St John's Ambulance – Written Evidence (Psr0030)

ST JOHN’S AMBULANCE – WRITTEN EVIDENCE (PSR0030)

Summary

St John Ambulance keeps people safe, responding to health incidents and emergencies, saving lives and supporting communities. The clinical skillset of St John volunteers, unique within the voluntary sector, has enabled us to step forward to support the national COVID-19 effort and improve the life chances of the sick and vulnerable. In our response to the COVID-19 pandemic, St John Ambulance has transformed, to focus the whole organisation on meeting the immediate needs of the NHS and communities.

Since the start of this crisis St John Ambulance volunteers have given over 100,000 hours of patient-facing care, providing an invaluable service for their NHS colleagues at currently 43 locations across 20 NHS Trusts, providing ambulance crews from 31 hubs and working at the heart of dozens of essential community projects such as caring for homeless people, transporting family doctors, supporting cancer patients and assisting with blood donations.

We now seek to build on our innovation in our delivery in response to this crisis, by moving towards a sustainable long term solution so that we can continue to offer essential extra capacity to the health service at times of crisis. We believe a formal designation as an NHS auxiliary organisation, the details of which we have set out in this response, would enable our trained volunteers to step forward in future times of crisis whenever they may be needed.

We are grateful for this opportunity to share with the House of Lords Public Services Committee our learnings from working with Government, NHS England, National Ambulance coordination centre, individual hospital and Ambulance Trusts and local organisations in our response to the COVID-19 pandemic. We have focused on those questions of most relevance to our work, namely those on successes and failures (1, 3 and 5), identifying and meeting the needs of vulnerable groups (9), the integration of services (14), the relationship between Government and services (16) and the role of the charity sector (20).

General Question 1. What have been the main areas of public service success and failure during the Covid-19 outbreak?

Successes

St John Ambulance has been able to transform to meet the needs of the NHS and communities due to our close partnership working and collaboration with national and local services. Our work providing ‘Winter Pressures’ support to the NHS, which was drawing to a close in March meant that we were in a good position to continue and extend our support with ambulance trusts and in Emergency departments and communities during this pandemic. We have had positive engagement with those making strategic decisions within both NHS England and government departments. We would not have been able to refocus our whole organisation on COVID-19 support to the NHS and communities to the extent and for the length of time we have, without £6.8m in financial support from the Government which was announced in April.

The pace with which this transformation in our services was achieved and the support delivered, is testament to the tireless work of our volunteers and support staff. The service we have been able to provide has been pivotal in alleviating pressures and demands on the system: St John Ambulance’s contribution has been recognised by the NHS COO, Amanda Pritchard, and National Strategic Advisor for Ambulance Services, Prof. Anthony Marsh, who have both recorded messages of thanks to St John people.

St John volunteers have brought their life saving skills to provide support in several identified areas to alleviate pressure and demands on the system:

- Ambulance Provision- under the control of the National Ambulance co-ordination Centre, providing ambulance crews to individual ambulance trusts across the country. At the peak of the crisis, this involved up to 60 volunteer-crewed ambulances on COVID-related operations every day and we now forecast 8-10,000 hours a month of provision for the months ahead. This level will be reviewed as we approach winter or a second peak. - Hospital Support – placing trained St John volunteers into Emergency Departments to provide additional clinical support to alleviate the pressure on this key part of the system. St John Ambulance Community Response teams have been working with individual trusts to identify an agreed scope of tasks within the Emergency Department which are suitable for trained volunteers to assist with. We have provided suitable and sufficient training and personal protective equipment. - Community projects – other community projects such as caring for homeless people, transporting family doctors, supporting cancer patients and assisting with blood donations.

During this crisis to date (20th June), St John People have contributed 113,559 hours to support the NHS and communities.

Question 3. Did resource problems or capacity issues limit the ability of public services to respond to the crisis? Are there lessons to be learnt from the pandemic on how resources can be better allocated, and public service resilience improved?

Building the capacity and resilience of the system will be crucial to tackling any second wave of COVID-19 later in the year and managing health service capacity needs over the long term. St John Ambulance have shown in this crisis that we can play a very important role. We want to put our crisis response support to the NHS on a stable footing and reinforce the capacity of the system so that the role St John Ambulance is playing in supporting the NHS during this pandemic can be sustained through future crises, through designation as a formal NHS auxiliary. This would mean the Government and NHS would have a built-in expectation of support from trained volunteers ready and able to step forward in future times of crisis whenever it may be needed. We believe elements of this relationship should include:

