NHS ambulance services

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National Health Service ambulance services provide free at the point of use emergency medical care to any person requiring treatment, regardless of immigration or visitor status, within the United Kingdom. These services are provided by National Health Services of England, Scotland, Wales and Northern Ireland. The current system comprises 14 NHS organisations: 11 ambulance services trusts cover the separate regions of England and; individual nationwide services cover Scotland, Wales and Northern Ireland respectively.

Contents

NHS ambulance services are classed as an emergency service, the public normally access emergency medical services through one of the valid emergency telephone numbers (either 999 or 112). Additionally, some ambulance services are considering trialing a 999 video calling service, in order to be able to visually assess patients whilst crews are en route. [1]

The work of ambulance services included responsibility for patient transport, but in England this is now often covered by separate contractual arrangements, and often delivered by private providers.

History

The National Health Service Act 1946 gave county (and county borough) councils in England and Wales a statutory responsibility to provide an emergency ambulance service, although they could contract a voluntary ambulance service to provide this.

In 1977/78 ambulance services in the UK cost about £138m. At that time about 90% of the work was transporting patients to and from hospitals.

The Regional Ambulance Officers' Committee reported in 1979 that:

There was considerable local variation in the quality of the service provided, particularly in relation to vehicles, staff and equipment. Most Services were administered by Local Authorities through their Medical Officer of Health and his Ambulance Officer, a few were under the aegis of the Fire Service, whilst others relied upon agency methods for the provision of part or all of their services.

The 142 existing ambulance services in England and Wales were transferred by the National Health Service Reorganisation Act 1973 from local authority to central government control in 1974, and consolidated into 53 services under regional or area health authorities. [2]

In Northern Ireland the service was the responsibility of the Northern Ireland Hospitals Authority before 1974, and was then transferred to the four health and social services boards.

Under the provisions of the National Health Service and Community Care Act 1990 England was covered by 31 ambulance trusts, which were structured as below. In July 2006 the number of ambulance service trusts was reduced to thirteen.

Following consultation, on 1 July 2006 the number of ambulance trusts fell from 29 to 13. [3] The reduction can be seen as part of a trend dating back to 1974, when English 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. [4] Most of the trusts followed government office regional boundaries. Exceptions included Staffordshire Ambulance Service (which had a temporary reprieve), the Isle of Wight (where provision remained with the island's primary care trust), South East Coast Ambulance Service, and South Central Ambulance Service. There have been two ambulance services trust mergers since 2006. [3]

Since 2013, the 11 ambulance trusts in England and Wales have been: [5]

TrustArea(s)200620072013Notes
East Midlands Ambulance Service Nottinghamshire, Derbyshire, Leicestershire, Lincolnshire, Northamptonshire, and Rutland ●●●
East of England Ambulance Service Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk, and Suffolk ●●●
Great Western Ambulance Service Bath and North East Somerset, Bristol, Gloucestershire, North Somerset, Swindon and Wiltshire before merger●○○Merged into South Western Ambulance Service on 1 February 2013
London Ambulance Service Greater London and the City of London ●●●
North East Ambulance Service County Durham, Northumberland, Tyne and Wear, and the area of the former county of Cleveland in North Yorkshire ●●●
North West Ambulance Service Cheshire, Cumbria, Greater Manchester, Lancashire, and Merseyside ●●●
South Central Ambulance Service Berkshire, Buckinghamshire, Hampshire (excluding NE) and Oxfordshire ●●●
South East Coast Ambulance Service Kent, East Sussex, West Sussex, Surrey, and North East Hampshire ●●●
South Western Ambulance Service Bristol, Cornwall, Devon, Dorset, Gloucestershire, Somerset, and Wiltshire ●●●
Staffordshire Ambulance Service Staffordshire and Stoke-on-Trent before merger●●○Merged into West Midlands Ambulance Service on 1 October 2007
West Midlands Ambulance Service Herefordshire, Shropshire, Staffordshire, Warwickshire, West Midlands, and Worcestershire ●●●
Yorkshire Ambulance Service East Riding of Yorkshire, North Yorkshire, South Yorkshire, and West Yorkshire ●●●
Welsh Ambulance Service Wales ●●●

In addition, the Isle of Wight NHS Trust, provides ambulance services for the Isle of Wight.

