Private Hire Licences for Ambulances
05/10/2007

PRIVATE HIRE REGISTRATION OF AMBULANCES.


As you will now be aware we are having a meeting to discuss this issue and form a plan of action.

Having tried all the persuasive arguments with the Prime Minister, the Department for Transport, Transport for London and the Department of Health to NO avail it appears that we will have to resort to confrontation rather than cooperation.

Please bear in mind the Prime Minister has been made aware of the concerns, and has done nothing about it. He will however be asking for your vote at the next election. Personally he can ask on bended knee, and I will simply remind him that ‘support’ works two ways !!!!.

The course of action will be decided by the votes taken at the meeting.

As an Association we have been fighting this Legislation ever since it first came to our notice about 6 months ago.

Other member Services have also been involved, additionally with their own are Licensing officers.

As it stands at this moment virtually every licensing authority is adopting different attitudes. Some are saying every Ambulance, some are saying the NHS are exempt, some are saying None Emergency Ambulances.

As an Ambulance is Registered at the DVLA in the category ‘Ambulance’, that vehicle can be used for whatever purpose in the Ambulance field. There is no such thing as an Emergency Ambulance.

An Ambulance is an Ambulance.

I can find NO provision in the new Law which allows Licensing Officers to make up their own definition of an Ambulance. However it appears they think they can. It is up to us to stop them from doing so.
The time to stop this is NOW !!!! - - Not wait until it is all in place, then complain.

I think it maybe fortuitous that this government maybe calling an election shortly. With a few thousand people employed in the Ambulance world possibly being forced out of business, and another few thousand of the relatives, dependants or what have you facing bleak prospects.

I would imagine a considerable number will NOT be voting for a government which seems determined once again to introduce yet another ‘stealth tax’ which will in fact affect every man woman and child in the Country, whether they are connected with the Ambulance field or not.

Some of the effects of forcing Private Ambulance Services out of Business :-

One there will be an enormous burden placed back on the NHS, with some three million patient movements currently being carried out under contract to the NHS.

I am sure everyone is aware of the number of daily complaints regarding the NHS Ambulance response times in an emergency.

Also the Hospitals themselves complaining daily about none urgent transport with patients waiting hours and hours.

If as we all know the NHS Ambulance Trusts can’t cope at this time, what is going to be the result of the additional work!!!! Longer and longer delays which will inevitably lead to unnecessary deaths in an increasing number of instances.

No longer will there be Ambulances available to cover the many Sporting Events which many people enjoy, and are required by the Health & Safety Laws to have Ambulance cover, Motor Racing, Motor Cycling, Equestrian Events, American Football, Kick Boxing, you name it, they will all virtually disappear.

To the best of my knowledge this ridiculous and unworkable legislation was introduced without any Consultation, or Regulatory Impact Assessment. If anything there should be an immediate assessment of who ever introduced this Legislation and the government bodies that supported it.

Perhaps if that were done quickly enough we may be able to get an Ambulance to transport them to the appropriate treatment centre whilst there is still an Ambulance available.

I would point out that this Prime Minister was a staunch supporter of the Competition Act, and the Enterprise Act, introduced by this government. Personally again I applauded that legislation, Sorely needed and seemingly sensibly introduced.
I wonder if that support was with the full knowledge that there was forthcoming legislation which “sneaked in’ without consultation would counteract those Acts, leaving us all back in the situation before they were introduced.

Lastly Transport for London have been visiting Services telling them what is required, costs, terms and conditions etc. I understand from conversation with Transport for London that they no more about Ambulance work than any of you , even those of you with 30 years experience

It appears they are totally dogmatic on this issue, they also state the NHS will have to conform, and once Registered not only will you have to comply with Ambulance Legislation, but their legislation as well.
When I pointed out that some of the Laws were contradictory, and conforming with them would put one in breach of the Law, they seem to think their word will be law !!!!.

Even though they give the impression of knowing as much about Ambulance work and Legislation as I know about flying to the moon.

Again only speaking for myself, when a death or other serious consequences occur due to this totally ill thought out legislation, I will be the first to support any members of the public with whatever expertise and experience I can muster to sue the government, or departments concerned with this nonsense.

I am sure many of you will think likewise.

