A leaked email from the Department of Health has thrown into question Staffordshire Ambulance Service’s recent decision to withdraw drugs from Community First Responders on legal grounds. Michael Fabricant says: "The new management of the Staffordshire Ambulance Service has cited the Medicines Act of 1968 as the reason for withdrawing lifesaving drugs. But if the leaked memo is to be believed, and the Department of Health has not denied its authenticity, the management of Staffordshire Ambulance Service were told by the Department of Health as far back as the end of July that there is no legal reason whatsoever for these drugs to be withdrawn. Indeed, this memo supports Roger Thayne’s contention that he checked the legal position and was assured that he could make these drugs available to Community First Responders resulting in many lives being saved. Roger Thayne is the former Chief Executive of the Staffordshire Ambulance Service. And a letter sent as recently as 14th November from the Department of Health reinforces this stating that it is up to Trusts to ensure that CFRs are adequately trained. CFRs in Staffordshire receive more training than their counterparts in other parts of the country where these drugs are still in use".

Michael adds: "It follows that I now have to ask: why has the new management of Staffordshire Ambulance Service withdrawn these drugs on legal grounds, and still claim this to be the case, when they have known since July that their use is legal? And how does Staffordshire maintain its stance while other counties still allow their first responders to use exactly the same drugs, with less training, and without any attempt by the Department of Health to stop them? Is the new ‘Partnership’ between West Midlands Ambulance Service and the Staffordshire Ambulance Service the root cause of the problem?"

Michael Fabricant is calling for an emergency Commons debate on the operations of the Staffordshire Ambulance Service and its Community First Responders. These and other questions will be raised with the Health Minister.

Two documents now follow.

(1) The email from the Department of Health to Staffordshire Ambulance Service:-

From: Ryan, Anne – Department of Health
Sent: 26 July 2006 12:10
To: enquiries@staffsas-tr.wmids.nhs.uk
Cc: Thyer, Anne
Subject: Community First Responder Scheme
FOR THE ATTENTION OF DR ABEYSINGHE
Dear Neil,
Thank you for your letter of 24 July about the legalities of administration of certain medicines by Community First Responders (CFRs). I assume from your letter and our previous conversation that the CFRs are supplied with the medicines by the Trust. As the CFRs are trained, work on behalf of and are fully accountable to the Trust (albeit financed through charitable sources), we would take the view that they are legally able to access the medicines as part of that Trust. This being the case, there is no bar to them administering Adrenaline and Glucagon. As you note, these are both on the list of parenteral medicines which may be administered by anyone for the purpose of saving life in an emergency.
Medicines legislation does not address the administration of non-parenteral medicines so there is nothing to prevent CFRs administering the remaining products listed in your letter. Although civil liability is not an issue for the Agency, we do advise that there should be guidance in place relating to the use of the medicines and the Trust should take responsibility for the CFRs’ activities/training. However, your letter suggests this has been addressed already.
Finally, it is correct that a Patient Group Direction can only be used by specified, registered health professionals and there are legal requirements relating to the particulars it must contain. Guidance and protocols in place for the administration of medicines by CFRs may well be on similar lines but should be called something else.
I hope this is helpful. I am on holiday for two weeks from tomorrow but if you need any further clarification, please contact my colleague Anne Thyer.
Anne

(2) Extract of letter dated 14th November 2006 from Victoria Milnes, Customer Service Centre, Department of Health, London sent to Ms Ann Peters, Brewood and District Community First Responder Group in Stafford:-

The view of the Medicines and Healthcare products Regulatory Agency is that community first responders are in a similar position to Trust employees if they:

A) are engaged by a Trust to provide emergency response services as part of the Trust’s business:
B) are trained by and subject to the direction and control of the Trust; and
C) work on its behalf and are fully accountable to it.

This means that they can be supplied with appropriate drugs by the Trust without contravening the Medicines Act. However, in addition to the specific legal restrictions, Trusts need to ensure that their clinical governance arrangements are sufficiently robust to ensure safe and effective practice.