Current ambulance services

There are currently 14 NHS organisations (ambulance services trusts in England) which provide ambulance services across the UK, which are listed below:

Ambulance serviceRegion servedPopulation servedEstablished
England
East Midlands Derbyshire, Leicestershire, Rutland, Lincolnshire (including North and North East Lincolnshire), Northamptonshire and Nottinghamshire 4.8 million1999
East of England Norfolk, Bedfordshire, Cambridgeshire, Essex, Hertfordshire and Suffolk 5.8 million1 July 2006
Isle of Wight Isle of Wight 139,800April 2012
London Greater London and City of London 8.6 million1965
North East Northumberland, Tyne and Wear, County Durham and Cleveland 2.6 million1 July 2006
North West Greater Manchester, Cheshire, Merseyside, Cumbria and Lancashire 7.1 million
South Central Berkshire, Buckinghamshire, Hampshire and Oxfordshire 4 million
South East Coast East Sussex, West Sussex, Kent, Surrey, and North Eastern Hampshire (Rushmoor and eastern parts of Hart)4.75 million
South Western Bristol, Bath and North East Somerset, Cornwall, Devon, Dorset, Gloucestershire, North Somerset, the Isles of Scilly, Somerset, South Gloucestershire and Wiltshire 5.47 million
West Midlands Shropshire, Herefordshire, Worcestershire, Staffordshire, Warwickshire, Coventry, Birmingham and Black Country 5.6 million
Yorkshire East Riding of Yorkshire, North Yorkshire, South Yorkshire and West Yorkshire 5 million
Northern Ireland
Northern Ireland Antrim, Armagh, Down, Fermanagh, Londonderry, Tyrone 1.8 million1 April 1995
Scotland
Scotland East Ayrshire, North Ayrshire, South Ayrshire, Scottish Borders, Dumfries and Galloway, Fife, Clackmannanshire, Falkirk, Stirling, Aberdeenshire, Aberdeen City, Moray, Glasgow City, East Dunbartonshire, East Renfrewshire, Inverclyde, Renfrewshire, West Dunbartonshire, Argyll and Bute, Highland, North Lanarkshire, South Lanarkshire, City of Edinburgh, East Lothian, Midlothian, West Lothian, Orkney Islands, Shetland Islands, Angus, Dundee City, Perth and Kinross and Outer Hebrides over 5 million1 April 1995
Wales
Wales Blaenau Gwent, Bridgend, Caerphilly, Cardiff, Carmarthenshire, Ceredigion, Conwy, Denbighshire, Flintshire, Gwynedd, Isle of Anglesey, Merthyr Tydfil, Monmouthshire, Neath Port Talbot, Newport, Pembrokeshire, Powys, Rhondda Cynon Taf, Swansea, Torfaen, Vale of Glamorgan, Wrexham around 3.1 million1 April 1998

England

Subcontracting

In 2019 the Care Quality Commission reported that ambulance services were relying on private providers because of lack of capacity. Some firms had failed to obtain references or carry out criminal record checks and a lack of staff training was leading to serious patient harm. More than £92 million was spent in 2018/9 on private ambulances and taxis. [6]

In May 2022 NHS England tendered a contract worth up to £30m for “auxiliary ambulance services”. This is worth £7.5m annually and is initially an eight-month contract. It covers both emergency and non-emergency ambulance crews “with the capacity to respond to callouts across categories one to four”. [7] Currently, England's ambulance auxiliary is provided by St John Ambulance. [8]

Targets

NHS England sets targets for response times to 999 calls, which were first established in the 1970s. Call handlers were, until 2017, given just 60 seconds to decide on the urgency of the call. The clock stopped once a vehicle reached the patient - even if it was not the appropriate vehicle.

