Professor Paresh Wankhade (Business School) analyses the latest announcements about ambulance alliance and its implications:
Interoperability between the emergency services (the police, ambulance and fire) is an important but highly contested topic of research. The governance of these ‘blue lights’ in England is complex given these services come under different departments and are structured differently largely as a result of the relatively ad-hoc nature of their historical development. Currently there are 11 ambulance trusts, 44 police forces and 55 fire and rescue authorities in England.
Collaboration between emergency services is neither novel nor new. Many emergency services are already working with each other, and other public bodies to provide better services while improving efficiencies. In September 2015 the Government published the consultation document ‘Enabling closer working between the Emergency Services’ aimed at promoting better coordination of emergency services in England. In January 2016, the government published the ‘Summary of consultation responses and next steps’ to the Consultation intending to legislate to:
- Introduce a high level duty to collaborate on all three emergency services, to improve efficiency or effectiveness;
- Enable Police and Crime Commissioners (PCCs) to take on the functions of fire and rescue authorities (FRAs), where a local case is made;
- Where a PCC takes on the responsibilities of their local FRA, further enabling him or her to create a single employer for police and fire personnel;
- In areas where a PCC has not become responsible for fire and rescue services, enabling them to have representation on their local FRA with voting rights, where the local FRA agrees; and
- Abolish the London Fire and Emergency Planning Authority and give the Mayor of London direct responsibility for the fire and rescue service in London.
The proposed governance arrangements contained within the consultation document present a number of challenges and has received mixed responses, and the consequent legislation was rushed through in the Parliament. Some of the proposals in the latest consultation are not original. In 2013, the government commissioned report Facing The Future led by Sir Ken Knight, former government Fire and Rescue advisor, had reviewed the efficiencies and operations in the fire and rescue authorities in England. The report had further proposed the merging of fire and rescue services with the possibility of the PCCs taking on the role of fire and rescue authority after due evaluation.
The Association of Ambulance Chief Executives (AACE) has welcomed the intention of the Government backing to keep ambulance services as part of the NHS, while reaffirming its support for closer collaboration and more innovative blue light working between the three emergency services. The Keogh Review and the NHS Five Year Forward View also acknowledge the role and contribution of the ambulance services to the Government’s urgent and emergency care strategy. The overall attendance of fire services incidents has shown a decline of more than 40% over the last decade. Recorded crimes (other than fraud) are showing a downward trajectory since its peak in 2003-04. But ambulance demand has shown a steady increase of almost 10% over the last five years.
While their position within the blue-light architecture is still being decided, the latest announcement by the North East, North West and Yorkshire Ambulance Service Trusts to launch the ‘Northern Ambulance Alliance’ to improve efficiency gains (Highlighted by the Carter Efficiency Review, 2016), presents opportunities for exploring new innovative organisational forms and management structures, to bring about a new model for regional collaboration in absence of a national initiative.
A statement issued by the new NAA clarifies that the move is not a merger, but ‘an attempt by all three organisations to work closer together to standardise care, identify savings through collaborative procurement, and be better placed to tackle the fast moving change agenda.’ The move opens greater opportunities to access new, modernisation funding streams such as the transformational funding collectively, while allowing greater synergy for working with other blue light partners. It has been also stated that the three trusts remain completely separate entities and will be regulated independently.
The alliance has been quick to dismiss the fears about potential amalgamation and job losses but questions have already been raised including:
- Implications for future joint appointments and re-categorisation of new roles and responsibilities;
- Whether staff will be rostered to work within the geographical boundaries of the other trusts in the Alliance
- The claim to improve quality and service delivery for all patients in the North of England remains to proven;
- Whether performance and quality standards will be assessed and monitored collectively across the North of England in future; and
- Importantly, the impact on devolution schemes which are at different stages in the North, remains unclear.
This new model can help drive regional collaboration and blue light interoperability but concerns about potential job losses, its impact on patient safety and service delivery will have to be quickly addressed to give it any meaningful chance of success and building a sense of confidence in the proposed Alliance.