- Planning and preparedness: It is essential that St John Ambulance’s insight and logistical expertise in deploying trained volunteers to support the NHS is a formal part of future strategic planning and preparedness for potential health emergencies at national and local level. - Build in surge capacity: There must be a built-in surge capacity of trained volunteers and ambulances ready for immediate deployment at times of high, unexpected levels of pressure on the system. St John Ambulance would train and upskill volunteers to ensure their readiness to step forward in any future health crisis. St John could also maintain a number of designated NHS crisis support ambulance crews and vehicles, ensuring their ongoing readiness for immediate deployment in a crisis through, for instance, deployment in first aid event coverage. - Effective mechanisms for deployment of skilled volunteers: Managing and preparing for surge capacity at times of crisis should be facilitated by effective mechanisms for enabling trained volunteers to step forward when needed in times of crisis. The Coronavirus Act 2020 makes provision for Emergency Volunteer Leave. Although this has not been triggered to date in this crisis, we believe this process could prove effective in any future deployment of trained volunteers such as St John Ambulance’s clinically trained volunteers. We believe an effective system would be one in which, when an employee takes a job, there is legal facility for them to ask their employer to sign an “Emergency Volunteering Leave agreement” setting out that they can take up to three months of unpaid leave in times of designated national crisis. NHS auxiliary organisations would then take these volunteers onto payroll for the duration of the crisis, administering a set fund from Government to pay their wages.

Question 5. Why have some public services been able to achieve goals within a much shorter timeframe than typically would have been expected before the Covid-19 outbreak – for example, the increase in NHS capacity? What lessons can be learnt?

St John Ambulance was able to respond extremely nimbly for such a large organisation, pivoting our work at great speed to support the national COVID-19 response. This has been due to a recognition at the start of the pandemic of the need to change the organisation’s rhythm and the way decisions were made and also the ability to give complete focus to the COVID-19 operation. St John’s regular activity, including Winter Pressures support to the NHS, also meant that relationships already existed with individual hospital trusts and the National Ambulance Service, enabling St John to deploy swiftly to support them.

Planning

St John Ambulance has stepped up to support the NHS in the last few months in the way we normally would in Winter Pressures operations. Our experience in this role has meant we have been able to move at an accelerated pace to create a COVID-19 plan. The plan has four activation levels, from Level 1 (“planning”) through to Level 4 (“critical impact”).

Adapting our organisational structure

To address the COVID-19 crisis, St John Ambulance’s Chief Executive and Senior Leadership Team put new structures in place from the outset of the pandemic. St John Ambulance’s Chief Operating Officer was appointed to be the National Strategic Commander for St John Ambulance’s response to COVID-19, supported by both our Event Planning and Delivery Director in the role of Deputy Strategic Commander and our Ambulance and Community Response Director as National Tactical Commander.

Since 28th March, a new Strategic Co-ordination Group (SCG), including stakeholders from across the organisation, has met twice weekly in order to develop the national strategy, assess the strategic consequences of COVID-19, coordinate resource sharing and manage localised strains through national collaboration. This system has allowed our Chief Executive to focus on the long-term sustainability of St John Ambulance and future planning. Our strategic intent guiding the work of the SCG has been to deliver a safe and effective response to the challenges of COVID- 19 for all St John People and the communities they serve. Four regional groups feed into the main SCG, allowing for excellent communication sharing about activities.

In addition, a Joint Operations Co-ordination Cell (JOCC) was created at national level. This cell is active 24/7 and is the single point of contact for all COVID-19 inquiries. The JOCC is supported by four Regional Operations Co-ordination Cells (ROCC), which work with local management units to achieve tactical objectives on the ground.

Tactical Co-ordination Groups (TCG) were also set up with responsibility for the development and delivery of operational tactics, and to oversee the organisation's resources and personnel in response to COVID-19. The TCGs hold calls seven days-a-week to monitor the progress of operations nationally and to gather intelligence on how we can learn lessons and continually improve.

Ensuring clear communication channels St John Ambulance has developed two significant dashboard reporting processes to inform both the Strategic and Tactical Groups.

 The SCG and Community Operations Team receive a daily report which focuses on key functions within the organisation such as personnel, sickness, fleet, training and a summary of operational delivery. This information allows them to make decisions about capacity and capability for operations. The report is summarised weekly for the charity trustees and executive team.

 A tactical report is published each day, giving a more detailed overview of our operational delivery.

Ensuring our St John People have all the skills they need

St John People have always brought patience and kindness to their work and been thoroughly trained in helping people in a crisis. These qualities and skills have been needed more than ever during the pandemic and we have worked at pace to support our staff and volunteers, who continue to attend routine clinical update sessions and undertake Continued Professional Development (CPD). To make sure that our people were ready for the challenges COVID-19 would bring, our volunteer training team created a bespoke 20 hour COVID-19 care course at great speed and brought our entire Ambulance Essential Education Programme forwards. To date (15th June), 1,790 people have been trained in this module.

