Dear Mrs Lynch,

Thank you for copying the Association of Ambulance Chief Executives AACE into the Regulation 28 ruling associated with the sad death of Rio Andrew age 15 at an illegal rave in Croydon in June 2014.

As you note in your letter AACE has not been required to respond to the Regulation 28 notice but was copied in as you felt it may be of interest to us.

Having considered the issue and discussed with the National Ambulance Medical Directors Group we did feel that we should write to you to make a few salient points and to encourage your engagement with the Care Quality Commission (CQC) to address the regulatory issues.

AACE remains concerned that private ambulance providers who are providing medical cover at events remain unregulated by CQC in terms of the medical care they are delivering within the event footprint. We have raised this previously with CQC and whilst we appreciate the additional workload it would bring them it is clear that at times the medical care provided can be tragically inadequate. This also brings an unquantifiable additional burden for the statutory ambulance service who have to intervene and also puts patients at risk.

We are also aware of course that the term ‘Ambulance Technician’ is not a protected title and is not regulated. The college of Paramedics has been lobbying for some time to have this title protected and to bring Ambulance Technicians under the same level of regulation as Paramedics. AACE is supportive of this and works closely with the College of Paramedics to attempt to progress this issue.

Statutory Ambulance services when contracting with private providers will undertake their own quality assurance checks to ensure that all staff of all grades used by that private provider in the execution of that contract are appropriately qualified and skilled. It would appear however that some private providers do not operate to the same level of diligence as would appear to be the situation in this case.

I hope this is helpful

Chairman: Dr Anthony C Marsh QAM SBStJ DSci (Hon) MBA MSc MA FASI Managing Director: Martin Flaherty OBE

From Ben Gummer MP Parliamentary Under Secrelary of State for Care Quality Department Richmond House of Health 79 Whitehall London POC 1014368 SWIA 2NS Tel: 020 7210 4850 Ms Selena Lynch HM Coroner South London Area Coroner'$ Office, St Blaise Building Bromley Civic Centre Stockwell Close Bromley BRI 3UH 2016 L+l Thank you for letter of 27th Jaruary to the Secretary of State about the death of Rio Andrew Iam responding as the Minister with portfolio responsibility for patient safety at the Department of Health: Iwas saddened to read of Rio'$ death: The death ofa young is always a loss. Please pass my condolences to his family. Your report noted a number of concerns which include the regulation of the private ambulance company by the Care Quality Commission (CQC) , exemptions around temporary events and regulation of the title 'ambulance technician - With regards to the regulation of the private company by the CQC, the exemption for temporary arrangements means that the provision of medical assistance at events is entirely unregulated. This includes not only illegal raves, but legal events such as sporting events, fetes and festivals Although Local Authorities are generally responsible for enforcing health and safety legislation at events where an event is actually organised by a local authority, the Health and Safety Executive (HSE) is normally responsible for enforcement: HSE is sponsored by the Department for Work and Pensions: To assist in the provision of safe and well run events Local Authorities have Safety Advisory Groups which promote high levels of safety and welfare at events by giving advice and guidance promote good practice in safety and welfare planning for events ensure events have a minimal adverse impact on the community May your great person

The CQC does not regulate the "treatment of disease, disorder or injury" where it is delivered under temporary arrangements for the purposes of sporting or cultural events The rational for this is because the short term nature of such events means system regulation does not offer an effective mitigation of the risks in the care provided over the course of the event: In most cases, the event would be over before the CQC would chance to inspect it Or provided any sort of assurance about the quality and safety of services provided at the event In addition, the costs and requirements of regulation to one-off events, such as village fetes and similar, would place a disproportionate burden on the organisations wishing to carry out those events. The Department has become aware of some permanent established companies that provide cover at temporary events These providers deliver services on a year round basis, to one off events and other social and cultural events. The range of services provided appears to go some way beyond basic first aid and in some cases involves the delivery of services by a multi-disciplinary team: The Department is intending to consult later this year as to whether providers of this sorty should be brought into the scope of regulation by CQC. The Department is proposing that permanent nature of these providers, as opposed to the temporary nature of the events provide services at, does offer sufficient continuity of service that system regulation by CQC could help mitigate the risks of the public receiving unsafe care at events. This proposal would not extend to organisations established on a temporary basis the purpose of = delivering services at a cultural or sporting event; for the reasons already set out above. Inote that you have been sent a report from pfLife Skills Medical UK which was, in this case; the Approved Training Centre and Provider of ambulance service qualifications training | made a number of recommendations which he believes would prevent future deaths. 1 asked my officials to review the issues and proposals put forward by Life Skills Medical UK and discuss them with the relevant bodies CQC, Association of Ambulance Chief Executives) in the light of on-going developments in the field: I hope that this infornation is useful, Thank you for bringing the circumstances of Rio'$ death to our attention. (Ks BEN GUMMER have they - for have (e.g Iav{