.
Since the start of this crisis, St John people have given over 200,000 hours of patient-facing care. We have delivered an essential service for our NHS colleagues at more than 50 locations, working alongside Trusts to identify an agreed scope of tasks within the Emergency Departments which are suitable for trained volunteers to assist with. These have included transporting, befriending and supporting patients; undertaking CPR; and noting clinical observations.
We have also provided ambulance services from 31 hubs involving, at the peak of the pandemic, 75 volunteer-crewed ambulances on COVID-19-related operations every day. In addition, we have supported community projects as needed in local areas – helping to transport doctors, caring for people experiencing homelessness, assisting with blood donations, and many other activities.
In a letter to St John Ambulance this summer, Professor Anthony Marsh, National Strategic Advisor for Ambulance Services at NHS England and NHS Improvement, wrote:
“I am writing to thank you and express my gratitude for the continued support, dedication, and co-operation that you have demonstrated from the initial stages of the Global Pandemic. I honestly believe that if we had not worked so closely, the ability of Emergency Ambulance Service within our Country to respond so effectively to the pandemic, would have been greatly hindered.
Without your volunteers and staff members, the country would not have been able increase the number of resources that we have been able to deploy. This has undoubtedly helped to relieve the pressure on the 999 service and ensure we have been able to save as many lives as possible. Your members have been a credit to themselves, and yourself as a National Charity, and have shown themselves to be professional, caring, and skilful in the way they have conducted themselves.”
How a National Health Reserve could support the NHS and reduce the burden on staff
The pressure placed on the NHS this year has been unprecedented and there has never been more need to identify new ways of lessening the burden on staff as the pandemic stretches on and resilience wears away. A standing reserve of support provided by St John Ambulance in the form of a National Health Reserve would go some way to making sure the health service is not swamped and staff are not overloaded. A National Health Reserve would give certainty that our clinically trained volunteers could always assist hospital staff when needed in an emergency situation, as they have throughout the pandemic, providing vital assurance to staff and hospitals that they will always have the support they require.
Our proposal of a National Health Reserve is also likely to alleviate pressure on the NHS through encouraging clinically trained volunteers to take on permanent roles within the health service. We have already onboarded almost 500 new volunteers during the pandemic, including hundreds of airline staff who have been on furlough, to support hospitals in preparation for the winter (please see case study below). The experience people gain through working with us can serve as an induction to taking up other roles in the health service, filling workforce gaps. This sits alongside our dedicated work to increase NHS staffing capacity, announced earlier this year in partnership with NHS England and NHS Improvement for St John Ambulance to provide an NHS Cadets scheme, aiming to enroll 10,000 young people from under-represented communities into the health service by 2023.
What St John Ambulance could deliver as the National Health Reserve
We can provide a standing reserve of trained volunteers and ambulances ready for immediate deployment at times of high pressure on the health system, in agreement with NHS England and Improvement. This would involve clinically training an agreed baseline number of volunteers and maintaining a fleet of fully equipped ambulances to ensure readiness to step forward in any future health crisis.
Specifically, St John Ambulance would train and upskill at least 200 Emergency Ambulance Crew volunteers and at least 100 Advanced First Aiders / Treatment Centre leads to ensure their readiness to step forward in any future health crisis, together with a fleet of at least 120 vehicles including Treatment Centres and emergency ambulances, fully equipped to meet NHS standards. In addition, St John would continue to build a wider reserve to ensure that during a national crisis they could provide 20,000 hours of response a month during a declared national emergency.
What we need for an effective National Health Reserve
Financial support: To maintain readiness to deploy our volunteers at times of crisis, St John Ambulance would require a level of financial support from Government, with deployment costs agreed with the NHS.
Mechanisms for deployment of skilled volunteers: Currently, St John Ambulance is constrained in how much crisis support we can offer the Government and the NHS by the number of volunteers who are available to deploy when a crisis hits. Managing and preparing for surge capacity at times of crisis should be facilitated by effective mechanisms for enabling trained volunteers to step forward when needed in times of crisis. The Coronavirus Act 2020 makes provision for Emergency Volunteer Leave. Although this has not been triggered to date, we believe this process could prove effective in any future deployment of trained volunteers.
Inclusion in planning processes: It is essential that St John Ambulance’s insight and logistical expertise in deploying trained volunteers to support the NHS is a formal part of future strategic planning and preparedness for potential health crises, such as by inclusion in future preparedness exercises and in national and local emergency planning. Specifically, the following should be considered:
Provision for organisations who provide key national resilience functions in emergencies, such as St John Ambulance, to be included in national and local strategic planning and preparedness for emergencies.
Civil Contingencies Act
Updating Civil Contingencies Act guidance
Civil Contingencies Committee/Secretariat
Our experience of providing significant and sustained crisis support to the NHS means we are confident we can deliver the National Health Reserve. Resourcing a maintained reserve of clinically trained volunteers, vehicles and equipment would provide Government and the NHS with the reassurance of a planned baseline of support in a crisis, enable effective long-range planning, and enable the volume of volunteer support provided by St John Ambulance to be significantly scaled up, building on lessons learned during this challenging year to provide resilience for the future.