Category A (Red 1 and Red 2) were classed as life-threatening and the national standard sets out that a vehicle should reach the scene within eight minutes for 75% of these calls . Red 1 calls are for patients who have suffered cardiac arrest or stopped breathing and require two vehicles. If onward transport is required a suitable vehicle should arrive on the scene within 19 minutes. The number of these rose from 2.5 million in 2011/12 to just under 3.4 million in 2015/16, but response times fell steadily and the 75% target was not met after 2013. [9] Green 1 required a vehicle within 20 minutes, Green 2 within 30 minutes. Green 3 required telephone assessment within 20 minutes and Green 4 telephone assessment within 60 minutes. These targets are only recommended. [10]

In July 2017 a new set of performance targets for the ambulance service were announced after a trial across four different ambulance trusts, looking at more than 1 million patients overseen by Sheffield University. [11] These are to apply to all 999 calls for the first time. Call handlers will be given four minutes to assess the urgency of the call before the clock starts. The target for the most seriously ill patients is now seven minutes. The 'clock' stops when the most appropriate response, not necessarily the first, arrives. There are condition-specific measures which will track time from 999 call to hospital treatment for heart attacks and strokes. 90% of eligible heart attack patients should receive definitive treatment (balloon inflation during angioplasty at a specialist heart attack centre) within 150 minutes by 2022. 90% of stroke patients should also receive appropriate management (thrombolysis for those who require it, and first CT scan for all other stroke patients) within 180 minutes of making a 999 call. [12] For other emergencies the target is for 90% to be seen in 40 minutes. Urgent or non-urgent calls should expect an average response time of 120 and 180 minutes respectively. Extensive trials have shown that fewer patients are classed as life-threatening and fewer vehicles are dispatched, but responses for the most urgent calls improved. [13]

Trusts asked for more resources to meet these targets, in particular the standards for the top 90% of responses. Taking patients to the "right" hospital rather than the nearest, leads to longer journeys. They were supported by a benchmarking exercise undertaken by the National Audit Office. [14]

In July 2018 eight of the ten services in England missed the seven-minute target. A review conducted by Lord Carter of Coles found that the rate of sickness of ambulance staff was the highest in the NHS - 20 days per person. Use of information technology was advancing very slowly. 25% of ambulances, of which there were 32 different types, were more than seven years old. There were large differences in costs and performance between the different trusts, some of which were attributable to local geography and the performance of other parts of the NHS. [15] Responses to the most urgent calls averaged 11 minutes in rural areas in 2018 but 7 minutes in urban areas. The worst waits were around Wells-next-the-Sea. [16]

The COVID-19 pandemic in England put huge pressure on ambulance services. In July 2021 there were 81,685 category one incidents, up 32% in July 2019, and up 16% on the previous high in December 2019. Response time performance for these calls slumped to 8 minutes 33s, against a target of 7 minutes, with a tenth taking more than 15 minutes 15s. Average response time for category two calls, still classified as emergencies and including heart attacks and strokes, was 41 minutes 4s against a target of 18 minutes. [17] In October 2021 there were around 28,900 ambulance handovers lasting longer than an hour. This was almost four times the 7,772 hour-long handovers recorded in October 2020. [18] In April one patient waited 24 hours in an ambulance - thought to be the longest ever recorded. 11,000 patients waited more than three hours for handover, with 7,000 of them taking more than four hours and 4,000 over five hours. [19]

11 July 2022 was said to be the worst night on record for ambulance services in England, with more than half of some trusts ambulance crews queued outside hospitals in very hot weather. [20] There were more than 85,000 category one ambulance callouts in July - the highest ever recorded. Category one performance averaged 9 minutes 35 seconds, the same as in March 2022 and the joint lowest on record. Category two calls took an average of 59 minutes 7 seconds. [21]

