The NARU HART Resilience and Capability Survey – Why do we need it?

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Dr Tony Zarola

The psychosocial monitoring of Hazardous Area Response Teams (HARTs) is conducted nationally through the annual Resilience and Capability survey commissioned by the National Ambulance Resilience Unit (NARU) in partnership with Zeal Solutions.

The Resilience and Capability survey was first implemented in 2007. This continuous and longitudinal evidence base enables the Ambulance Service and NARU to assess, very accurately, the confidence and resilience of ambulance personnel who are expected to commit to and work in what are potentially dangerous, complex and life threatening situations.

The evidence that is collected is used both by NARU and the local Trusts to enhance levels of confidence and preparedness to deal with major incidents.

Why do we need to bother?

The Health & Safety at Work Act 1974 (and corresponding regulation) places a duty on employers to ensure the health and wellbeing of their workforce as far as is reasonable practicable.

Where a member of staff suffers physical or psychological damage in the course of their work, there may be a breach of this statutory duty if sufficient support was not providing as assessed against the role and its requirements.  If the exposure to harm was foreseeable, a relationship of proximity existed and it is reasonable for the law to recognise a duty on policy grounds, there may also be a breach of the common law duty of care giving rise to potential civil action.

HART personnel maintain a state of readiness to provide NHS care inside the inner cordon of hazardous situations that, from time to time, injure or kill emergency responders. To maintain this capability they are expected to operate safety critical systems and perform their role to exacting standards. The confidence and personal resilience of each member of the team to deploy their skills within the team environment is a safety critical factor.

In other sectors that employ teams to operate safety critical systems (such as the aviation industry or technical rescue providers) the industry standard requires regular monitoring and management of personal attributes that may impact on the wider team safety. The Resilience and Capability survey is the only nationally consistent, objective measure of these personal attributes within HART. As such it is a key component of the legal and professional duty of care obligations for both local and national HART operations.

BriefingWhat is measured?

The Resilience and Capability survey assesses and reports on 27 indicators. These indicators are grouped into three domains:

  • Workplace features are those things within the work environment which can have either a negative or positive impact on the health, well-being and resilience and confidence of HART’s.
  • Preparedness indicators are highly relevant to the environment in which HART’s operate in and are also referred to as core indicators.  These indicators assess levels of individual and collective readiness to deal with the range of incidents that HARTs are designed to respond to.
  • Health and Well-Being indicators have been grouped into four categories; Work attitudes, Safety Culture, Health & Stress and Withdrawal & Performance.  They assess individual as well as Unit health and well-being and are directly affected by workplace features and levels of preparedness.

The model that is used to assess and support HART understands that individual and organisational resilience is a dynamic process. It appreciates that workplace features, levels of preparedness and health and well-being influence each other in one way or another. Understanding this dynamic interplay between each of these domains enables NARU to provide HARTs with greater levels of support.

There has been, and continues to be, a substantial level of resource invested in specialist EPRR capabilities such as HART across the Ambulance Services. The need for these capabilities has been identified nationally (e.g. through the Civil Contingencies Act 2004, CONTEST, National Capabilities Programme). The process for designing and implementing HART was utilised to provide a national and interoperable service. Levels of preparedness, resilience and confidence can change and be influenced directly by the way organisations are managed and also by the frequency, nature and intensity of incidents that organisations and individuals have to respond to. The evidence that is collected through the Resilience and Capability survey helps stakeholders to monitor preparedness in a proactive way and enables actions to be prioritised that will ensure HART staff, Units and the Trusts remain confident and prepared at both local and national levels.

If you have any comments on this article or wish to find out more about the work on team cohesion and identity, please contact Dr Tony Zarola at Zeal Solutions via


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