Emergency medical services in England

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Emergency medical services in England are almost all provided by the National Health Service - the public health service in England.

Contents

[edit] Remit of the Ambulance Services

NHS ambulance services across England are required by law to respond to four types of requests for care[1], which are:

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

Ambulance trusts and services may also undertake non-urgent patient transport services on a commercial arrangement with their local hospital trusts or health boards, or in some cases on directly funded government contracts.[2] This is an area where an increasing amount of private firms are taking business away from the trusts.

[edit] Ambulance Trusts

Crest of NHS ambulance services in England
Crest of NHS ambulance services in England

Emergency medical services are provided through local ambulance services, known 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.
An ambulance waiting outside of a hospital in Leeds, West Yorkshire.

Twelve ambulance 'Trusts' cover England, with boundaries generally following those of the regional government offices[3].

The ambulance services across England have been increasingly busy, with a significant increase in calls in the last two decades,[3] as shown in the table below:

Year Emergency Calls Source
1994/5 2.61 million [3]
2004/5 5.62 million [3]
2006/7 6.3 million [4]

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 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 follow government office regional boundaries, exceptions to this are the Isle of Wight (where provision will remain with the Island's Primary Care Trust), and South East and South West England which are both split into two Trusts. This has led to a number of old trusts ceasing to exist. Staffordshire ambulance trust had a temporary reprieve, but became part of the West Midlands ambulance trust on 1st October 2007. The new Trust structure is as follows:

NHS Ambulance Service Trusts
Ambulance Service Headquarters[6] Local Authority Areas Covered[6]
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
West Midlands Ambulance Service NHS Trust Brierley Hill Herefordshire, Shropshire, Staffordshire, 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

[edit] Measuring performance

The performance of every Ambulance Trust is measured by the government, as part of a system called 'ORCON'.[7] 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 where CBD (Criterion Based Dispatch) is used), within 8 minutes. A number of initiatives have been introduced to assist meeting these targets, including Rapid Response Vehicles and Community First Responders.

[edit] Private Ambulance Services

Private ambulance services are becoming more common in England, 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.

[edit] Voluntary Ambulance Services

St. John Ambulance emergency/multi-purpose ambulance.
St. John Ambulance emergency/multi-purpose ambulance.

The main voluntary ambulance providers are the British Red Cross and St. John Ambulance, who have been providing emergency medical cover in England 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.[8]

[edit] Big White Taxi Service

 It has been suggested that Big White Taxi Service be merged into this article or section. (Discuss)

Big White Taxi Service is an informal term sometimes used by NHS ambulance staff to refer to the ambulances that they drive, or the service that they work for. This is mainly due to the fact that in recent years the ambulance services are persistently abused my members of the public who dial 999 for minor ailments and injuries that could be dealt with by the local General Practitioner.[9]

[edit] See also

[edit] References

  1. ^ Ambulance Service Definition. Retrieved on 2007-06-15.
  2. ^ NHS Ambulance Trusts Description. Retrieved on 2007-06-15.
  3. ^ a b c d e NHS Information on Ambulance Services. Retrieved on 2007-06-14.
  4. ^ "Emergency ambulance calls 'peak'", BBC News, 21st June 2007. Retrieved on 2007-06-22. 
  5. ^ Taking Healthcare to the Patient. COI Communications for the Department of Health (June 2005). Retrieved on 2007-06-15.
  6. ^ a b NHS Ambulance Trusts List. Retrieved on 2007-06-15.
  7. ^ 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). 
  8. ^ "Ambulance Staff strike over pay", This is Cheshire, July 20th 2006. Retrieved on 2007-06-14. 
  9. ^ Meetings with destiny. The Guardian. Retrieved on 2007-12-29.

[edit] External links

Retrieved from "http://en.wikipedia.org/wiki/Emergency_medical_services_in_England"
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