Funding and activity

Between 2011-12 and 2015-16 ambulance activity in England rose by 30%. Funding only increased by 16%. [22] In May 2018 several trusts told commissioners that they needed to spend many millions on extra staff and ambulances if they were to meet the response time targets. [23]

Information technology

In November 2018 NHS Digital launched the National Record Locator Service which gives ambulance staff access to patient records of mental health trusts, initially for the North West, North East, Yorkshire and London Ambulance Services. It is planned to roll it out across England and to include other records. [24]

See also

Related Research Articles

<span class="mw-page-title-main">London Ambulance Service</span> Ambulance service in London

The London Ambulance Service NHS Trust (LAS) is an NHS trust responsible for operating ambulances and answering and responding to urgent and emergency medical situations within the London region of England. The service responds to 999 phone calls across the region, and 111 phone calls from certain parts, providing triage and advice to enable an appropriate level of response.

<span class="mw-page-title-main">Northern Ireland Ambulance Service</span> Ambulance service that serves the whole of Northern Ireland

The Northern Ireland Ambulance Service is an ambulance service that serves the whole of Northern Ireland, approximately 1.9 million people. 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 300-plus ambulance vehicles at its disposal. Its fleet includes mini-buses, ambulance officers' cars, support vehicles, RRVs and accident and emergency ambulances.

<span class="mw-page-title-main">Scottish Ambulance Service</span> Scotlands public ambulance services

The Scottish Ambulance Service is part of NHS Scotland, which serves all of Scotland's population. The Scottish Ambulance Service is governed by a special health board and is funded directly by the Health and Social Care Directorates of the Scottish Government.

<span class="mw-page-title-main">Welsh Ambulance Service</span> NHS trust and ambulance service in Wales

The Welsh Ambulance Services University NHS Trust is the national ambulance service for Wales. It was established on 1 April 1998 and as of December 2018 has 3,400 staff providing ambulance and related services to the 3 million residents of Wales. As of 1 April 2024, the trust was awarded "university" status by the Welsh government, making it the second ambulance trust to achieve university status in the United Kingdom.

<span class="mw-page-title-main">South East Coast Ambulance Service</span> Provider of ambulance services for south-eastern England

The South East Coast Ambulance Service NHS Foundation Trust (SECAmb) is the NHS ambulance services trust for south-eastern England, covering Kent, Surrey, West Sussex and East Sussex. It also covers a part of north-eastern Hampshire around Aldershot, Farnborough, Fleet and Yateley. The service was made an NHS foundation trust on 1 March 2011.

<span class="mw-page-title-main">North West Ambulance Service</span> Ambulance service for North West England

The North West Ambulance Service NHS Trust (NWAS) is the ambulance service for North West England. It is one of ten ambulance trusts providing England with Emergency medical services, and is part of the National Health Service, receiving direct government funding for its role.

<span class="mw-page-title-main">South Western Ambulance Service</span> UK ambulance service

The South Western Ambulance Service NHS Foundation Trust (SWASFT) is the organisation responsible for providing ambulance services for the National Health Service (NHS) across South West England. It serves the council areas of Bath and North East Somerset, Bournemouth, Christchurch and Poole Council, Bristol, Cornwall, Devon, Dorset, Gloucestershire, North Somerset, Plymouth, Isles of Scilly, Somerset, South Gloucestershire, Swindon, Torbay and Wiltshire.

<span class="mw-page-title-main">Yorkshire Ambulance Service</span> Ambulance trust in Yorkshire, England

Yorkshire Ambulance Service NHS Trust (YAS) is the NHS ambulance service covering most of Yorkshire in England. It is one of ten NHS Ambulance Trusts providing England with emergency medical services as part of the National Health Service it receives direct government funding for its role.

<span class="mw-page-title-main">South Central Ambulance Service</span> Regional ambulance service in England

The South Central Ambulance Service NHS Foundation Trust (SCAS) is the ambulance service for the counties of Berkshire, Buckinghamshire, Oxfordshire and most of Hampshire. It is a foundation trust of the National Health Service, and one of ten NHS ambulance trusts in England. As of August 2022, SCAS is currently rated Inadequate by the CQC following multiple failings within the trust. SCAS is the only Ambulance Service in England to have received this rating.

