Emergency medical services in the United Kingdom

Crest of NHS ambulance services in England

Emergency medical services in the United Kingdom are almost all provided by one of the four National Health Services through local ambulance services, known in England and Wales as trusts. Each service in England is specific to a one or more local authority areas, and so the country is divided across a number of ambulance services, in a similar way to the British Police.

An ambulance waiting outside of a hospital in Leeds, West Yorkshire.

In England there are thirteen ambulance 'trusts', with boundaries generally following those of the regional government offices^[1]. In Scotland, the Scottish Ambulance Service (a Special Health Board) serves the whole of Scotland, in Wales the Welsh Ambulance Service covers throughout the country and similarly in Northern Ireland the Northern Ireland Ambulance Service provides cover.

Remit of the Ambulance Services

NHS ambulance services are required by law to respond to four types of requests for care^[2], which are:

Emergency Calls (via the 999 system)
Doctor's urgent admission requests
High dependency and urgent inter-hospital transfers
Major incidents

The ambulance services have been increasingly busy, with a significant increase in calls in the last two decades,^[1] as shown in the table below:

Year	Emergency Calls	Source
1994/5	2.61 million	^[1]
2004/5	5.62 million	^[1]
2006/7	6.3 million	^[3]

Ambulance trusts may also undertake non-urgent patient transport services on a commercial arrangement with their local hospital trusts, or in some cases on directly funded government contracts.^[4] This is an area where an increasing amount of private firms are taking business away from the trusts.

Ambulance Trusts and Services

England

Following consultation, on 1 July 2006 the number of ambulance trusts fell from 29 to 13^[1]. The reduction can be seen as part of a trend dating back to 1974, when local authorities ceased to be providers of ambulance services. This round of reductions in the number of trusts originated in the June 2005 report "Taking healthcare to the Patient", authored by Peter Bradley, Chief Executive of the London Ambulance Service, for the Department of Health.^[5] Most of the new Trusts will follow government office regional boundaries.

Exceptions include Staffordshire Ambulance Service (which has a temporary reprieve until October 1st 2007, when it will become part of the West Midlands trust^[6]), the Isle of Wight (where provision will remain with the island's Primary Care Trust), South East Coast Ambulance Service, and South Central Ambulance Service. This has led to a number of old trusts ceasing to exist. The new trust structure is as follows:

	Ambulance Service	Headquarters^[7]	Local Authority Areas Covered^[7]
NHS Ambulance Service Trusts	East Midlands Ambulance Service NHS Trust	Nottingham	Derby, Derbyshire, Nottingham, Nottinghamshire, Lincolnshire, North Lincolnshire, North East Lincolnshire, Leicestershire, Rutland and Northamptonshire
	East of England Ambulance Service NHS Trust	Norwich	Luton, Bedfordshire, Cambridgeshire, Hertfordshire, Norfolk, Suffolk, Peterborough, Southend-on-sea, Thurrock and Essex
	Great Western Ambulance Service NHS Trust	Chippenham	Bath and North East Somerset, Bristol, Gloucestershire, South Gloucestershire, North Somerset, Swindon and Wiltshire
	Isle of Wight Primary Care Trust	Newport	Isle of Wight
	London Ambulance Service NHS Trust	London	Greater London
	North East Ambulance Service NHS Trust	Newcastle-upon-Tyne	Darlington, Durham, Hartlepool, Middlesbrough, Northumberland, Redcar & Cleveland, Stockton-on-Tees and Tyne & Wear
	North West Ambulance Service NHS Trust	Bolton	Blackburn with Darwen, Blackpool, Preston, Cheshire, Cumbria, Greater Manchester, Lancashire and Merseyside
	South Central Ambulance Service NHS Trust	Wokingham	Berkshire, Buckinghamshire, Hampshire, Milton Keynes, Oxfordshire, Portsmouth & Southampton
	South East Coast Ambulance Service NHS Trust	Lewes	Brighton & Hove, Kent, Medway, Surrey, East Sussex and West Sussex
	South Western Ambulance Service NHS Trust	Exeter	Bournemouth, Cornwall, Devon, Dorset, Plymouth, Poole, Somerset and Torbay
	Staffordshire Ambulance Service NHS Trust	Stafford	Staffordshire and Stoke-on-Trent
	West Midlands Ambulance Service NHS Trust	Brierley Hill	Herefordshire, Shropshire, Telford & Wrekin, Warwickshire, West Midlands and Worcestershire
	Yorkshire Ambulance Service NHS Trust	Wakefield	East Riding of Yorkshire, Kingston-upon-Hull, North Yorkshire, South Yorkshire, West Yorkshire and York

Scotland

Two Mercedes Sprinter vehicles of the Scottish Ambulance Service

The Scottish Ambulance Service is a Special Health Board funded directly by the Health Department of the Scottish Executive^[8]. In 2006 the service responded to over 520,000 emergency calls. Scotland also has Britain's only publicly funded Air Ambulance service, comprising of two Eurocopter EC 135 Helicopters (based in Glasgow & Inverness) and two Beechcraft B200C King Air fixed-wing aircraft (based at Glasgow & Aberdeen).^[9]

