The demands and roles of ambulance trusts, fire and police organisations are ever changing but there is a strong impetus and defined measures to improve closer working between these emergency services, writes Nathan East
The consultation paper Enabling Closer Working Between the Emergency Services is designed to formalise the push towards collaboration between emergency services.
Closer working between emergency services has been evolving organically between ambulance trusts and fire and police organisations over recent years, in particular between trusts and fire and rescue authorities on co-responding initiatives. In addition, co-location and other projects have begun to feature more prominently.
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Changing nature of services
The driver for collaboration has not simply been driven by financial pressures, despite such considerations being ever present, but by the changing demands and roles of each of the services. The consultation recognises the increase in demand of ambulance services, while the roles of fire, and to a lesser extent police services, have been evolving due to changing demands and a greater focus on public protection and assisting those who are at risk or vulnerable.
On a practical level, demand for each of the services tends to overlap significantly in some communities due to socioeconomic or urban conditions and as such greater collaboration will be able to deliver a more cohesive approach to the wider safeguarding and prevention agenda. For example, in terms of cross over, a large majority of fire deaths are among those aged over 70 who have pre-existing health issues.
‘Will greater collaboration bring any relief for cash strapped ambulance trusts?’
So to what extent do the consultation proposals impact ambulance trusts, and go further than the collaboration which is already occurring. Do they propose fundamental changes in the way ambulance trusts operate? Will greater collaboration bring any relief for cash strapped ambulance trusts?
While the consultation paper is in broad terms aimed at all three emergency services, most of the specifics relate to the operation of fire and police services. This is consistent with the fact that while fire services have a transformation fund and police have an innovation fund to encourage the development of collaboration initiatives, similar funding has not been provided to ambulance trusts.
In addition, the most far reaching provisions requiring widespread governance changes are confined to police and fire. No far reaching proposals for governance changes are put forward for ambulance trusts so trusts are unlikely to face any immediate organisational change.
The only organisational proposal in this respect is that ambulance foundation trusts consider police and crime commissioner representation on their council of governors.
The push to collaborate
In other respects, the proposals requiring further emergency service collaboration are fairly generic. The government intends to introduce a new statutory duty on the three emergency services to collaborate with each other to improve efficiency and effectiveness.
This duty is intended to be broad to allow for local discretion as to how this is implemented.
While flexibility around local solutions is welcome, in reality the more straightforward forms of collaboration are already being pursued by most ambulance trusts. In this respect, the paper does not propose any ground breaking new initiatives.
It also doesn’t identify or tackle a number of the historical barriers to collaboration which will need to be addressed if the policy is capable of being implemented to a more fundamental degree.
‘One key constraint is the vast cultural and organisational differences between them’
One of the key constraints is the vast cultural and organisational differences between ambulance trusts and fire and police organisations. Culturally, ambulance services are closely aligned to the wider NHS in terms of governance, their statutory powers, regulation and funding.
In most cases, the sizeable differences in the geographical areas covered by ambulance trusts compared to fire and police inevitably means that collaboration projects for any trust will not necessarily cover their whole territory and will be on a piecemeal basis with different fire and police authorities within its geographical area.
The types of collaboration with fire and police will vary across the territory of ambulance trusts and may require separate agreements with a number of organisations so that one cohesive policy for the type of service collaboration that will be pursued by a trust may not be possible. To work effectively, a strong degree of collaboration and coordination between cross-boundary fire and police forces will be required which cannot be guaranteed.
In terms of more fundamental proposals that could apply such as back office and property collaboration these may need greater flexibility in the powers of trusts than current NHS legislation provides. The powers for collaboration will differ for ambulance trusts depending on whether they are an FT or not. Amalgamating back office functions whether by transfer to another service or by using a new organisational structure will all face issues with regard to pensions.
Contracts only go so far
Ultimately, what can be achieved by ambulance trusts will continue to depend on the existing powers they have to collaborate in the absence of additional legislation. Traditional contractual forms of collaboration by contract only go so far.
Where budgets and in particular capital is to be shared or organisational joint governance needed contractual collaboration is often insufficient. A more integrated approach through separate organisational vehicles in often more effective but there are limitations on ambulance trusts participation in such vehicles.
‘Trusts should be pro-active and look to identify how they aim to comply with any duty to collaborate’
Though FTs have greater flexibility certain forms of collaboration may need Monitor approval. By comparison non-FTs have more limited statutory powers to, for example, establish and invest in limited liability companies for joint service delivery.
Some legislative powers to collaborate already exist for specified purposes.
Health bodies are public bodies for the purposes of certain local authority legislation and so may contract with police and fire bodies, to be provided with:
- the supply goods or materials;
- any administrative, professional or technical service;
- the use of vehicles, plant or apparatus and appropriate staff; and
- works of maintenance.
These powers exclude new construction and the supply of property, so whilst this may assist in terms of shared service provision it is not relevant to holding and developing property.
Local authorities may second staff to health bodies on such terms (including as to payment) as may be agreed. Such secondments could be without charge, at cost or on a profit making basis.
In summary, the proposals contained within the consultation do not vastly change the landscape for ambulance trusts. Trusts however should be pro-active and look to identify how they aim to comply with any duty to collaborate and try to steer the agenda to areas which will benefit the trust and its patients, cognisant that the circumstances and form it should take may be limited or restricted by statute or regulation.
Nathan East is partner at national law firm Weightmans LLP