<span class="mw-page-title-main">East of England Ambulance Service</span> Ambulance service in England

The East of England Ambulance Service NHS Trust (EEAST) is an NHS trust responsible for providing National Health Service (NHS) ambulance services in the counties of Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk, in the East of England region. These consist of approximately 6.2 million people across an area of 7,500 square miles (19,000 km2).

<span class="mw-page-title-main">North East Ambulance Service</span> UK public sector ambulance service

The North East Ambulance Service NHS Foundation Trust (NEAS) is an NHS foundation trust responsible for providing NHS ambulance services in North East England. Headquartered in Newcastle upon Tyne, NEAS provides emergency medical services to the metropolitan boroughs of Newcastle upon Tyne, Gateshead, North Tyneside, South Tyneside and City of Sunderland; the ceremonial counties of County Durham and Northumberland; and the area of North Yorkshire commonly known as Teesside. NEAS was formed on 1 July 2006, following the merger of the existing North East Ambulance Service with the Tees division of the Tees, East and North Yorkshire Ambulance Service (TENYAS). Northumbria Ambulance Service and County Durham Ambulance Service had previously merged on 1 April 1999.

<span class="mw-page-title-main">West Midlands Ambulance Service</span> Ambulance trust in England

The West Midlands Ambulance Service University NHS Foundation Trust (WMAS UNHSFT) is responsible for providing NHS ambulance services within the West Midlands region of England. It is one of ten ambulance trusts providing England with emergency medical services, and is part of the National Health Service.

<span class="mw-page-title-main">Emergency medical services in the United Kingdom</span>

Emergency medical services in the United Kingdom provide emergency care to people with acute illness or injury and are predominantly provided free at the point of use by the four National Health Services (NHS) of England, Scotland, Wales, and Northern Ireland. Emergency care including ambulance and emergency department treatment is only free to UK residents and a charge may be made to those not entitled to free NHS care.

NHS targets are performance measures used by NHS England, NHS Scotland, NHS Wales, and the Health and Social Care service in Northern Ireland. These vary by country but assess the performance of each health service against measures such as 4 hour waiting times in Accident and Emergency departments, weeks to receive an appointment and/or treatment, and performance in specific departments such as oncology.

<span class="mw-page-title-main">East Midlands Ambulance Service</span> UK public sector ambulance service for the East Midlands region of England

The East Midlands Ambulance Service NHS Trust (EMAS) provides emergency medical services, urgent care and patient transport services for the 4.8 million people within the East Midlands region of the UK - covering Nottinghamshire, Derbyshire, Leicestershire, Rutland, Lincolnshire and Northamptonshire. It was formed in 1999 by amalgamating several county ambulance services, and in July 2006 was dissolved and reformed under the same name as part of a nationwide reorganisation of ambulance service provision.

111 is a free-to-call single non-emergency number medical helpline operating in England, Scotland and Wales. The 111 phone service has replaced the various non-geographic 0845 rate numbers and is part of each country's National Health Service: in England the service is known as NHS 111; in Scotland, NHS 24; and in Wales, NHS111 Wales.

United Lincolnshire Hospitals NHS Trust is an NHS trust which runs County Hospital Louth, Lincoln County Hospital, Pilgrim Hospital in Boston, Skegness and District Hospital, and Grantham and District Hospital.

<span class="mw-page-title-main">NHS Pathways</span>

NHS Pathways is a triage software utilised by the National Health Service of England to triage public telephone calls for medical care and emergency medical services – such as 999 or 111 calls – in some NHS trusts and seven of the ambulance services in the country. In its emergency capacity, it has replaced the Advanced Medical Priority Dispatch System for some trusts, and in non-emergency telephone triage it is found in many medical care triage systems, such as NHS 111.

