The implementation and maintenance of HART capabilities, whilst at times controversial, has been a significant success [1].
UK Ambulance Services are now able to commit NHS Paramedics into a wide range of hazardous environments and provide early life-saving interventions to patients. That is not to say that hazardous area working is the preserve of HART. Other NHS Paramedics provide public order, mass casualty and decontamination services as well as support to firearms incidents.
HART Units based throughout the country have combined to provide a successful contribution to national events including the 2012 Olympic Games and the widespread flooding of 2007, 2011 and 2014. In addition to national interoperability, to date HART units have responded to 49,169 incidents [2] to support the local ambulance response with their specialist skill sets, equipment and training. HART has become part of core service delivery.
Part of the success story is the speed in which these extensive new capabilities were introduced within the NHS but HART is a high-risk business. Recent responses to gas explosions and water operations have significantly improved the clinical outcomes for a range of patients but have also seen HART staff injured and hospitalised.
Ambulance Commanders are still learning how to effectively manage risk when committing Paramedics into the most dangerous of environments. At the same time the common law duties of the ambulance service continue to evolve and have been distinguished by the courts from the duties of other emergency services [3]. We now have a situation where the ambulance service has far greater legal responsibility for patients requiring rescue than any other emergency provider, and they have the capability and equipment to provide it.
Controls have been put in place from the outset to safely manage these risks. They include a national service specification, standard operating procedures, risk assessments and a comprehensive training component. But have we got all of these things right? Are the assumptions upon which they are based correct? Are these capabilities fully compliant with the extensive array of legal, regulatory and professional requirements that apply to the operation of safety critical systems? NARU feels it is time to find out and has commissioned a robust ‘confirm and challenge’ process to test the systems and processes behind the HART capabilities.
The Compliance Project, initiated in January 2014, will analyse the current provision of specialist HART capabilities and then test the safe systems of work with support from external legal advisors, the Health and Safety Executive and other quality assurance mechanisms. This work will feed into the current Stage 3 review of HART to inform the commissioning arrangements and future specification. The project will also produce a compliance schedule to support local service delivery. This will set out the mandatory minimum standards for the management of HART skill sets, equipment and training required to meet legislative, regulatory and professional compliance requirements. NARU has published a Compliance Project Business Case setting out the rationale and scope of the project. Copies are available directly from NARU.
The key contact for the Compliance Project is Christian Cooper MSc DipLaw, NARU Compliance Officer, via email christian.cooper@nhs.net.
[1] As confirmed by the Value for Money report produced for the Department of Health by Values in Practice (the Kathy Jones Report), May 2013 and the National HART Audit conducted through 2013 (report published February 2014).
[2] Incident reporting data from the PROCLUS system, Zeal Solutions, as at 25/02/14.
[3] Leading cases include Kent v Griffith [2000] 2 WLR 1158 – other cases and the ambulance duties are covered in detail by the NARU Legal Duties Presentation, available on request.