Charities such as British Red Cross and St John Ambulance have been regular features at events for well over a hundred years. On 23 October 2019, British Red Cross announced they are to cease all event medical cover from 31 March 2020. The exit of a significant player in an industry that is still growing may seem paradoxical but reflects a complex business model that is undergoing considerable change.
According to the market intelligence firm, Mintel, the UK music concert and festival industry is currently estimated to be worth £2.61bn (up from £2bn in 2015) and is projected to be worth in excess of £3bn by 2022. UK spectator sports ticket sales, after a dip from 2015-17, are now at more than £1.45bn, and are predicted to grow in the short to medium term. The industries which require medical provision are therefore buoyant, which leaves open the question of why a major provider would exit a growing industry?
As one of the oldest first aid organisations, British Red Cross have been providing first aid and crisis support since 1870. A visual presence at both large and small events since before there was a commercial event medical industry, the organisation is probably better known for its response to communities in crisis, emergency response and supporting international development work. The decision to cease covering events reflects a strategic refocus on their crisis response activities.
Michael Adamson, chief executive of British Red Cross, said: “In recent years, we have seen increasing pressures on both our income and the demands for our assistance, which means we must prioritise how we use every pound donated to us.
“Unfortunately, our event first aid work has been running at a financial loss for some time — the service still requires £1.8m of donations annually to cover the shortfall between income and costs — and this is diverting vital funds from our efforts to provide emergency support for major domestic and global crises.
“So, it is with real sadness that we have taken the very difficult decision to close our event first aid service by March 31, 2020.”
The BRC’s event work has been declining for several years. Successive annual reports show patient numbers shrunk from 26,400 in 2016 to 11,500 in 2018. Part of this was deliberate: A review of their event first aid model in 2017 led to a decision to reduce their event portfolio by two-thirds in order to focus more on medium and large events. This decision illustrates a unique distinction between private commercial operations and non-profits such as BRC and St John Ambulance.
While cover provided to medium and large events (particularly those being run for commercial profit) are charged at market rates, surpluses from these events go towards providing a significant amount of below cost or pro bono event cover for small community-based events. Events such as school fetes or fairs which would otherwise not be able to afford commercial first aid cover. These events, which are of little interest to a private provider, will now find it more difficult to source reputable first aid cover.
In the professional arena, the event medical sector has become increasingly crowded in recent years. Numerous new providers have sprung up in response to growing demand for their services. This growth in demand has been complimented by an increase in current or former NHS staff looking for new opportunities or income, as well as relaxation of the first aid regulations making it easier to train first aiders for events. As with any crowded market, quality varies. While minor injuries and ailments are almost certain (and generally easy to deal with) it is impossible to guarantee that someone will fall seriously ill or have an accident that will call upon the more advanced skills that were likely a key part of the sales pitch.
One of the major challenges of deciding on a provider is that, ultimately, organisers are paying for something that may or may not get tested at their event. An under-resourced event may ‘get lucky’ and just happen to have the right people, in the right place, at the right time. Conversely, an event that has much more medical resource than the risk assessment identifies as needed may still get overwhelmed if multiple severely ill patients occur simultaneously or in hard to reach places.
In short, organisers may be paying for a service that is never truly tested until it is too late. Unfortunately, there are too many cowboy outfits who take advantage of this uncertainty and sell a sub-standard service.
Regulators are starting to take notice, and action will follow. The Care Quality Commission (CQC), which regulate ambulance activity in the UK, have for some time had event medicine in its sights. In November 2018, the deputy chief inspector and National Ambulance Lead for the CQC wrote to local authorities advising them of concerns in medical cover at temporary events. While not currently regulated, a CQC report published in March 2019 highlighted significant risks in medical cover at temporary events and recommended working with the Department for Health and Social Care to review whether increased regulation was required.
A review of regulation could mean that only providers who are registered with the CQC will be permitted to provide medical cover at events. Given that large events now have facilities not dissimilar to a local hospital, this is perhaps unsurprising. However, the impact will be keenly felt by smaller events charged higher prices by companies passing on the cost of registration.
The loss of British Red Cross means those organising small and/or not-for-profit events will find it even more difficult to source appropriate cover at reasonable rates. What makes the decision to withdraw doubly sad is that BRC would have been well placed to take advantage of increased regulation and compete more effectively in the sector. As an established provider of ambulance and other response services, they were already CQC registered, and could therefore have been poised to take market share from private providers unwilling or unable to secure CQC approval.
So, what does this mean for event organisers? With one less highly respected name to choose from, event organisers will have to select their provider carefully. However, two event types will be disproportionately affected. Major large events requiring a level of resource beyond the capability of most first aid providers, and small community events unable to afford to pay for medical cover.
As for the British Red Cross, this has come as a major blow to both staff and volunteers. The charity is taking steps to mitigate the impact and are in talks with fellow charity St John Ambulance to see how volunteers could be transferred across and be able to continue to provide event medical cover as part of their charitable and commercial output.