Regulation of the Indpendent Ambulance sector.
11/02/2006

Meeting to discuss the Quality Assurance of
Independent Ambulance Provision

Friday 28th October 2005


Purpose of the Meeting:
In June 2005, a strategic review of ambulance services was published - Taking Healthcare to the Patient – Transforming NHS Ambulance Services.




It set out a deliberate direction for NHS ambulance services. In future, they will provide an extended range of services, focusing on taking healthcare to the patient, providing fast, effective and convenient care at the first point of contact.




Increasingly, NHS ambulance services are not provided by NHS ambulance trusts, particularly in terms of PTS. This is a trend likely to continue; therefore, it made the following recommendation:

“The Department of Health should support the NHS in taking further steps to ensure that services provided by the independent ambulance sector on behalf of the NHS are of at least as good quality as those provided by the NHS……..
The NHS should ensure that existing standards and legislation are consistently enforced through contractual arrangements with the independent sector. The Department should support services by putting in place a system of accreditation of independent ambulance providers”.






This recommendation has been accepted by the Department of Health subject to consultation with stakeholders on the most appropriate system for accrediting independent ambulance providers. This meeting is the first step in that consultation process and is designed to begin to explore the possible options for quality assurance including models of regulation.



It needs to be recognised however, that any changes to regulation will clearly be subject to Ministerial agreement, public consultation and appropriate legislative/regulatory changes, including impact assessments.



Supporting Information:
In order to help stimulate and inform discussion, papers have been prepared on two areas:

• Paper 1 - the role and remit of the NHS and independent sectors, and the case for change in the way quality is assured in the independent sector; and


• Paper 2 - a summary of stakeholders’ views received to date.





Paper 1 - Independent Ambulance Provision and its Quality Assurance



For the purposes of this paper, the term “independent ambulance provider” is defined to mean private, voluntary, not for profit and independent ambulance services i.e. non-NHS ambulance services. This includes private trading concerns of NHS ambulance trusts.

Their main activity includes:
• non-emergency patient transport, inter-hospital transfer (including some high dependency transfers) and discharges
• first aid training to industry
• ambulance cover for public events e.g. sporting events, pop concerts, etc
• transportation of human organs for transplant purposes, and the transportation of organ retrieval teams
• contracts with private hospitals and clinics to provide ambulance services.



Some services may also be contracted by NHS ambulance trusts to provide support to emergency ambulance services, mainly in the form of high-dependency emergency transfers between hospitals and Category C and GP urgent calls at times of peak demand. NHS major incident plans also acknowledge the supporting role that may be required from the private and voluntary sector.

Unlike other private companies providing NHS services, there is no statutory regulation of independent ambulance services, although anyone running such a service must of course comply with all legal requirements concerning condition of vehicles, manner of driving, administration of medicines etc. Paramedics have to be registered with the Health Professions Council but technicians and other ambulance staff are not subject to the same regulation, as this simply does not currently exist.



In December 1993 a Code of Practice for private ambulance services was sent to all those within the NHS with responsibilities for the commissioning and or provision of patient transport services. The Code of Practice covered such issues as staff selection and training, vehicle standards, drivers’ hours regulation, etc.



The Code of Practice remains the only Government-set standards. It was primarily designed as a tool for purchasers to employ to help satisfy themselves of competency when deciding on a prospective provider.

There is some self-regulation in the private ambulance sphere, provided in the main by two organisations, the British Ambulance Association (BAA) and the National Association for Private Ambulance Services (NAPAS). Any private ambulance service that chooses to become a member of either of these must satisfy certain standards laid down by that organisation. Members can also expect to be subjected to unannounced inspections to check standards.


Context


In 2000, it was estimated that there were in the region of 150 private and voluntary ambulance services in England operating about 600 vehicles. Our best approximation is that there are currently between 250 and 300 organisations. The BAA having 91 members, NAPAS having 60.



In June 2005, a strategic review of ambulance services was published - Taking Healthcare to the Patient – Transforming NHS Ambulance Services. The Department should support services by putting in place a system of accreditation of independent ambulance providers



There are a number of reasons why the review group felt that accreditation would be helpful:
• Compliance with the existing 1993 Code of Practice is voluntary and needs updating to reflect changes in legislation and modern practice.


