From its beginnings, St John Ambulance in England has employed ranks and insignia to distinguish grades within its membership and management structure.
The basic "star" or "pip" has at its centre the eight-point Maltese Cross, the badge of the Order of St John.
Also, officers who hold rank within the organisation at or above R4 wear a cockade in their hat (women) and have a silver bar (men), however at or above R3 wear a cockade and tuft (women) and silver bar and Wort cap (men).
It was decided to remove all NCO ranks for adult volunteers and staff across the organisation, though not cadets.
A Sergeant Major at National Headquarters continues to be appointed to advise on matters relating to ceremonial events.
Leadership positions on the frontline were no longer indicated by the volunteer's rank insignia, but by the role bar worn on the uniform.
In May 2023, the conclusion of the Rank Review was officially announced concluding that Officers would continue to wear insignia to denote their position within the service.
However, rank insignia was no longer to be worn by any volunteer in patient-facing activity, including those in management positions.