One member called us gung-ho, demanded to know what legal mind had cast an eye over the proposed legislation, threatened to leave the Association, but we knew we were right.
We had taken legal advice and had also put the issue before numerous MPs who all agreed that we were right to fear the Government's Deregulation Bill. Essentially it was planned as a catch-all device to tweak all sorts of tricky bits of law—from apprenticeships to rules governing sellers of knitting yarn, from exempting Sikhs from wearing crash helmets to the erection of statues in London—that were not working as intended.
But the unintended consequences of what was proposed in Section 36 of the Bill had alarm bells ringing in our heads—if not, in future, on our members' vehicles. ‘Road traffic legislation: use of vehicles in emergency response by NHS.’ It was the last two words in that sentence that threatened what our members have been doing every day for more than 30 years: saving lives.
The precise wording about the use of speed exemptions and the use of blue lights on a vehicle in an emergency said: ‘for the purpose of providing a response to an emergency at the request of an NHS ambulance service.’
Thousands of patient journeys are carried out each day by independent providers for NHS hospitals, not NHS ambulance services. In Bristol one Independent Ambulance Association (IAA) member is contracted by intensive care medical teams at Bristol Children's Hospital to retrieve critically-ill babies and children from across the south west and Wales under emergency conditions. In Cambridge, Addenbrookes hospital has contracted out blue light services to another IAA member.
‘The NHS ambulance service does not hold a monopoly on the transport of the sick and injured,’ said event paramedics and IAA director, Rick Player. ‘The Care Quality Commission regulates this and that lawfully includes private providers. Many private ambulance companies are contracted directly to hospitals through clinical commissioning groups (CCGs) to provide high dependency and critical care (blue light) ambulance transport for inter-hospital transfers. This is not at the “request of an NHS ambulance Trust”.’
The other area affected by the legislation was the event world, which our members specialise in each and every day across the country. Public and private sporting and social events like cycle races, marathons, air-shows, music festivals, equestrian events and town festivals rely on independent or voluntary medical cover. Indeed, most cannot get a licence to operate without first detailing who is providing emergency services. NHS ambulance Trusts cannot possibly provide cover to all these events and do not have appropriate vehicles, such as 4x4 or motorcycle units, which suit the circumstances.
‘For more than 30 years independent and voluntary ambulance service providers have used such exemptions based on need, not on which organisation happens to operate the vehicle’
The legislation would mean a competitor or spectator at an event could not get fast treatment as a rapid response vehicle (RRV) couldn't get to the patient on a public highway using blue lights or driving at speed or transport them, if needed, to hospital.
One IAA member covering a cycle event took 4 minutes using an RRV to get to a badly injured competitor who had come off on a downhill straight at 30–40 mph. An NHS ambulance was called at the same time: it took 40 minutes to arrive. Another IAA member has dealt with a cardiac arrest at a half marathon, a stabbing which penetrated the heart, and several heart attacks. After initial treatment by their paramedics, who reached them by RRV, the patients were rapidly transported to hospital. Without the ability to use driving exemptions on public highways they would have had to wait for an NHS ambulance to travel to an unfamiliar event site through crowds of spectators.
That would have presented an immediate threat to time-critical patients. And it would have added further stress to already-stretched NHS ambulance services.
Another IAA member runs a night-time service at weekends in four large cities at the request of local police. He responds to incidents at pubs and clubs before the NHS using RRVs. He couldn't get to the scene, or if faced with a seriously injured patient, could not rapidly get them to hospital, without using driving exemptions.
For more than 30 years independent and voluntary ambulance service providers have used such exemptions based on need, not on which organisation happens to operate the vehicle.
Organisers in the event and festival world were similarly aghast when we alerted them to the situation. Time was against us. The Deregulation Bill by now was at report stage in the House of Lords. IAA director Rick Player found he had a great ally in the organiser of the Secret Garden Party Festival in Cambridgeshire, which his firm has covered for years. The owner of the land on which the festival is held sits in the Lords. He put down his suitcase on his way to the airport and contacted fellow peers.
We started an online petition, got members to lobby their MPs and engaged in direct dialogue with the Bill's sponsoring MP cabinet minister, Oliver Letwin, via Twitter and email.
The noise worked. We were invited to a meeting in the Department of Health (DH) with senior advisers from health and the Department for Transport. They were able to clarify that ambulances, that is vehicles designed or adapted to carry a semi-recumbent patient, can continue to use driving exemptions whoever operates them. Great news.
But they clearly had little understanding of the nature of the modern event world. ‘Why not just send an ambulance?’ was the response to concerns about the issues of covering events without being able to use blue lights. RRVs are cheaper, quicker and often mean bikes/motorbikes/4x4s or quads which are vital in off-road events.
The clear response to the meeting was the Deregulation Bill—which contained so many bits of law about a myriad other businesses—could not and would not be stopped in its rapid progress to the statute book before the general election. It takes effect two months after it gained Royal Assent—that is 26 May.
So RRVs can operate on private land. But they cannot venture off site using blue lights or driving at speed to rescue an injured competitor or spectator. By excluding both private and voluntary providers, the IAA claims this equates to stealth legislation to stop a lawful activity.
IAA chairman James Barnes, who attended the meeting at the DH, said: ‘It was very disappointing that they were not willing to put an amendment forward. But they have promised to work with us after the election.
‘We will continue to continue to push parliament and other relevant agencies to amend the Bill. We are prepared to engage with both health and transport departments to achieve this goal.’
The IAA is now preparing a dossier of members' experiences of situations in which lives could have been lost if RRVS had not been able to gain rapid access to injured patients using blue light exemptions. This will be presented to the Whitehall advisers.
‘The examples we outlined from work at events had real impact. It was obviously an area they didn't know about or understand,’ said Barnes. ‘We will get more examples to them. We have their ear now—and we are going to use it. No other ambulance body has been invited into such a meeting—or been asked to go back. The Blue Light Fight goes on. Lives depend on it.’
The hope is that members have to rely on historic situations for the dossier's examples. Not an upcoming verdict from a coroner's court.