• An accreditation system would help to ensure a level playing field when competing for contracts and reduce the risk of unsuitable organisations delivering care.


• The rapid growth of competitive tendering for contracts puts significant pressures on purchasers and providers with a consequent risk to maintaining high standards.

Benchmarking would clearly provide a measurement for and commonality of measuring quality.
• Further accreditation and associated agreed training requirements would help to ensure commonality of standards between providers.


• All staff employed by an independent or NHS provider who have access to patients in the normal course of their duties, should have been checked through the Criminal Records Bureau prior to employment. Regulation would provide a method for checking.



Private ambulance companies and their representing associations are calling for a regulatory body to be introduced.



There is an increasing call for all providers of ambulance services to be governed by the same standards. NHS organisations are responsible for providing care to patients that complies with the standards set out in ‘Standards for Better Health’, whether care is provided directly or by contract with a third party.






Paper 2 – Summary of views received

Ambulance Service Association
The ASA has pledged its full support to the recommendation in ‘Taking Healthcare to the Patient’ that independent ambulance providers should be accredited.

The ASA suggest that as an absolute minimum any independent provider contracted to the NHS should be accredited and ideally any business trading as an ‘ambulance service’ even if its work is entirely non-NHS should also require accreditation.

The ASA’s view is that accredited independent providers would need to meet the standards expected of NHS ambulance providers in terms of vehicle provision, equipment and staff training, relevant to the services that are being provided. In addition, the ASA believe that independent providers should meet the appropriate standards set by the Healthcare Commission, National Patient Safety Agency and the Medicines and Healthcare Products Regulatory Agency as well as complying with the various laws and regulations concerning vehicles, driver training etc., and that staff employed in clinical roles should be registered with the appropriate regulatory body.

The ASA’s view is that responsibility for accreditation and its periodic review should lie with the Healthcare Commission with the proviso that as the HCC remit legally extends just to England (although it operates under contract to the devolved administrations in Wales and Northern Ireland to provide a limited range of services) – any solution should cover the whole of the UK. In addition, the ASA point out that the system should be forward looking, recognising the likely growth of plurality in the NHS.

Ambulance Service Institute
The ASI expressed the need for full consultation with associations/organisations and with independent operators making them aware of any regulation or recommendations to improve the services and accountability to the public who use the services.

The ASI commented that any system of quality assurance or regulation will need to be administered by a body independent from government or local councils and that this body should register and monitor private/Independent ambulance providers. In addition, their view is that the rules and regulations must be same for every ambulance provider, i.e. NHS, private sector, military or voluntary sector.

The ASI believe that a code of conduct for private ambulance services with built in quality standards should be devised and acceptable qualifications of staff working within ambulances should be agreed (i.e. new ambulance carers award with Edexcel/IHCD/Btec.). Furthermore, ASI believe that all organisations/ companies must be allowed to register and run courses if they meet clear criteria and that the NHS must not be sole provider of the award and the examination body must be independent.



British Ambulance Association
One of the expressed objectives of the BAA is to campaign for the establishment of a regulatory body for the private ambulance sector.

The BAA and its members give their full support to this initiative to introduce a regulatory body/accreditation and have expressed a strong interest in forming such a regulatory body were it established.




The BAA believe that any system introduced must not be discriminatory in favour of any sector within the ambulance spectrum and that the law must be followed in relation to the Competition Act 1998 (now incorporated into the Enterprise Act 2002).





They suggest that legislative action is necessary to stop sub-standard services from continuing to operate and that commissioning by NHS organisations needs to be supported so that sub-standard services are not kept in business.





The BAA propose that a regulatory body be set up by and from within the private ambulance sector, directly answerable to the Department of Health (with the potential for a DH representative to be nominated to the regulatory body) and that all terms and conditions of registration of a private ambulance service would be negotiated between the regulatory body and the Department of Health.




The regulatory body would then be responsible for the admission to, or refusal of, membership and no independent provider would be allowed to operate unless they were a member of the regulatory body.

In addition, the BAA envisages that the regulatory body would be responsible for the maintenance of standards of all members, together with promoting the pursuit of excellence by all members in all areas of their operations.




