Key areas of internal governance

• Advisory groups

  A series of advisory groups comprising representation from all ten Ambulance Services, along with subject matter experts and practitioners, work through developments and changes to the NHS emergency capabilities. Advisory groups are not decision-making bodies.

• National Capabilities Group

  Advice or recommendations from the Advisory Groups come to the National Capabilities Group (NCG) for decision.  The NCG comprising managers of sufficient seniority to make decisions on behalf of the NHS Ambulance Trusts.  Decisions made by the NCG are then communicated to various senior groups in the form of the decision log.  The NCG also maintains a risk register for the specified NHS emergency capabilities. Matters beyond the authority of the NCG are escalated either to NHS England or to National Ambulance Sector under the Association of Ambulance Chief Executives.  The NCG operates under NHS England, so its jurisdiction is limited to the English Ambulance Trusts, however, membership includes representation from the Devolved Nations.

• Ambulance sector engagement

  Engagement with the NHS Ambulance Sector for the specified emergency capabilities is facilitated primarily through the NCG. However, the ECU also has representation at the AACE EPRRG (Association of Ambulance Chief Executives, Emergency Preparedness Resilience and Response Group) and the AACE National Directors of Operations Group (NDOG). The decision log from the NCG is formally received by these groups and the ECU representative provides regular updates and briefings on national activity involving the emergency capabilities. For matters that are deemed by the NCG Chair to be beyond the authority or competence for the NCG meeting, one route of escalation is to refer the matter to EPRRG or NDOG for resolution. The other route of escalation for the NCG is NHS England, who will then usually engage Ambulance Chief Executives directly.

  Clinical or medical practice matters are managed by the ECU Medical Advisor. The Medical Advisor is a permanent member of both the NCG and the ECU Business Group Meeting. They closely monitor the ECU work programme and matters arising within those groups. The Medical Advisor then determines if the clinical or medical practice matters arising can be resolved with their advice within those respective groups, or if the matters need to be escalated for resolution. The normal route for resolution of clinical or medical practice matters is via the Ambulance Sector’s National Medical Director’s Group (NASMeD) or one of NHS England’s National Clinical Reference Groups.

   

• ECU national team

  The National ECU Team comprises individual staff members employed under the ECU contract. These may be permanent staff who transition under TUPE arrangements each time the contract transitions to a new host, or they may be fixed term secondments. There are four teams within the unit that deliver its commission and day-to-day functions:

  1. Capabilities Team: Comprising subject matter experts who work within set capability portfolios. Those capability portfolios reflect the specified NHS emergency capabilities

  2. Education Team: Comprising education managers and specialist tutors. This team focuses on maintaining the curriculum linked to the emergency capabilities, the delivery of national training and supporting quality assurance of locally delivered training.

  3. Support Team: Comprising logistics and administration staff who support the day-to-day service delivery of both the Capabilities and Education teams. This also includes business support functions linked to the host Trust’s facilitation obligations.

  4. Leadership Team: Comprising senior managers for each of the other three teams and Executive level management from the host Trust.

   

• ECU Business Group

  The ECU Business Group is an internal meeting, chaired by an Executive Director of the host Ambulance Service.  It brings together senior managers from the four internal ECU teams and key partners from the host Trust.

  The main function of the Business Group is to ensure effective coordination between the ECU, the host Trust, NHS England and wider multi-agency partners.  It represents the main internal body for managing service facilitation, including; finance, people & culture, procurement, communications and contract management.  It also reviews work programme delivery across the commissioned activities and agrees the papers or reports for submission to the formal NHS England groups.

• National Task / Finish Projects

  Task / Finish Projects are usually commissioned within a financial year and are in addition to the Core Commissioned Outputs of the ECU service but are linked to emergency capability improvements.  This occurs when the Department of Health and Social Care (DHSC) or NHS England make additional funding available to nationally improve a particular capability under a specific business case.  The governance arrangements for national task / finish projects commissioned by DHSC or NHS England are defined within the specific business case linked to the project and may vary depending on the nature of scale of the project itself.  The ECU facilitates practitioner engagement and the development of user requirements for task / finish projects.  This can be achieved through the existing Advisory Group mechanisms or through user groups established specifically to support the improvement projects.

• NHS England

  NHS England is the ‘authority’ under the ECU contract and commissions the service. Within NHS England the service has direct links with the National Resilience Team, the Urgent and Emergency Care Team and the Central Ambulance Team. The ECU Medical Advisor also represents the service at NHS England Clinical Reference Group meetings.

  Oversight of the ECU service is facilitated through two principal meetings; the Contract Meeting and the Programme Meeting. Both are NHS England owned and facilitated.

  The Contract Meeting comprises senior leaders from NHS England, the Host Ambulance Service and the ECU National Team.  The Department of Health and Social Care also has representation at the Contract Meeting. The Contract Meeting sets the service strategy, agrees the annual work programme, monitors service delivery against the contract, and agrees any in year variance to the main service commission.

  The Programme Meeting comprises service managers and the NHS England ECU contract lead. This meeting is primarily responsible for the monitoring the work programme and includes a detailed bi-monthly review of the work programme tracker. It also acts as the parent body for the National Capabilities Group, resolving any matters escalated to it from that group. As a result, it receives the NCG decision log and risk register as standing agenda items.