Proposed changes to healthcare requirements at events could lead to the loss of a “significant number” of doctors willing to provide cover.
A new event healthcare standard, which would standardise healthcare provision for everyone at events, and the extension of the regulatory remit of the Care Quality Commission (CQC) into sporting and cultural events are two proposals being taken forward by the Government’s Department of Health and Social Care. This follows recommendations from the Manchester Arena inquiry, following the terrorist attack in 2017.
The CQC registers “service providers”. For most doctors, the CQC registration at their normal place of work would not extend to event coverage, so doctors providing this service would have to register as individuals or be employed for this by a CQC-registered provider.
A survey by the Faculty of Sport and Exercise Medicine found that this could mean 29% of doctors would stop providing medical support at equestrian events, and 36% for racing. An impact assessment by the CQC and the Department of Health and Social Care estimated that the registration fee per provider would be £1,200 annually, plus an additional £1,900 in the first year for admin costs.
Those H&H has spoken to stressed that they support the standard, but are concerned about the CQC aspect.
Consultant surgeon Stephen Andrews, chairman of the Medical Equestrian Association (MEA), told H&H the MEA is “very concerned about the potential impact of CQC regulation and how it might affect our members”.
“We fully support the aims behind the event healthcare standard to ensure a standard of care at all events. Our professional members are already fully regulated health care professionals,” he said.
“We have not been convinced that adding another layer of regulation, with the significant costs involved, would be of measured benefit. If individual doctors were required to be individually registered with the CQC to be able to support medical care at equestrian events, we have no doubt that a significant number of doctors would withdraw from participation as the costs to individuals would make it unworkable.
“If those costs were passed to the event organisers, many events would become completely unviable financially.”
He added: “Many of our members have full-time jobs, mostly in the NHS, and cover local events a few times a year in their spare time. Individual CQC registration would be a significant step too far for many of these highly experienced doctors.
“Our paramedic members are less affected as they are employed through ambulance providers who are already CQC-registered. We are unsure as to how our nurse members will be affected if they are not employed via a CQC-registered company.”
‘Could have negative consequences’
British Equestrian chief executive Jim Eyre told H&H the event healthcare standard is “a positive move”.
“However, the additional cost and administration of a CQC requirement is a concern for our industry. The direct impact on the dedicated medical staff is worrying but the knock-on effect on the quality of provision, running costs and ultimately event and organisational viability may be unsustainable,” he said.
“We will continue to work with our member bodies and the experienced and dedicated medical practitioners who support our sports and activities, alongside the Sport and Recreational Alliance and British Horseracing Authority to ensure the voice of our industry is heard in this important debate.”
British Eventing chief executive Rosie Williams said that there is “growing concern that these pressures may push our sport toward becoming unviable”.
“Our medical teams – both human and equine – are highly trained, deeply committed professionals who place the welfare of riders and horses at the centre of everything they do. Their expertise and dedication are not in question,” she told H&H.
“The challenge arises in how the cost of delivering this exceptional level of care is distributed. Increasingly, these expenses are being passed on to event organisers and, ultimately, to participants. It is here that the balance becomes difficult, as the financial burden risks outweighing the sustainability of the sport itself.”
British Horseracing Authority outgoing chief medical adviser Jerry Hill said the standard is a “proportionate response” to findings from the inquiry and that “when completed, trialled and refined will ensure a minimum standard of care at all events”.
Dr Hill added that racing anticipates only minor changes will be needed to be compliant with that, but said: “Adding another layer of regulation with associated costs to staff and venues by requiring CQC registration could however have negative consequences with the potential loss of experienced medical staff, reduced quality of care and event cancellation.”
‘I believe it is the right body’
The draft legislation was also debated in both the House of Commons and House of Lords on 15 April.
Zubir Ahmed, parliamentary under-secretary of state for health and social care, said there will be a 15-month period for registrations before regulation becomes enforceable, and that the CQC will consult.
“I do not want small events and village fêtes to be overregulated; that is not the intention of this legislation. Nor do I want individual doctors, clinicians and other volunteers to be over-burdened with financial registration fees, and we will look into this with the CQC,” said Dr Ahmed in the Commons.
“Given the changes that have been made to the CQC governance architecture, I believe that it is absolutely the right body to do this work.”
Speaking during the Lords debate, senior steward at The Jockey Club Baroness Dido Harding said: “The CQC’s initial impact assessment claimed that only 36 healthcare providers would need to register.
“Horseracing alone thinks that we have 350 individual clinicians who would need to register, even allowing for the fact that each clinician tends to work in three different sports.
“Potentially, the Faculty of Sport and Exercise Medicine UK’s estimate of 23,000 is an overestimate. Even if it is one third of that, it is still massively more than the CQC expected.”
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