British Paramedic Association
The BPA’s purpose is to provide representation and support for the wider ambulance profession in ensuring that standards are appropriate to the work of the profession, and that educational delivery meets the requirements of professionals leading to common standards of practice and high levels of patient care. Their aim is to ensure that these principles apply across the spectrum of delivery, whether it is the public, private, military or voluntary sectors delivering care to patients. They are also aiming to achieve a level of education and awards that will be open to all ambulance staff irrespective of who employs them ensuring that standard approved awards are used making career progression easier and improving the flexibility and movement of the workforce.

The BPA supports regulation of the independent ambulance sector as a way of developing systems and standards for approving all ambulance providers to deliver safe and effective services for patients. The BPA is also of the view that the development of any system of regulation will need to be entirely appropriate to the level of service delivered which can vary significantly. Finally, the BPA feel that the system needs to ensure that the education and training of staff is appropriate and that vehicles, equipment and support services produce high quality, low risk services to patients.

National Association of Private Ambulance Services
NAPAS’s view is that:
• All three sectors must be regulated (public, private, voluntary);
• Self-regulation within each individual sector with peer reviews would be the preferred method;
• Regulatory costs must not exceed existing costs or they must be provided on a low-cost basis by any regulators;
• NHS ambulance trusts or their officers as the determined dominant provider of ambulance services in the UK, cannot be involved in producing regulatory standards for the private sector (this may well instigate separate action by individual businesses under the Competition Act and European Community Law);
• Should regulation be instigated through the Healthcare Commission then each and all sectors shall be likewise regulated, not just the independent sector, and the preferred method would be through peer reviews with each sector reviewing itself through compliance with acceptable written codes of practice applicable to the services being provided, with consent of those affected, and the required documentation being passed onto the Healthcare Commission for final acceptance; and
• Ultimate aim over a period of time will be regulation that provides “that no such service shall trade unless they belong to a self-regulatory group with an acceptable written code of practice”. This will however require the consent of all involved.

ASSOCIATIONS
21/07/2002

OK as Aidan requests, lets get real. The British Ambulance Association wants
to create a representative body for the whole of the Ambulance Spectrum. It
doesn't matter what qualifications you hold, or what grade you are, AS LONG
AS THE QUALIFICATIONS ARE FROM A RECOGNISED SOURCE.

Anyone joining will be a member of the Association, registered in the
category in which they hold that qualification. State Registered Ambulance
Paramedics, or EMTs or Care Assistants, or whatever. Remote Medics,
Military Medics, First Responders.
There will be categories for ALL

However we are trying to encompass the whole of the Ambulance spectrum, AND
that does not simply mean medically trained staff. What about Full Time
Control staff, are they not part of the Ambulance world. Funny sort of
Service that could operate without them !! Yes there will be a Registration
category for them also.

Some people make a big point of the fact that we represent Private Ambulance
Services. So what !!! All of the Private Service members have supported the
Association in its efforts to introduce legislation to improve the Ambulance
world and will continue to do so.
It would be a strange Association that helped and assisted the membership to
become recognised as a truly professional body, and didn't have any regard
whatsoever for the Services, and the standards of the Services they may work
for.
Does anyone want to be a really proud professional, skilled, smart, competent, and drive around in a bucket of rust. ???

You will have seen postings critical of the fact that we are an "Employers
Association" Absolute Rubbish !!! - - - Unless of course you believe that two
NHS State Registered Ambulance Paramedics crewing an NHS Ambulance together,
who decide they have had enough of the NHS. Leave the NHS, buy an Ambulance,
start a Private Service are suddenly classed as employers. They are still
out on the road working, they still have to maintain their skill levels, they
still have to prove competence when it comes to re-certification.

You may also wish to look at the BAA main site, www.baa999.co.uk .When you get to the home page Click on the button that says “Request Form”, you will then see that someone may have been deliberately trying to mislead you.


When we get to the topic of the Health Professions Council, firstly let me say that my understanding is that you don’t have to belong to any “Association” in order to be State Registered. As long as you are State Registered, and pay your renewal fees to the HPC, - - and of course can meet the requirements. That is the only requirement.

