INDEPENDENT AMBULANCE SERVICES TO REGULATE?

Transcription

1 INDEPENDENT AMBULANCE SERVICES TO REGULATE? A Consultation Paper

2 INDEPENDENT AMBULANCE SERVICES TO REGULATE? A Consultation Paper Scottish Executive, Edinburgh 2005

3 Crown copyright 2005 ISBN: Scottish Executive St Andrew s House Edinburgh EH1 3DG Produced for the Scottish Executive by Astron B /05 Published by the Scottish Executive, January, 2005 Further copies are available from Blackwell s Bookshop 53 South Bridge Edinburgh EH1 1YS The text pages of this document are produced from 100% elemental chlorine-free, environmentally-preferred material and are 100% recyclable.

4 Introduction 1. The Executive's March 2000 consultation paper Regulating Private and Voluntary Healthcare, and the 20 November 2000 policy position paper which followed, provided the basis for the introduction of a new regulatory framework for many services provided by the independent healthcare sector. The subsequent Regulation of Care (Scotland) Act 2001 (the Care Act) established the Scottish Commission for the Regulation of Care (Care Commission) and set out 14 care services, of which one is independent healthcare service (covers hospitals, clinics and medical agencies), to be regulated by it. In carrying out its regulatory role the Care Commission is required to take account of National Care Standards issued by Scottish Ministers. Provision was included in the Care Act for Scottish Ministers to be able to make regulations to add to the list of 14 care services in the Act. This in part reflected the feedback from the majority of consultees who felt that the Regulatory Framework as set down in the consultation document may need to be expanded. This paper invites comments on whether independent ambulance services should be added to the list of services subject to regulation by the Care Commission under the Care Act. An Overview of the Position of Independent Ambulance Operators in Scotland 2. Scotland has at present less than 10 independent ambulance services. It is the understanding of the Scottish Executive Health Department that for most of these the core business is in providing non-emergency patient transport services and what may best be described as care and treatment of an enhanced first aid nature at sporting and other events. Some may also support the medical repatriation of patients from outwith Scotland. By contrast, England has many independent ambulance operators, many of which contract to provide patient transport services for NHS patients. The Department of Health has not, so far, considered it necessary to statutorily regulate the sector. That decision is in part due to the fact that there currently exists a degree of monitoring of the standards of service being provided by independent ambulance services through the contractual arrangements that underpin the provision of patient transport services to the NHS. What the Department of Health has done is to provide Health Authorities with a set of minimum standards that they should be looking to the independent operators to achieve when contracting with them. 3. The Executive is not aware of any instances of independent ambulance operators in Scotland providing patient transport services under contract for NHS patients. There has not therefore been the related need for the Executive to offer guidance on the minimum standards that might apply in Scotland. Only in circumstances where an independent ambulance operator was providing services that are subject to current systems of regulation in Scotland would there be any monitoring of the operator and of the services being provided (eg, Health and Safety Regulations; Care Act regulations if one of the care services currently defined in the Act is provided eg, Nurse Agency). In addition, the March 1997 Safety at Sports Ground Guidance provides for local authorities in Scotland to take advice from the Scottish Ambulance Service (SAS) where the authority may be proposing to license a sporting event at which it is proposed that the ambulance cover might be provided by an independent service operator. The 1993 Guide to Health, Safety and Welfare at Pop Concerts and similar events also obliged local authorities to consult with the Scottish Ambulance Service in planning for such events. While this arrangement of looking to the Scottish Ambulance Service to provide advice may assist the local authorities with their risk management processes, it sits uncomfortably with one of the key principles of regulation