Healthcare in Lincolnshire was, until July 2022, the responsibility of integrated care systems covering Lincolnshire West, Lincolnshire East, North East Lincolnshire, North Lincolnshire, and South Lincolnshire.

The Association of Ambulance Chief Executives is a non-statutory organisation that facilitates the coordination of programmes of work and policies across National Health Service ambulance services trusts in England. It is analogous to the National Police Chiefs' Council for police forces in the United Kingdom.

References

  1. ↑ Whitehead, Dan (10 May 2018). "Medics to assess 999 callers by video before ambulance sent". Sky News.
  2. ↑ "Royal Commission on the National Health Service". Socialist Health Association. HMSO. Retrieved 12 June 2015.
  3. 1 2 "Secondary legislation relating to ambulance services". legislation.gov.uk. Parliament of the United Kingdom . Retrieved 28 April 2020.
  4. ↑ Bradley, Peter (30 June 2005). "Taking Healthcare to the Patient: Transforming NHS Ambulance Services" (PDF). aace.org.uk. Department of Health . Retrieved 28 April 2020.
  5. ↑ "Structure of the UK Ambulance Services". aace.org.uk. Association of Ambulance Chief Executives . Retrieved 7 July 2018.
  6. ↑ "Patients 'at risk' as NHS spends £92m on private ambulances and taxis" . Independent. 27 August 2019. Archived from the original on 18 June 2022. Retrieved 2 October 2019.
  7. ↑ "NHSE tenders £30m deal for emergency 'surge' support". Health Service Journal. 12 May 2022. Retrieved 30 June 2022.
  8. ↑ "St John Commissioned as the Nation's Ambulance Auxiliary". www.sja.org.uk. Retrieved 9 March 2024.
  9. ↑ "Ambulance response times". Quality Watch. November 2016. Retrieved 15 July 2017.
  10. ↑ "Ambulance response categories explained". North East Ambulance Service. Retrieved 15 July 2017.
  11. ↑ "Jeremy Hunt signs off changes to 'dysfunctional' ambulance targets". Health Service Journal. 13 July 2017. Retrieved 23 August 2017.
  12. ↑ "New ambulance service standards announced". NHS England. 13 July 2017. Retrieved 15 July 2017.
  13. ↑ "Fewer ambulance 999 calls to be classed as 'life-threatening'". BBC News. 13 July 2017. Retrieved 15 July 2017.
  14. ↑ "Ambulance trusts demand millions to meet new targets". Health Service Journal. 4 May 2018. Retrieved 13 August 2018.
  15. ↑ "Ambulances not an A&E taxi service, NHS warned". BBC. 27 September 2018. Retrieved 27 September 2018.
  16. ↑ "Critically injured? The longest waits for 999 help". BBC. 6 March 2019. Retrieved 15 April 2019.
  17. ↑ "Big surge in the most serious ambulance calls". Health Service Journal. 12 August 2021. Retrieved 26 September 2021.
  18. ↑ "Leak reveals hour-long ambulance delays have quadrupled in 12 months". Health Service Journal. 3 November 2021. Retrieved 27 December 2021.
  19. ↑ "Exclusive: Patient waited 24 hours in ambulance for A&E". Health Service Journal. 16 May 2022. Retrieved 30 June 2022.
  20. ↑ "24 hour ambulance handover on 'worst night ever'". Health Service Journal. 12 July 2022. Retrieved 26 August 2022.
  21. ↑ "Summer crisis deepens as trolley waits hit new high". Health Service Journal. 11 August 2022. Retrieved 29 September 2022.
  22. ↑ "'Model ambulance' to be created to achieve Carter savings". Health Service Journal. 20 June 2017. Retrieved 15 July 2017.
  23. ↑ "Ambulance trusts demand millions to meet new targets". Health Service Journal. 4 May 2018. Retrieved 26 June 2018.
  24. ↑ "New National Locator Service links paramedics to shared care record". Digital Health. 28 November 2018. Retrieved 29 November 2018.
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