I am basing this on the forum I attended last week, and listening to the questions and answers to and from a number of state registered Personnel, Mostly Chiropodists and Physiotherapists, many of whom do not belong to an “Association” but are State Registered. It seems the same criteria applies to all State Registered bodies.
Next ?? Is the HPC a representative body. NO IT IS NOT. It is simply the governing body for the granting of State Registration.

That means it is pretty obvious that apart from the State Registered Members the BAA has, the HPC will be of no consequence whatsoever.

BUT, BUT, BUT, amongst our members we are bound to have many members who are seeking State Registration, some who feel that they are qualified NOW, others who are working their way towards meeting the criteria.

THIS IS WHERE the BAA hopes to come into the picture. If the HPC accepts the BAA as a Representative body, not only will we be able to put forward arguments, proposals, suggestions or whatever from State Registered Ambulance Paramedics, (who please remember are in the minority at this time), BUT any proposals or suggestions would have the backing of everyone throughout the Ambulance spectrum.

This is where ONE Association with weight of numbers can play an important roll for ALL of its members.
No matter which individual section has a problem. IF that problem is recognised by your own elected committee, the weight of the whole membership will then be behind the efforts to solve that problem.

Now the question of costs. Membership is £52 . 00 per annum. Some people have queried this. They think it is too high.

A reasonable amount of members will involve, a reasonable amount of “office equipment”, and will cover, Registration, ID Cards, maybe checking references or qualifications, postage, telephone bills, all normal office expenditure, computer, computer time, printer, photo copier, fax machine, scanner, web site costs, GO ON, add in whatever else you like, countless small items which all add up. Stationary, envelopes, Ink cartridges, the list seems endless.

It will also require at least one full time staff, to cover wages, National Insurance, Tax etc, an absolute minimum of £12000 . 00 per annum.

Simply to cover wages alone would take 230 members, add in all the previous items, and we get up to say 460 members. Let us say that is absolute breakeven point. Without any cash flow whatsoever the Association will fail. There will be no funds for any unforeseen eventuality.

It is pretty obvious that such a low number would not even be “representative”. .. OK we get, more, and more members, BUT in doing so the amount of expenditure also increases, more post, more telephone calls, more costs to virtually everything.

More than obvious is the fact that the membership needs to be in the thousands. If you accept that, the one office staff would not be enough, so additionally another £12000 or so on the wages bill.

We are not talking about a profit making business here. The officers and committee members will all be working Ambulance staff. It would be impossible for them to also devote 40 hours a week, to office routine.

There is one last point I would like to make to all the people involved with “other” Ambulance Associations. If you accept that the figures above foe expenditure etc are about right, wouldn’t it make sense to have all the Associations under one umbrella.
Why multiply the office administration costs by 5 or six times, when sensibly a Single Association with all the various ambulance factions encompassed in it would lead to a saving of simply duplicated administration costs.

The money saved could be used to compensate committee members etc, who are involved in expenditure attending meetings etc.

I appreciate that many people will offer their services, without payment, but this may not always be the case, in all instances, travel, meals and accommodation are not cheap these days.

You are more than welcome to put any comments on to the 999 org postings. BUT if they are not of a general nature, maybe specific questions, or proposals, put them to me direct if you wish baa999@cwcom.net The choice is yours.
Don Williams

Insurance
05/07/2002

Commercial vehicles / Ambulances / PTS Vehicles /Fast Response Cars

Have facilities in place at present although currently negotiating a scheme for BAA members with alternative Insurers.

Private Car Insurance

Special rates & exclusive facilities available with Zurich & Royal & Sun Alliance.
For an individual quotation members should ring Freephone 0800 019 0059 and confirm they are members of the BAA.

Alternatively they can visit our website on at www.askajk.co.uk where policies can be arranged on line with Zurich Financial Services.

Breakdown, legal expenses, motor warranty policies are also available.

Household Insurance

Exclusive facilities with leading insurers call Free phone & quote BAA. Alternatively policies can be arranged with Zurich Financial Services by visiting our website.

