Written evidence submitted by The Air Ambulance Service (DEL0185)

1. Overview

1.1 The Air Ambulance Service and its sister charity, the Children’s Air Ambulance, have continued to provide their lifesaving emergency medical and hospital-to-hospital transportation services throughout the covid-19 pandemic. Despite a number of obstacles relating to the virus and the resulting social and financial measures, both charities are continuing to support their NHS partners, doing all they can to support NHS ambulance capabilities at a time when local services are already under so much pressure. In this submission, we have set out how both charities are providing their services at a crucial time, how we are working to overcome various obstacles and the measures we are taking to adapt our services so that we can increase our support to the NHS. The Air Ambulance Service would be happy to provide further information or give oral evidence to the Health and Social Care Committee, if appropriate.

2. About The Air Ambulance Service

2.1 The Air Ambulance Service was founded in 2003 and operates across , , , and , as well as operating the UK wide Children’s Air Ambulance. The Air Ambulance Service helicopters provide a rapid response to trauma and medical emergencies over an area of 3,850 square miles, covering many of the UK’s major road networks including the M1, M6, M69 and M42. With an average response of just 13 minutes between them, they attend on average six missions a day – working closely with the Ambulance University NHS Trust and the East Midlands Ambulance NHS Trust. The service has completed over 39,500 missions since 2003.

2.2 The Children’s Air Ambulance is a unique national service flying critically ill babies and children from one hospital to another for specialist care. It is the only dedicated neo-natal and paediatric helicopter emergency transfer. The free of charge service works alongside 10 NHS transport teams nationwide to help fly neo-natal and paediatric patients to specialist treatment.

3. Our essential service

3.1 The Air Ambulance Service provides helicopter emergency medical services to a total of five counties in the UK. We strive to ensure that patients receive treatment as soon as possible within the golden hour, in order to improve their chances of survival and recovery. This includes ensuring that critical care paramedics and doctors are onboard our helicopters to attend each emergency, whether medical or trauma, to deliver prompt and appropriate care as soon as they reach patients. Our highly trained staff are also able to perform advanced medical interventions at the scene, effectively bringing the hospital to the patient.

3.2 Our HEMS (Helicopter Emergency Medical Services) operation is also supported by two critical care cars, which attend emergencies during hours of darkness or periods of bad weather, enabling us to provide lifesaving care 24 hours a day, seven days a week, 365 days a year.

3.3 The Air Ambulance Service works in close partnership with local NHS ambulance services and hospitals. As there is no equivalent NHS air ambulance service, we work in collaboration – rather than in competition – with the NHS. As a voluntary, independent care provider, we do not receive funding from the NHS but raise it through a well-established system of fundraising like any other major charity. This means that we support vital care provision but at no cost to the NHS. In the case of the Children’s Air Ambulance, local NHS departments do not incur considerable costs by scrambling an RAF or private helicopter or have to make an impossible decision between whether or not to deploy an air ambulance. 3.4 The Children’s Air Ambulance is currently the only air ambulance to offer a clinically custom- designed flying intensive care unit for children. We travel the length and breadth of the country to provide our lifesaving transfer service to very sick babies and children who need to travel to specialist hospitals to get the treatment they need to survive. With flight times around four times quicker than a transfer by road, in many cases, the time saved means a life saved. Furthermore, due to the increased time and risk associated with transporting vulnerable children via road, this service is often the only way that paediatricians can ensure these very vulnerable children can access the specialist care they need.

3.5 We continue to provide our essential services across the country, attending to medical emergencies, industrial accidents, victims of other accidents and victims of violent crime. Although we have seen a reduction in road traffic incidents due to social distancing measures, the volume of road traffic has in recent days started to increase again. Furthermore, we attend a steady number of incidents related to violent crime and in particular, incidents related to knife crime, which continue to occur despite lockdown measures, and which have sadly seen a rapid rise since the beginning of the year.

4. Operational impact of covid-19

4.1 There were a number of immediate consequences of covid-19, not least the need to install even tighter standards for infection prevention control on our helicopters and the need initially not to transport anyone with symptoms of the disease. Another consequence which we observed in the early phases of the pandemic was that around half our doctors (who work on a seconded basis from the local NHS) bravely returned to the NHS to fight the disease on the frontline. As we directly employ our paramedics, we were able to continue providing our HEMS services at a reduced capacity of 40%. Some other air ambulance charities that do not employ their paramedics directly have been forced to temporarily ground their fleets. We were able to support a neighbouring air ambulance charity where this was the case by covering their geographical remit as well as our own.

4.2 The Air Ambulance Service is currently implementing measures to make our helicopters covid-19 protected, whilst taking into consideration technical specifications and the need for efficient crew communication. We are currently installing a wall inside the aircraft, between the cockpit and the cabin, so that patients who have tested positive for covid-19 can be transported safely.

4.3 In order to offer our support to those battling the virus on the frontline, we offered our helicopters to the NHS to help transfer clinicians to the new, purpose-built Nightingale hospitals across the country, should the need arise.

5. Financial impact of covid-19

5.1 The other significant impact was financial. The Air Ambulance Service is normally completely financially independent from the NHS, raising its annual £24 million operating costs through a comprehensive fundraising programme. However, due to the lockdown, we have had to cancel all of our upcoming fundraising events and close all of our retail outlets, the latter of which alone bring in £800,000 a month. In addition, we cannot progress any fundraising activities scheduled for the autumn because we do not yet know what the situation will be. We currently estimate that between the months of April and June, our projected net loss will be at least £2.18 million, although the figure will likely be much higher. Although we will be able to continue to provide our core service, we do not as a charity have large reserves and the financial impact of covid-19 will have implications for the extent of our operations at a time when we are needed more than ever to support local NHS emergency services. 5.2 The Department for Health and Social Care has advised us that Air Ambulances UK, an organisation representing some – but not all – of the UK’s air ambulance charities, has made a bid for £10 million which if successful will be split equally between the UK’s 21 HEMS charities, including The Air Ambulance Service. However, the Department has also advised us that The Air Ambulance Service’s sister charity, the Children’s Air Ambulance, will not be eligible from any money directed through Air Ambulances UK and will therefore not benefit from this funding.

5.3 The charity is putting in place plans to allow for the reopening of our shops in a way which takes into account appropriate social distancing measures with a speculative target of June 2020. We are also exploring further opportunities to fundraise online to replace some of our physical fundraising activities.

6. Government considerations

6.1 We suggest that the government considers a second wave of funding directed at charities providing NHS services who were not accommodated in the limited initial wave of funding. We would advocate for a more clear and transparent application process so that all charitable service providers to the NHS have a chance to apply.

6.2 We believe that we, and many other charitable providers across the country, have demonstrated at this difficult time how professionally and effectively we work with our NHS partners as well as our ability to step up when needed to ensure that essential services can continue when the health service itself is under unprecedented pressure. We believe that there is evidence that charitable service providers have the ability to work together with their NHS partners to innovate and collaborate in how services are delivered – particularly at a local level – as evidenced by our experience collaborating with the West Midlands Ambulance Trust on providing critical care cars that are better suited to reaching emergencies in the regional geography at night. We would ask that we are considered, and our voice is heard in future policy discussions and that, as a sector, we are given opportunities to showcase and share best practice.

May 2020