WHO REGULATES THE ambulance service?
That’s an interesting question. In Ireland, ambulance services are provided to the public by the State (via the HSE and Dublin Fire Brigade), and by private operators contracted to the HSE whilst also providing services to private health insurers and event companies. Lifeline Ambulance Service is the largest private ambulance service, of which I am the managing director and owner. Services are also provided by the voluntary ambulance sector (which often covers public events and undertakes routine and emergency ambulance transfers) and the auxiliary ambulance services; other services are provided by the Dublin Airport Authority, the Guinness factory, some pharma companies, etc.
The combined ambulance services treat and transport hundreds of thousands of people each year, throughout Ireland.
Remarkably, with all of these organisations able to treat, and possibly mistreat, a patient, there is no requirement within the State for any ambulance service provider to be regulated or licensed. Indeed there is no regulator. There is no-one ensuring compliance with best operational and clinical practice and there is no independent organisation tasked with ensuring that the patient in the ambulance setting is safe. Anyone can set up and run an ambulance service at the present time.
At this time I’m sure my friends in PHECC [the Pre-Hospital Emergency Care Council] are getting a little excited. The reality is that they are not the regulator. They have statutory responsibility for the establishment and maintenance of a register of practitioners and awarding of clinical practice guideline (CPG) approval to ambulance services, whom they do not even have to inspect in order to award same.
‘The reality is a far cry from this’
As we know, the public tend to look at an ambulance provider, such as those identified above, and presume that they meet specific standards. However, the reality is a far cry from this ideal. If you own a dog or even a television you need a license, but no license is needed to transport sick, injured and vulnerable people.
There is no-one independently and routinely ensuring that staff are appropriately trained or vaccinated, ensuring ambulance staff wear identification clearly stating their qualification. No-one is checking that staff are Garda vetted, no-one checks that the essential equipment carried on an ambulance is serviced as the manufacturer recommends, that drugs are in date, that the vehicle is roadworthy; no-one conducts hygiene inspections…
PHECC have not approached this on a proactive basis, even after having to terminate the CPG approval of a private operator two years ago. This should have been the clearest reason to inspect ALL providers. What are they afraid they might find? I’m very sure that professional ambulance operators have nothing to fear, so who does?
‘Lives are at stake’
There is no independent mechanism to ensure that ambulance staff do not exceed the working time directive, which is obviously a very serious and potentially dangerous issue as people’s health (and possibly lives) are at stake when staff, having worked excessively long hours, are out driving emergency vehicles and treating patients.
PHECC’s own rules state that they may conduct inspections. But in one of the areas where they have jurisdiction they have chosen not to inspect the majority of providers. I wonder are they afraid of what they might find? None of the other ambulance providers in the auxiliary or voluntary field have ever been inspected for CPG approval. Remarkable for an organisation which professes to be the “regulator of EMS in Ireland”.
PHECC is, in my view, not independent and, worse again, has given patients, the public, practitioners, nursing and medical staff a false sense of security with its self-promotion. How independent can a regulator be if it is controlled by the main providers of pre-hospital care? Does a regulator not ensure standards in all aspects of the provision of an ambulance service, and not simply on a piecemeal basis in the areas of CPG guideline approval or maintenance of a register, as important as those areas are?
‘Things are still very unsafe’
I am of the firm opinion that no organisation should be allowed treat or transport patients, and that includes my own company, unless they have been independently inspected and awarded an appropriate license. If anyone does anything wrong there is no obvious, severe sanction at present. So an independent regulator with the ability to remove an organisations license might safeguard patients. Since I commenced campaigning for regulation of the Irish ambulance sector in 2006 things have improved somewhat, but in my view they are still very unsafe.
I believe that for many years the ambulance service has been poorly managed and now the excuse is the current economic climate. Years of reports have been published, conference after conference held, discussion after discussion, often quite secretively. And still we have the service as it currently stands.
I have many friends who work for the HSE; they are all committed to patient care and safety. EMTs, paramedics and advanced paramedic staff throughout the country only want the best for patients. They have for years gone above and beyond the call of duty to ensure that their patients receive the best care possible. I get the sense they are deeply frustrated, as I am.
There is a lot of talk about change but no one is ensuring it happens. No one is answerable to failed policy papers and no independent body exists to regulate patient care and transport providers. It’s time to leave aside cosy relationships and concentrate on introducing an effective regulatory system. This must include severe penalties up to termination of a license for breaches of patient safety issues.
The lack of regulated systems in other areas of our lives has caused great damage to our country. Let’s be mature and have effective regulation of the ambulance service. Those who are doing things professionally have nothing to fear. Let’s get on with it.
David Hall is the managing director of Lifeline. He also works with New Beginning, a group of lawyers, businesspeople and citizens set up to defend citizens facing home repossession.
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