Business Combined Insurance

Policies can be arranged to include:

- Commercial All Risks
- Business Interruption
- Money
- Employer’s liability
- Public / Products liability
- Professional Indemnity

Medical Malpractice

Facilities available for both individuals & companies placed at Lloyds

Via our sister company AJH Financial Services Ltd we can also offer a range of financial services products including:

- Mortgage Protection
- Life assurance/Funeral Expenses
- Critical Illness
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- Accident/sickness & redundancy cover

I recent years the premiums of the above contracts have fallen substantially.For a no obligation quotation ring Freephone 0800 019 0059 and quote BAA.

Contact names

John Knox - Private Motor, Household
Andrew Crouch - Commercial contracts
Dudley Hendricks - Financial Services products

Freephone 0800 0190059

Join the BAA
03/06/2002

Many of you will be aware of the work this Association has been undertaking on behalf of Ambulance personnel, and people in associated fields. NONE of our efforts were devoted simply to members of the Association, but would have benefited all Ambulance personnel. The main problem in trying to attract the attention of the government is lack of numbers. The strength of any representative body relies not only on the policies it wishes to pursue, but on the amount of support those policies have.

Simply look at the British Medical Association, the Royal College of Nursing, The Police federation, and the influence they have in negotiations due to the volume of support they can obtain simply by weight of numbers.

All of these organisations were formed initially by the people employed in those professions. Today their representatives are ‘hands on’ working professionals, elected by the members from within their group.

THAT IS EXACTLY WHAT THE AMBULANCE SPECTRUM NEEDS. A representative body, with hands on working professional elected by and from the membership. An Association open to anyone within the Ambulance field, membership being granted within the Association, but in the category in which they hold certification of competence to practice. i.e State Registered Ambulance Paramedics, Emergency Medical Technicians. First Responders or whatever. Each of these groups to elect their own representatives to the committee. The committee would then be representatives for ALL, with the backing and support of the overall membership.
Until such time as this is in place the Ambulance world will still be regarded as the ‘Cinderella’ service.
Again, many of you will know This Association has been trying to promote this idea for some time. We have been canvassing support and have already submitted articles to the Ambulance Today Magazine in attempt to launch the formation of such a representative body to coincide with the forthcoming Ambex exhibition. Additionally we have also placed an individual membership application pack on the 999.org.uk web site, simply click on the Logo, and download the application.

YOU WILL NOT BE SURPRISED TO KNOW THAT DETAILS OF OUR LAUNCH WERE LEAKED TO OTHER ASSOCIATIONS, ( we are aware of who by). WOULD YOU BELIEVE OTHER ASSOCIATIONS NOW THINK IT IS SUCH A GOOD IDEA THEY ARE JUMPING ON THE BAND WAGON AND LAUNCHING THEIR OWN REPRESENTATIVE ORGANISATIONS.

I would ask if it is such a good idea, why have they never done it before!! Why suddenly present the proposals simply because we have. Could it be that they weren’t really interested in the overall welfare of Ambulance personnel.

OR could it be that, if this Association succeeds in its aims, the other Associations will simply disappear ???

The choice will be yours. An Association formulated by YOU the members, with equal voting rights throughout, where your views, opinions, suggestions will all be used to formulate the constitution and Rule Book of YOUR Association. We all know what happens when something is put into place with limited consultation amongst the people concerned. This will not be the case with this Association. Basic criteria for membership will be in place. YOU will decide the Associations future.

I would urge you to join NOW. Annual membership is only £52.00. If during the first year you feel nothing has been achieved, simply don’t renew. Your future MUST be worth the gamble.

Change of Administration
11/05/2002

Emergency Care online is now being run by the British Ambulance Association and is back online.

List Server Upgraded
03/05/2002

The list server on which Emergency Care Online runs has been upgraded and the addresses for posting to the list have changed. The old addresses will still work also for the time being.

To post to the list send to: list@999.org.uk - all e-mails must be in plain text format and with no attachments. You will get a confirmation message back when you submit your message letting you know if it was okay.

To unsubscribe send a blank e-mail with REMOVE in the subject line to: listadmin@999.org.uk

The new unsubscribe system is less fussy than the old Majordomo mailing list software which was being used before, so as long as you send from the e-mail address you signed up with it should take you off the list.

Also a web based system to view messages posted to the list and manage your subscription will be available shortly.

If you have any queries please e-mail listowner@999.org.uk.