5 that of the regulatory body being independent and having no interest in providing the services itself. The Scottish Ambulance Service is not of course exercising a regulatory role in their considerations, but the potential for conflict of interest is real as the SAS may be competing with the independent sector to provide the service. Consideration 4. To properly consider whether regulation under the Care Act may be required, it may help to reflect on the range of services which it is understood independent ambulance operators in Scotland may provide and the contractual arrangements under which they may operate. It is also important to consider the standards and processes that might apply to independent ambulance operators were Regulation to be supported. Range of Services and Arrangements 4.1 An independent private ambulance service may provide: patient transport services for taking patients to and from independent healthcare facilities or NHS facilities where the patients may be receiving private healthcare. Such transfers may, depending upon the patient's mobility and clinical needs, require the operator to have a range of transport options and professional competencies; repatriation of patients from healthcare services outwith Scotland (this may include repatriations that are being supported by a range of clinical professionals other than paramedics or technicians); paramedic or technician-led health cover at events including where drugs may be being prescribed under the POM 1 Order. Such event services may or may not provide for the independent operator to manage transfers to hospital that may be required. Standards 4.2 Any regulation of independent ambulance operators under the Care Act would have to be underpinned by appropriate and proportionate National Care Standards. National Care Standards are developed by the National Care Standards Committee on behalf of Scottish Ministers and ultimately are approved and issued by Ministers. The Standards set out the standard of service and care a service user can expect on their journey through the service and might be expected to cover: information on services and costs; management and staffing arrangements including; staff selection, recruitment, qualifications and training; infection control; drivers hours regulations; vehicles and equipment; evidence of arrangements for accessing medical advice; insurance liability; patient confidentiality; telecommunications; and complaints processes. 1 Prescription Only Medicines (Human Use) Order 1977

6 5. The nature of the arrangements under which such services currently operate may often provide for a degree of quality assurance. Where the patient contact arises through a contractual relationship involving the operator and another independent healthcare provider, or an event organiser, or a travel insurer, then there exists a third party who will have a duty of care to the patient. That is likely to include a requirement to be satisfied about the capacity of the operator to provide a service that matches the needs of the patient or patients. It will involve the third party in addressing any complaints the patient may have about the service received. However, patient contacts also arise without third party involvement and with the patient believing that there already exists a process that assures the standards of treatment and care being provided. The Executive has received letters from both patients and health professionals who have highlighted concerns about what they felt to be significant and potentially serious shortcomings in the standards of service and care provided by some independent ambulance operators. They believe that the absence of independent regulation serves to deny those with genuine concern for patient safety the means by which quality of care could be better secured for future patients. Responding to this Consultation Paper 6. You are invited to comment on whether you feel that independent ambulance services should be added to the list of services regulated under the Care Act by the Care Commission. Comments may cover any aspect of this issue including service experiences, risk perceptions, proposed standards etc and should be made using the respondee form at Annex A as a cover to your response to: Gwen.Nicholson@scotland.gsi.gov.uk or by writing to: Gwen Nicholson Scottish Executive Health Department Performance Management Division Area 2E (North) St Andrew s House Regent Road EDINBURGH EH1 3DG If you have any queries, or would wish to discuss any of the issues raised in this paper, then please contact Gwen on Comments should be returned by 21 March 2005 This consultation, and all other SE consultation exercises, can be viewed online at You can telephone Freephone to find out where your nearest public internet access point is. The Scottish Executive now has an alert system for SE consultations (SEconsult). This system allows stakeholder individuals and organisations to register and receive a weekly containing details of all new SE consultations (including web links). SEconsult complements, but in no way replaces, SE distribution lists, and is designed to allow stakeholders to keep up to date with all SE consultations activity, and therefore be alerted

7 at the earliest opportunity to those of most interest. We would encourage you to register by accessing Annex B provides an opportunity for you to comment on how this consultation exercise has been conducted. Access to Consultation Responses We will make all responses available to the public in the Scottish Executive Library by 30 March 2005, unless confidentiality is requested. All responses not marked confidential will be checked for any potentially defamatory material before being logged in the library or placed on the website. DISTRIBUTION LIST FOR CONSULTATION PAPER ON REGULATION OF PRIVATE AMBULANCES NHS Boards to cascade to operating divisions and GPs and Special Health Boards The Scottish Commission for the Regulation of Care Local authorities to cascade down to those responsible for licensing public events, etc., and interest groups where they perhaps hold regular events in the local authority s area CoSLA Scottish private ambulance companies National Association of Private Ambulance Services (NAPAS) British Ambulance Association (BAA) Scottish Ambulance Service St Andrew s Ambulance Association St John s Ambulance British Red Cross British Medical Association Royal Colleges of Nursing, Surgeons, Physicians, Psychiatrists SHOW website The Royal Highland and Agricultural Society of Scotland Scottish Police Forces Sportscotland EventScotland Scottish Football Association Scottish Rugby Union Scottishathletics Scottishswimming Scottish Sports Association Football Safety Officers Association (Scotland) VOCAL (The Voice of Chief Officers of Cultural, Community & Leisure Services in Scotland) Motor Sports Association Association of British Travel Agents Association of British Insurers