Northern Ireland

The Northern Ireland Ambulance Service (NIAS) is the ambulance service that serves the whole of Northern Ireland, and was established in 1995 by parliamentary order.^[10] As with other ambulance services in the United Kingdom, it does not charge its patients directly for its services, but instead receives funding through general taxation. It responds to medical emergencies in Northern Ireland with the 270 plus ambulances at its disposal. The Service employs approximately 1044 staff based across 32 stations & sub-stations, 4 Control Centres and a Regional Training Centre.^[10]

Wales

The Welsh Ambulance Service NHS Trust (also called Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru) was established on April 1, 1998 and has 2,500 staff providing ambulance and related services to the 2.9 million residents of Wales.^[11]

Its headquarters is located at H.M.Stanley Hospital, St Asaph, Denbighshire and it is divided into three regions ^[12]:

Central and West Region based at Ty Maes Y Gruffudd, Cefn Coed Hospital, Cockett, Swansea
North Region based at H.M.Stanley Hospital, St Asaph, Denbighshire
South-East Region based at Caerleon House, Mamhilad Park Estate, Pontypool

Measuring performance

The performance of every Ambulance Trust is measured by the government, as part of a system called 'ORCON'.^[13] The Governments targets are to reach 75% of Category A (life threatening) calls - as decided by the computerised AMPDS (except the Berkshire Division of South Central Ambulance were CBD (Criterion Based Dispatch) is used), within 8 minutes. A number of initiatives have been introduced to assist meeting these targets, including Rapid Responders and Community Responders.

Private Ambulance Services

Private ambulance services are becoming more common in the UK, performing a number of roles, including providing medical cover at large events, either alongside, or instead of the voluntary sector providers. Some organisers use a private firm instead of a voluntary ambulance service because of wider availability during the week (sometimes difficult for a voluntary service to cover) or for a wider range of skills, such as provision of qualified Paramedics.

The most common type of private ambulance provider is in the Patient Transport role, with many trusts and hospitals choosing to outsource this function to a private company, rather than use the NHS service, although the policy differs from trust to trust. It is uncommon to find an emergency (999 call) being attended by a private ambulance, although it has become more common with some of the PTS contracted ambulance companies providing 'second-tier' vehicles, capable of stretcher transport or attending non-life threatening emergencies. Recently, some companies have been contracted to provide additional emergency crews and vehicles to supplement the core NHS staff at busy times (such as New Year). The relevant UK legislation applies to all ambulances with no discrimination as to who owns or operates them.

Another type of private ambulance are those operated by undertakers, who generally favour black vans, with the words private ambulance written discreetly on the vehicle.

Voluntary Ambulance Services

St. John Ambulance emergency/multi-purpose ambulance.

The main voluntary ambulance providers are the British Red Cross and St. John Ambulance, who have both been providing emergency medical cover in the UK for many years, including active service in both World Wars (pre-dating the existence of any government organised service). The primary activity of both organisations in relation to ambulances, is the provision of ambulance cover at events, as an extension of their First aid contract.

Depending on their agreement, or agreements, with their local ambulance service trust (known as a Memorandum of Understanding or MOU), they may treat and transport certain categories of patient to hospital, although for more serious incidents, such as cardiac arrest it is likely that they would be expected to summon the assistance of the statutory ambulance service.

Both organisations also provide 'reserve' or 'support' cover to some, though not all, of the ambulance trusts (dependent on the local MOU), where ambulance crews from one of the organisations (who are usually volunteers, but in some instances may be paid staff) will attend 999, GP Urgent or PTS calls on behalf of the ambulance trust, with the organisation receiving recompense from the trust. This service is most often called on during major incidents, when there is a high level of staff absence or when there is an unusually high call volume, although in some areas, voluntary crews are regularly used to supplement full time trust cover.

Both organisations have also provided cover for the public when unionised NHS ambulance trust staff have held strikes or walk outs.^[14]

References

^ ^a ^b ^c ^d ^e NHS Information on Ambulance Services. Retrieved on 2007-06-14.
^ Ambulance Service Definition. Retrieved on 2007-06-15.
^ "Emergency ambulance calls 'peak'", BBC News, 21st June 2007. Retrieved on 2007-06-22.
^ NHS Ambulance Trusts Description. Retrieved on 2007-06-15.
^ Taking Healthcare to the Patient. COI Communications for the Department of Health (June 2005). Retrieved on 2007-06-15.
^ "Ambulance staff in strike threat", IC Birmingham, 26th June 2007. Retrieved on 2007-06-28.
^ ^a ^b
^ Scottish Ambulance Service Website. Retrieved on 2007-06-15.
^ Scottish Ambulance Service Air Wing. Retrieved on 2007-06-15.
^ ^a ^b Northern Ireland Ambulance Service Trust. Retrieved on 2007-06-15.
^ Welsh Ambulance Services NHS Trust. Retrieved on 2007-06-15.
^ Welsh Ambulance Services NHS Trust Contact Details. Retrieved on 2007-06-15.
^ Nicholl, Jon; Coleman, Patricia; Parry, Gareth; Turner, Janette; Dixon, Simon. (1999). "Emergency Priority dispatch systems - a new era in the provision of ambulance services in the UK". Pre-hospital Immediate Care 3 (71-75).
^ "Ambulance Staff strike over pay", This is Chesire, July 20th 2006. Retrieved on 2007-06-14.

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