Loophole in the law leaves patients at risk of abuse and sexual assault

A loophole in the law is leaving vulnerable patients at risk of abuse and sexual assault by unregulated private ambulance staff, The Independent can reveal.

While many private ambulance providers are regulated, a small number, such as those providing services at events, those providing first aid, and those who are subcontracted, fall outside the reach of the Care Quality Commission (CQC).

This is due to a loophole in the legislation, which means that organisations providing healthcare at events are not required to be CQC registered.

The Independent has learned that around 10,000 patients a day are seen by ambulance workers who are unregulated and not part of any registered professional body.

According to a senior civil servant, the NHS is also failing to carry out as many criminal record checks on staff as it should be. Suzanne Smith, director of the Disclosure and Barring Service (DBS) for the government, revealed that the NHS had made just 430 DBS referrals in the period covering 2020-21.

Alan Howson, chief executive of the Independent Ambulance Association, said he was concerned about healthcare providers that “operate outside of the scope” of the care watchdog and in “plain sight and unchecked”, leaving patients at risk from staff who might “seek to misuse their power”.

His concerns were in response to an internal report by the CQC, completed last year, which identified specific risks around sexual harm in relation to private providers, as well as “inconsistency” in providers’ recording of incidents.

Earlier this week, the government launched an independent inquiry into the horrific sexual abuse of 100 corpses at an NHS trust, carried out by NHS electrician David Fuller.

“Operating unchecked”

A recording of an event held by the CQC in September, seen by The Independent, revealed that the care watchdog has been “lobbying” the government to make changes to the legislation since 2018, but that delays during the pandemic have meant it will not be consulting on the issue until Spring 2022.

During the event, Mr Howson said: “I’m well aware of the level of trust the public places in the ambulance sector as a whole, and that this level of trust attracts those who would seek to misuse it.”

He said there were around 15,000 workers employed to work in private ambulances across 250 registered providers, which is “a lot of people with access to a lot of patients on a daily basis, often unsupervised and unaccompanied, across a range of settings”.

However, he highlighted a specific worry over “ambulance providers who operate outside of the scope of CQC, often in plain sight and unchecked – on-site event cover, street first aiders being two examples”.

He added: “This is a sector that’s constantly recruiting, so finding a job isn’t difficult ... Starting an ambulance business isn’t difficult, nor is writing your own reference. There should be no hiding places in the sector for those who would seek to abuse their work.”

Mr Howson also revealed that there was a “loophole” for first aiders working for bars and nightclubs, who work on the “fringe” of regulation as they are not taking patients to hospital.

He told The Independent: “If we go to the bottom of this, there are offenders who prey on vulnerable people. I think there is a kind of social responsibility that goes with this, to say, ‘Look, we, the CQC, and the ambulance providers, [and] the police, are all on the same page to try and address this.’”

Dangers of unregulated staff

In the UK, staff working within ambulances, who are not paramedics, do not have to be registered or regulated.

Grant de Jongh, chief executive of the Health Practice Associates Council, which has created a voluntary register for all staff below paramedic level, said that 50 per cent of first responders are unregulated workers, and that they are responsible for seeing 10,000 patients a day.

He said there were staff working zero-hour contracts for different ambulance providers who could easily jump to another provider when concerns were raised about them.

In one example, he said an NHS trust he worked for discovered that one staff member, who had been working for them for six months, had had significant concerns raised against them at a previous trust but had managed to get a job with a private ambulance provider.

He added that the risks did not exist only within the private sector.

Ms Smith, the government’s DBS director, warned during the CQC’s event that NHS referrals to the service were “much lower than they should be”. Despite the size of the NHS, just 403 referrals were received in 2020-21, which is just five per cent of the overall number received by the DBS each year.

She also revealed gaps in the use of the DBS, for example where police have information about sexual harm allegations this isn’t always disclosed to the DBS.

Her warning comes after health secretary Sajid Javid said the government’s inquiry into David Fuller’s abuse would look at employment checks, especially DBS checks, after it was found that Mr Fuller’s convictions had not been picked up by DBS checks.

Anthony Marsh, chief executive of the West Midlands Ambulance Service, said: “I’ve devoted my entire career to the NHS – 35 years – and nothing hurts more than when I hear these stories, particularly when they affect the ambulance sector, our staff and sometimes patients, and we should all be outraged when we hear these stories of abuse.

“Recently we heard stories of new staff, university paramedics, and the risk they’re being exposed to, and it’s just wrong.”