8 Web addresses referred to in Independent Ambulance Services To Regulate? Consultation Paper Document Regulating Private and Voluntary Healthcare Policy Position Paper SE Consultations SE Consult Web address

9 ANNEX A RESPONDEE FORM Please complete the details below and attach it with your response. This will help ensure we handle your response appropriately: Name: Postal address: Consultation title: 1. Are you responding as: (please tick one box) (a) (b) an individual? (go to 2a/b) on behalf of a group or organisation? (go to 2c). 2a. Individuals: Do you agree to your response being made available to the public (in SE library and/or on SE website)? Yes (go to 2b below) No, not at all 2b. Where confidentiality is not requested, we will make your response available to the public on the following basis (please tick one of the following boxes). Yes, make my response, name and address all available Yes, make my response available, but not my name or address Yes, make my response and name available, but not my address

10 2c. On behalf of Groups or Organisations: Your name and address as respondees will be made available to the public (in the SE library and/or on SE website). Are you content for your response to be made available also? Yes No SHARING RESPONSES/FUTURE ENGAGEMENT 3. We will share your response internally with other SE policy teams who may be addressing the issues you discuss. They may wish to contact you again in the future, but we require your permission to do so. Are you content for the Scottish Executive to contact you again in the future in relation to this consultation response? Yes No 4. Your comments on this possible regulation of independent ambulance services may focus on one or more of the following issues: Service experience; Perception of risks, proportionality to prospect of regulation; Proposed standards; Other (please specify):

11 ANNEX B The Scottish Executive Consultation Process Consultation is an essential and important aspect of Scottish Executive working methods. Given the wide-ranging areas of work of the Scottish Executive, there are many varied types of consultation. However, in general Scottish Executive consultation exercises aim to provide opportunities for all those who wish to express their opinions on a proposed area of work to do so in ways which will inform and enhance that work. While details of particular circumstances described in a response to a consultation exercise may usefully inform the policy process, consultation exercises cannot address individual concerns and comments, which should be directed to the relevant public body. Consultation exercises may involve seeking views in a number of different ways, such as public meetings, focus groups or questionnaire exercises. Typically, Scottish Executive consultations involve a written paper inviting answers to specific questions or more general views about the material presented. Written papers are distributed to organisations and individuals with an interest in the area of consultation, and they are also placed on the Scottish Executive web site enabling a wider audience to access the paper and submit their responses. Copies of all the responses received to consultation exercises (except those where the individual or organisation requested confidentiality) are placed in the Scottish Executive library at Saughton House, Edinburgh (K Spur, Saughton House, Broomhouse Drive, Edinburgh EH11 3XD, telephone ). The views and suggestions detailed in consultation responses are analysed and used as part of the decision making process. Depending on the nature of the consultation exercise the responses received may: indicate the need for policy development or review; inform the development of a particular policy; help decisions to be made between alternative policy proposals; be used to finalise legislation before it is implemented. If you have any comment about how this consultation exercise has been conducted, please send them to: Name: Address: Dr P Collings Directorate of Performance Management & Finance Health Department Room 1E.07 St Andrew s House EDINBURGH EH1 3DG Peter.Collings@scotland.gsi.gov.uk

12 Crown copyright 2005 This document is also available on the Scottish Executive website: Astron B /05 Further copies are available from Blackwell s Bookshop 53 South Bridge Edinburgh EH1 1YS Telephone orders and enquiries or ISBN Fax orders orders business.edinburgh@blackwell.co.uk w w w. s c o t l a n d. g o v. u k