Words: Alan Howson, Executive Chairman, Independent Ambulance Association & Vice Chairman, the Health Practice Associates Council.
The ambulance sector prides itself on trust, honesty and integrity, absolutes for staff managing the needs of patients (many of them vulnerable) and working with colleagues. The public places their trust in ambulance staff. Paradoxically, this trust attracts offenders* who use it to gain access to vulnerable patients (and/or colleagues).
The Care Quality Commission (CQC) 2020 State of Care Report highlighted issues of concern on contemporary safeguarding in independent ambulance providers; these included: personal recruitment processes (such as word of mouth or previous work); Disclosure and Barring Service (DBS) checks not always being carried out; previous employment references not always present in staff files; CQC registered providers sub-contracting work to non-registered providers; and providers registering their business outside England to avoid CQC regulation.
The trust placed in ambulance staff can attract offenders* who use it to gain access to vulnerable patients (and/or colleagues) in order to: engage in unwanted or inappropriate behaviour (both physical and non-physical); access personal details (such as addresses, mobile numbers or social media contact points) in order to ‘groom’ the victim; and share information with other on potential victims.
The rank structure of the ambulance sector also provides offenders with opportunities to operate in positions of authority, which they use to exploit staff and patients.
‘Workplace banter’ is a known tool used by offenders to check boundaries and weaknesses in individuals; so be curious when an employee requests a change of work colleague or shift; has this happened before? is there a pattern?
CQC hosted a three-hour Sexual Safety Webinar, in September 2021, to raise awareness in this area, and to share examples of ‘best practice’. This included input from the police, the Disclosure and Barring Service (DBS), the Association of Ambulance Chief Executives (AACE), NHS ambulance trusts, the IAA and independent ambulance providers.
The CQC webinar highlighted extreme instances of offending, including that of Andrew Wheeler, an NHS Paramedic convicted of the of the rape and sexual assault of two patients and the sexual assault of a child under 13. The offences dated back from 2009 and were carried out across different organisations; he was operating in ‘plain sight’.
The webinar highlighted the role of Freedom to Speak Up Guardians, who act as focal points for colleagues to share concerns or experiences without fear of retribution.
The recruitment challenge
The ambulance sector is one that’s constantly recruiting, meaning opportunities are many and various.
While Paramedics are regulated (Wheeler was ‘struck-off’ as a Paramedic), there’s currently only a voluntary register for non-Paramedic ambulance staff, whose numbers are estimated somewhere between 15,000-20,000. Paramedics who have been ‘struck-off’ are known to ‘downgrade’ to a lower clinical level outside of scope.
Disclosure and Barring Service (DBS) disclosures don’t always tell the full story as not all disclosures are notified to the DBS. Similarly, employment references, which in the main simply state the start and finishing dates; at worst references are easily forged or a company created to fill gaps in employment.
There is of course the need to respect the legal principle of innocent until proven otherwise, particularly important where to mitigate against malicious or vexatious claims.
Notwithstanding, what can/should an employer do where an individual facing accusations of sexual misconduct (or any offending) leaves before the disciplinary process is concluded? The policy in some organisations is to continue with the process to conclusion, with the individual afforded the opportunity to participate/be represented.
A ‘factually accurate’ employment reference may put a tick in the recruitment process, but being candid, it does little to make it difficult for people to they have what value this has to counter offending is questionable in the context of countering offending.
Raising awareness
The IAA felt there should be no easy or safe hiding place for offenders to operate within the independent ambulance sector. Key to this was raising awareness of the issues and challenges being faced, and the potential consequence for patients and staff.
We invested in a series of webinars to raise awareness about sexual safety, and to shine a light on a subject that’s outside normal comfort zones. Be Curious was an expression used by the CQC Head of Inspections when briefing IAA Directors; being curious is what we want people to be.
Be Curious aired in November 2021, led by Dave Blain. Dave is an expert on safeguarding in the ambulance sector and has over 20 years’ experience, including involvement in the Saville enquiry.
At the beginning of the webinar, delegates were asked to mark themselves out of 10 on how effective they considered their recruitment, staff monitoring and policies/procedures for managing allegations or instances of offending.
In the conclusion, they were asked to reflect on their original mark; feedback confirmed that scores were lower, and organisational changes were planned. Awareness had been raised and will be further developed in Be Curious II.
Be Curious II (what do you do when… ) ran from 1-2 March and took a Town Hall format, with attendees posing (anonymised) questions to Dave Blain on specific safeguarding issues, for example an employer’s legal obligations to report information on individuals to the DBS.
Summary
This is not an easy subject; while it’s good to know that this issue is being addressed, we simply don’t know to what extent this problem exists in the ambulance sector.
If safeguarding was only about DBS checks and employment references, none of the above would have happened.
This is a societal problem, which impacts everyone. The IAA are committed to making it as difficult as possible for offenders to have access to potential victims. We’ve started with Be Curious and will work closely with the CQC, NHS Ambulance Trusts and independent providers to this end.
For more information on the Be Curious webinars contact the IAA on quality@iaauk.org
*offenders is used to describe those who are committing offences as defined by Law.
