Scottish Government

INDEPENDENT AMBULANCE SERVICES - TO REGULATE?

A Consultation Paper

Scottish Executive, Edinburgh 2005
ISBN: 0-7559-4457-7

This document is also available in pdf format (120k)

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 - 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:

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:

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 0131 244 2439.

Comments should be returned by 21 March 2005

This consultation, and all other SE consultation exercises, can be viewed online at http://www.scotland.gov.uk/consultations . You can telephone Freephone 0800 77 1234 to find out where your nearest public internet access point is.

The Scottish Executive now has an e-mail alert system for SE consultations (SEconsult). This system allows stakeholder individuals and organisations to register and receive a weekly
e-mail 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 at the earliest opportunity to those of most interest. We would encourage you to register by accessing http://www.scotland.gov.uk/Consultations/seConsult .

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

Web addresses referred to in ' Independent Ambulance Services - To Regulate?' Consultation Paper

Document Web address

Regulating Private and Voluntary http://www.scotland.gov.uk/consultations/phc-letter.asp
Healthcare

Policy Position Paper http://www.scotland.gov.uk/library3/health/rihs-00.asp

SE Consultations http://www.scotland.gov.uk/consultations

SE Consult http://www.scotland.gov.uk/Consultations/seConsult

ANNEX A

RESPONDEE FORM

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 0131 244 4552).

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:

If you have any comment about how this consultation exercise has been conducted, please send them to:

Name: Dr P Collings

Address: Directorate of Performance Management & Finance
Health Department
Room 1E.07
St Andrew's House
EDINBURGH EH1 3DG

E-mail: Peter.Collings@scotland.gsi.gov.uk

Footnote

¹ Prescription Only Medicines (Human Use) Order 1977