Supporting our St John People

We have taken care to ensure our St John People have sufficient supplies of PPE and that they know they always have the option to take a step back if they do not feel safe in any situation. Behind our clinical teams we also have an army of support volunteers making sure that our vehicles are in the right place, that our kit is restocked and importantly to pick up the phone whenever staff and volunteers have questions or want to book onto a shift. In addition, our Fleet Team have ensured we always have sufficient vehicles around the country which have been utilised in a range of different ways, as well as ensuring we have appropriate resilience and breakdown services in order to respond.

Collaboration As part of our approach we are continuing to work in partnership with the Association of Ambulance Chief Executives through participation on the weekly Director of Operations Group calls. Additionally, following on from the successful collaboration during Winter Pressures, we have regular contact with the British Red Cross and AgeUK to keep one another updated.

Inequalities

Question 9. Have public services been effective in identifying and meeting the needs of vulnerable groups during the Covid-19 outbreak? For example, were services able to identify vulnerable children during lockdown to ensure that they were attending school or receiving support from statutory services? How have adults with complex needs been supported?

St John Ambulance’s Hastings Homeless Service, a nurse-led, primary healthcare service run as part of St John Ambulance’s Sussex homeless service, provides an excellent example of voluntary sector service effectiveness in identifying and meeting the needs of vulnerable groups during the COVID-19 outbreak. The service is committed to finding ways to take vital healthcare to vulnerable people who fall through the cracks in the system. As COVID-19 lockdown set in, the service was unable to use its usual premises for seeing clients. Fortuitously, the service had recently acquired a mobile treatment centre in preparation for a new outreach initiative later in the year. Instead it was swiftly mobilised for use as a mobile wound care clinic for the clients the service sees regularly for leg ulcer care. In addition, the service has received referrals for three other homeless or ex-homeless men with leg ulcers who had disengaged with services and/or who had found GP services even harder to access than usual during COVID-19 restrictions. One of these men, who was referred by A&E after parasuicidal actions, was still rough sleeping despite “everyone in” measures and hadn’t seen a nurse or GP for at least two years, despite having chronic bilateral leg ulcers. For other health reasons he was unable to walk the distance to where the treatment centre was stationed, so the St John service took the vehicle to him twice/week to dress his ulcers. As a result of this positive engagement the service was able to link him up with housing and substance misuse services. He is now housed in a beautiful flat with a sea view and is back on a methadone script, something he was desperate to resume. The services continues to see him twice/week, he is happy and settled, and the leg ulcers are healing well. By adopting a proactive, innovative and person- centred approach, a turnaround from complete disengagement to full engagement with services was achieved, with the client’s own goals being successfully attained.

Integration of services

Question number 14. Are there any examples of services collaborating in new and effective ways as a result of Covid-19? Are there lessons to be learnt for central Government and national regulators in supporting the integration of services?

As detailed in our response to question 3, we believe that the role St John Ambulance has taken during this pandemic should be formalised, to ensure we are able to support the NHS and communities in the same way through future peaks and other crises. We have set out in our response to question 3 how we believe this could look.

The relationship between central Government and local government, and national and local services

Question number 16. Can you provide any examples of how public services worked effectively with a local community to meet the unique needs of the people in the area (i.e. taking a “place-based approach” to delivering services) during the Covid-19 outbreak?

As well as working nationally with the National Ambulance Co-ordination Centre (NACC) to provide ambulance crews to individual ambulance trusts across the country, we have also offered clinical support to hospitals to alleviate pressure on this key part of the system. The St John Ambulance Community Response Team has been working with individual trusts to identify an agreed scope of tasks suitable for our trained volunteers to assist with within Emergency Departments in order to provide much- needed additional clinical support. Outside of Emergency Departments, we engaged with many community projects, such as supporting Primary Care Networks, homeless outreach, hospital discharge support, provision of treatment centres and many more. Our volunteers have always been given excellent training and suitable PPE. Role of the private sector, charities, volunteers and community groups Question 20. What lessons might be learnt about the role of charities, volunteers and the community sector from the crisis? Can you provide examples of public services collaborating in new ways with the voluntary sector during lockdown? How could the sectors be better integrated into local systems going forward?

The substance of our submission and responses to questions 1,3,5, 9, 14 and 16 provide a clear example of a voluntary sector organisation and its volunteers supporting the NHS and local communities in enhanced ways during this crisis, making the most of the expertise and capacity we have to offer. The NHS Long Term Plan recognises the key role that volunteers already play within the NHS. As set out in our response to question 3 we believe that the role St John Ambulance has taken during this pandemic should be formalised, to ensure we are able to support the NHS and communities in the same way through future peaks and other crises.

We believe an NHS auxiliary role for St John Ambulance would mean the Government and NHS would have a built-in expectation of support from trained volunteers ready and able to step forward in future times of crisis whenever it may be needed. We believe elements of this relationship should include: