Care Quality Commission (CQC) Registration and the Law (In relation to Ambulances & Paramedics on Film Sets):
Since 2009 it has been a legal requirement for independent medical services offering “regulated” activities in England to be fully registered with (and therefore inspected by and approved by the Care Quality Commission (CQC).
The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 states that “Regulated activities” (i.e. that do require the operator to be CQC registered by law) include:
“Transport services, triage and medical advice provided remotely”
including “(4), transport services provided by means of a vehicle which is designed for the primary purpose of carrying a person who requires treatment”.
I.e. The regulations apply to anyone providing an ambulance which is intended to, or which might, take a patient to hospital.
If you have been informed otherwise then you have been misinformed. The only relevant exception in the regulations is:
(3) Transport services which are provided within the confines of the site or venue being used for an activity or event mentioned in paragraph 4(3)(f) or (g)
And the exemptions in paragraph 4(3)(f) or (g) are:
f) the provision of treatment in a sports ground or gymnasium (including associated premises) where it is provided for the sole benefit of persons taking part in, or attending, sporting activities and events,
(g) the provision of treatment (not being first aid for the purposes of paragraph 9 of Schedule 2) under temporary arrangements to deliver health care to those taking part in, or attending, sporting or cultural events,
So – despite what numerous unregistered providers are leading clients to believe - the only time an ambulance service does not have to be CQC registered by law are if they working at a temporary sporting or cultural event (? A film set) and where the ambulance is used only to transport people within the confines of the event (ie not to hospital) . So you may be able to provide an ambulance to take patients from one side of a studio to another – or, perhaps get a patient off set and to a roadside position that an NHS ambulance could meet them – however if you expect your ambulance provider to be able to transport a patient to hospital in the event of an accident or emergency, they must be CQC registered to provide this service.
If they are not then, in the event of an emergency, they are either going to call 999 and wait for the NHS to arrive (potentially exposing the production to claims that the medical cover provided was inadequate – being incapable of getting a patient to hospital without delay) or transport the patient illegally (exposing the production to potential claims based on the provision of an illegal, unregistered and unregulated ambulance service).
What is CQC Registration and Regulation
CQC registration is the same process of external regulation inspection and ongoing monitoring that applies to all NHS hospitals, NHS ambulance services and GP practices in England (it does not apply in Scotland or Wales).
It is a lengthy and detailed process and, once registered, providers are regularly inspected to ensure that all the required standards of safety and care are being met. In practice this involves actual “on site” detailed inspections of everything from:
- Staff vetting checks and references.
- Staff qualifications, ongoing training and statutory and mandatory training (things like safeguarding, information governance, respect and dignity etc)
- Staff appraisals
- Vehicle maintenance records
- Vehicle and equipment cleanliness checks (including checks or cleaning records and swab testing)
- Equipment servicing and maintenance records
- Medicines management (including checking expiry dates and records for everything)
- Clinical governance
- Complaints investigations procedures
- Customer feedback procedures and records
- Risk management
- Verification of numerous policies
- Interviews with all managers
- Interviews with staff (selected at random)
- Interviews with patients or customers.
The list goes on..
If there are any shortfalls in standards at an inspection the company may be placed into special measures with an action plan they have to adhere to – or (if the QCQ things that patient may be at risk) suspended altogether. If their registration is suspended, they cannot legally provide regulated activity and have to cease trading until re-registered.
How to check if a provider is registered
Don’t take the companies word for it and don’t believe their website – check!
Companies that are properly QCQ registered are listed on the CQC website https://www.cqc.org.uk/ – along with all the inspection reports.
Companies may be listed as not inspected. This literally means that they have applied but not been checked. Take that at face value.
What happens if a unregistered company provided regulated services?
Nothing. The CQC, it seems, can only take enforcement action against companies that are registered with it.
Anyone can still go to an auction, buy an ambulance, equip it with anything that looks the part, put a couple of first aiders in yellow coats and call up productions offering ambulance services.
The CQC are working to encourage other regulatory agencies else (like local authorities, the HSE and events licencing groups) to take action to outlaw unregulated companies – or at least provide advice to purchasers of medical services – but don’t seem to see this as their remit. (See www.cqc.org.uk The unregulated independent ambulance sector for more info)
So far the film & TV industry seems to not be on the “radar” of the CQC – but at the end of the day its likely that, as with many things, the consequences of using unlawful operators will only be revealed in legal action following accidents etc – much of which is, of course, settled “out of court” as opposed to being publicly documented.
Each production company should make their own assessment of the potential risks to them of using an unregulated (and possibly uninsured) ambulance provider, but ignorance is never a robust defence!
Background, declaration of interest & Disclaimer: Daniel Melhuish is Managing Director and registered CQC manager of Location Medical Services Ltd, A CQC regulated company providing medical services to the Film production industry for over 22 years. Any company that goes through CQC registration embarks on a steep “learning curve” and has to become familiar with the regulations and how they affect the activities of their companies – and this review is intended as a helpful summary of some relevant information. Dan Melhuish is not legally qualified and the above interpretation of the regulations and how they apply to the film & TV industry is based on his own research, understanding, and working knowledge. Any production should seek independent advice or undertake their own research before making decisions in relation to the proper appointment of health care professional staff and services or before evaluating the potential legal impact of different options.