Dear Editor, I am grateful to Peter Jones for taking the trouble to respond to my paper (Woollard, 2010).
Mr Jones’ thoughtful reply adds further information that highlights the weaknesses in the ill thought-out proposal from the Chief Fire Officers Association. We will, however, have to differ with respect to my criticisms of the Fire Brigades Union’s refusal to support co-responder schemes. I fully accept that for many of the ambulance service calls co-responders attend, the patients have non-critical problems. However, this is also true of fire calls, and to extend the similarity occasionally, the situation is time-critical and the skills of the co-responders do make a life-or-death difference.
Despite the evident and major failings in their strategy to absorb England’s ambulance services, the Chief Fire Officers Association (CFOA) are still pushing their proposal for adoption, as evidenced by its inclusion in their strategy document Fire Futures. Role of the Fire and Rescue Service (Delivery Models) Report. This echoes the implication that the amalgamation of ambulance and fire services would result in improved ambulance response times, but offers absolutely no evidence to support this argument. Further, this report makes it quite clear that the sole motivation for its proposals is to offset the 30% cut in funding that fire and rescue services (FRS) face in the next four years.
It adds that demand on FRS is likely to grow during this period and does not identify any proposals that would reduce the range of activities they currently provide or any other means of cutting their costs. Indeed, the report suggests that all possible cost savings have already been made, and implies that further funding and staffing reductions would mean that the fire services could not meet their current operational obligations.
It seems evident, therefore, that should the CFAO’s fire and ambulance service amalgamation strategy be adopted, fire chiefs would be looking to meet their 30% cost savings target by cutting ambulance budgets. If it is true that there are currently only just enough fire fighters to meet the existing demand for fire and rescue services and ambulance budgets are to cut by 30%, how then would this lead to improvements in ambulance service response times?
History tends to repeat itself, since moving funding from ambulance to fire-fighting budgets is just what Fire Chiefs in the US did when they took over ambulance service provision. As with their previous paper, the authors of the latest CFOA report continue to reveal fire officer’s profound lack of understanding of the NHS’s modern ambulance service. For example, they suggest that amalgamation with the ambulance service would lead to an enhanced role for the Fire Service Training College. Not only does this demonstrate ignorance of the sheer number of ambulance staff that undertake educational programmes each year, but also reveals the lack of awareness of the long-established move from vocational training to higher education for ambulance clinicians.
This latest report also states that ambulance trusts lack local accountability. Apparently the authors are unaware of the statutory public consultations that ambulance services have to undertake before making changes such as moving ambulance dispatch centres, and the fact that board meetings are open to the public.
They also suggest that foundation trusts will further this lack of local accountability, yet even a brief examination of the process for achieving foundation status and the structures associated with their formation demonstrate that this is manifestly not the case.
The good news is that the Chief Fire Officers are no longer picking on the ambulance service alone. Their megalomaniac aspirations now extend to assuming some of the duties of police constabularies too, since the latest report proposes that fire services should assume the responsibility for ‘traffic control’.
It is time for some realism in this debate. The reality is that, if take-overs and amalgamations of emergency services are the accepted way forward to cut budgets, there is much stronger evidence to support the strategy of ambulance trusts absorbing fire and rescue services.
Ambulance managers have successfully demonstrated their ability to tightly control costs over a number of years whilst coping with huge and ongoing increases in 999 call volumes. They have successfully managed mergers of numbers of small ambulance services into a few large regional trusts; have introduced flattened, modern management structures; and have successfully reduced the number of dispatch centres.
Fire services have persistently resisted mergers and consequently the number of fire and rescue organizations is four times that of ambulance trusts— they have retained their traditional and out-dated hierarchical, pyramidal officer structures; and have failed to regionalize their control centres at a considerable cost to the public purse—all making the management costs of fire and rescue services considerably higher than that of ambulance trusts.
Ambulance service managers run organizations that on a daily basis cope with four times the number of 999 calls that fire services receive, and although there is no fire to fight for a large proportion of FRS calls, almost all ambulance responses result in some form of patient care.
During the last fire service strike, I staffed one of the ambulance service units established to provide light rescue while fire-fighters were taking industrial action. I covered two 24-hour shifts in one vehicle providing service to three counties. In that 48-hour period, I responded to a grand total of one call, for which I was stood down on route.
Ambulance services in other countries (for example Australia) and police authorities in others (parts of the US) provide rescue units as part of their normal duties.
Perhaps the English ambulance services should follow their example in order that the funding for this work can be cut from the UK fire and rescue services budgets?