 | Around the World in 80 Ideas |
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PUBLIC SERVICES 73: Private rescue services Probably the best rescue service in the world? The problem: a core function? Rescue services are often thought of as belonging to a state's core functions, along with police and defence - and the assumption is that they must also be provided by the state. Given the poor performance of some state agencies, does that really have to be? The idea: private rescue services In Denmark, while still publicly funded, most rescue services have always been provided by one private company: the Group 4 Falck, formerly the Falck Corporation. And, with the growth of outsourcing, international surveys consistently point to Falck as the model for reorganizing rescue services the world over. Example: fire and ambulance Established in 1906, Falck has provided firefighting and (from 1908) ambulance services for nearly a century. Originally a family business founded in Copenhagen by Sophus Falck, the group is now a limited company, with the main Danish insurance companies among its shareholders. Since its establishment, Falck has expanded into other fields, such as home care, maintenance, meter-reading for utilities, cleaning, safety, and security; and it now works internationally in Sweden (where it has worked since 1934), as well as Norway, Finland, Germany, Poland, France, Hungary, Austria, the United Kingdom, the Czech Republic, Estonia, Belgium, and even South Africa. Even the guard services at the Danish royal palaces and government buildings are now provided by Falck. But domestic rescue services remain the group's dominant sector, employing 65% of its 20,000 employees, and delivered from 132 Falck stations, co-ordinated by 16 operation control centres, administering all emergency calls. Fire-fighting in Denmark was effectively contracted out by the country's first Social Democratic government in 1926, when the Fire Act was passed, allowing municipalities to hire private fire-fighting companies. More than half of the 275 municipalities today, fire-fighting is provided by Falck, the rest being provided by municipal or voluntary fire brigades. Falck's provision of the service is based on an agreement between Falck and Denmark's association of local authorities, within which Falck and individual municipalities can draw up contracts comprising fire-fighting and related services. For decades Denmark has enjoyed one of the lowest-cost fire-fighting services in the world (three times cheaper than in the United Kingdom, measured as a proportion of GDP). At the same time, however, Denmark has the most rigorous fire legislation in Europe, covering the size of fire brigades, training, equipment, response time, and other standards, backed up by rigorous control by public authorities. Falck provides 85 % of the ambulance services in Denmark through a similar contractual scheme. A standard agreement between Falck and the Association of County Councils lays down Falck's emergency service obligations, among which is the obligation to dispatch the closest available ambulance, irrespective of where it is stationed. The payment for ambulance services is dependent on response time and activity, so that individual counties must pay more if they demand an increase in either, and if Falck fails to honour its part of the agreement they must pay a refund. The guidelines for medical training etc are developed by Falck, but approved by the national health board. The duties of Falck ambulance personnel are: 1. Preliminary examination of the patient outside and inside the ambulance. 2. Resuscitation outside and inside the ambulance. 3. Stabilizing treatment of the patient in transport of the patient to the (nearest) place of treatment. 4. Basic extrication and basic fire-fighting. Because the ambulance service is run in joint operation with Falck's other activities, such as subscription-based patient transport services, Falck already maintains a 'reserve emergency facility', without this increasing the cost of the statutory service to county councils. Falck is also unique in having a rescue (extrication) service attached to its ambulance services, instead of having this service provided independently (and with the consequent communications problems that happen in many countries with state-run emergency services. In 1992, a German study showed that Danish ambulance services were Europe's most efficient and economically sound, and in Denmark Falck enjoys one of the three highest company images on both attitude (highest score) and knowledge - ahead of more internationally renowned companies such as Carlsberg. Probably the best emergency service in the world? For further information:
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Copyright 2002: Adam Smith Institute
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