The day in January 2017 when I signed the Companies House paperwork for Larrey Society Limited to be struck off the public register remains the worst disappointment of my 12 years' consulting experience within the ambulance service.
It was my decision alone, but as I had failed to attract a successor once I retired, I had no alternative. Sadly, my fear that it would turn out to be a bad decision has proved right.
Public and private affair
The problems the NHS and private companies are facing today are the worst in memory—yet neither the Association of Ambulance Chief Executives (AACE), nor the Independent Ambulance Association (IAA), have so far shown any serious desire to speak up and be counted.
While the issues remain the same for both public and private sectors, they still obstinately refuse to talk with one another; if it still existed—The Larrey Society—as it was set up to do, would have created the ‘common independent ground’ where customer and provider could debate their shared problems and concerns and then, with a single voice, seek to influence government policy.
I had become aware, years before, of the lack of honest goodwill between NHS leaders and privately-owned ambulance companies; soon after I had set up the Independent Ambulance Association in January 2012, it did quickly become the industry's first formally recognised voice by both legislators and regulators.
I did manage to persuade both sides to sign a Memorandum of Understanding that declared that they would work together in all patients' best interests and wellbeing. It turned out to be for public show—as unfortunately, I was unable to build any further on their words.
A growing body
Despite this situation, the IAA grew both in company membership and reputation within healthcare and political circles.
In the first 6 months, more than 40 companies, all regulated by the Care Quality Commission (CQC), had been recruited into membership. Very quickly, their views on issues ranging from ‘blue light’ speeding charges to the role of contract commissioners, were presented to national government departments, local authorities, and police bodies. These included the Department of Health and Social Care (then the Department of Health); Department of Transport; Crown Prosecution Service; Local Government Association; NHS Monitor; NHS Co-operation & Competition Panel Police Federation; and National Association of Chief Police Officers.
Senior management at the CQC soon recognised the important role the IAA had opening; for the first time, a channel of communications between the regulatory bodies and individual private companies.
Thanks to the encouragement of Sir (then Mr) David Behan, the CQC's forceful and far-seeing Chief Executive, I was invited to represent the IAA on various committees and given access on a confidential need-to-know basis to internal research reports.
Unrivalled care and safety
I continually reminded the CQC then, as I would certainly do today, that having ‘open minded’ dialogue with not only the regulators but also other public and private healthcare bodies, was the way forward to achieving our mutual goals to further professionalise the independent ambulance sector in England—which in turn would lead to an unrivalled patient experience of care and safety.
Inspecting services
Given the huge task the CQC has as the independent regulator of all health and social care services in England, inevitably, ambulance services have remained low down in the Commission's list of priorities. Even with a continually increasing staff of more than 21 500 people, it fails to keep up to date with its main task to inspect establishments and report back its findings.
The IAA took up this concern in 2012 in a memorandum which called for the CQC to take urgent and decisive action to speed up the first-time on-the-spot compliance inspections of registered private ambulance services.
At the end of March that year, the CQC had inspected and published reports on only 19 of the 323 registered ambulance services; we estimated at the then-present rate of inspection and the projected increase in the number of new ambulance companies, it would be 2027—at the earliest—before all locations had been inspected.
I believe this forecast has been marginally improved, but I do know with more certainty that our second demand for more robust inspections was taken up with vigour—and with the whole process now significantly strengthened, companies are complaining that the inspections are too robust, particularly as they are made without warning.
The Larrey Society
Three years on and, with the IAA ready for a facelift and fresh thinking, I decided to move on to my next challenge. I ruled out another trade association because there are clear conflicts of interest for directors who also run their own companies which, in turn, give rise to governance issues.
My experience with the IAA had also dampened my commitment to the cause by excessive bureaucracy and in-fighting among the Board, which encouraged my decision to run and fund The Larrey Society personally; and while I had a Board of Directors and, later the support of a group of pre-eminent advisers, the strategy and day-to-day decisions were largely mine alone.
Shaping the ambulance service
The Society was the first cross-sector ‘think tank’ formed to influence the future shape of ambulance services in the 21st century, and it also offered its increasing membership of paramedics and pre-hospital care clinicians and academics a voice to express their views and ideas to decision-making legislators and regulators.
Father of emergency services
Its approach to campaigning was as uncompromising as the attitude of the man it was named after—Dominique Jean Larrey, the 17th century French military surgeon whose introduction of the first battle ground treatment for wounded soldiers and the introduction of ‘flying ambulances’ has earned him recognition as the ‘father’ of modern-day emergency medical services.
Larrey was a relentless advocate of innovation and, as a result, he was in constant conflict with the military and political bureaucracy. His policy to treat the wounded according to the seriousness of their injuries and urgency of need for medical care, regardless of their rank or nationality, almost cost him his life. He won—and soldiers of enemy armies, as well as those of the French and their allies, were treated.
Portfolio of causes
In its first 12 months, the Society took up a portfolio of different causes including job-related burnout among paramedics, and a change in the law to give paramedics greater protection against physical attack while on duty.
It also sought improved commissioning of NHS ambulance contracts; complained against serious police delays over disclosure and barring service (DBS) approval procedures; identified flaws in ambulance tariffs produced by Monitor; and continued to complain at the mounting backlog of ambulance inspections by the CQC.
At two successful conferences, we brought together speakers from both the NHS and private sectors, held private dinners with VIP speakers and, as membership grew to more than 300 paramedics and academics from the UK and around the world, we created the first global discussion forum for ambulance services.
Stepping up for Larrey 2.0
With so much achieved so quickly, my decision to close The Larrey Society was taken with a heavy heart but, without a successor in the wings and no regular modest income, the decision was inevitable.
The need for it is greater now however than ever before, and I would be happy to help anyone who would be interested in stepping up to take it on.