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Ambulances

  • Last modified date:
    20 March 2008

The ambulance service provides the first point of access to health care for a wide variety of patient conditions, ranging from life-threatening emergencies to chronic illness and social care. The 11 National Health Service (NHS) ambulance service trusts in England are the first and often the most important contact for approximately six million 999 callers each year.

Key standards for ambulance services include:

  • responding to 75% of ambulance category A (life-threatening) calls within eight minutes or less
  • an ambulance able to transport the patient is expected to arrive at the scene of 95% of Category A calls within 19 minutes or less of the request for transport
  • responding to 95% non-life threatening (Category B) calls within 19 minutes or less

Taking healthcare to the patient: transforming NHS ambulance services

The report on the outcome of the Department of Health's strategic review of NHS ambulance services was launched on 30 June 2005, at AMBEX - the annual ambulance conference and exhibition.    The Department's National Ambulance Adviser, Peter Bradley, has been leading this strategic review, supported by a reference group of senior NHS managers and clinicians.  Input from key stakeholders, through consultation events, has also been fed into the report.

The report sets out how ambulance services can be transformed from a service focusing primarily on resuscitation, trauma and acute care towards becoming the mobile health resource for the whole NHS - taking healthcare to the patient in the community.

The Department is taking forward a programme of work to support the NHS in implementing the main recommendations and consult further on  implementing some of the recommendations.  Work centres around five main areas: quality and consistency of care, efficiency and effectiveness, organisational development, performance and workforce development.

Patient transport services

Access to transport was raised as an issue during the Your Health, Your Care, Your Say deliberative events in 2005.  At the same time, the Department had just completed a review of eligibility for non-emergency patient transport services (PTS) and the hospital travel cost scheme (HTCS). The White Paper, Our Health, Our Care, Our Say set out the conclusions of that review.

The White Paper made a commitment to extend eligibility for the Hospital Travel Costs Scheme (HTCS) and Patient Transport Service (PTS) to procedures that were traditionally provided in hospital, but are now available in a community setting.  This has meant that people referred by a health care professional for treatment in a primary care setting, and who have a medical need for transport, receive access to the PTS and HTCS. It also committed the Department of Health to updating existing eligibility and finance guidance documents.

A 13-week consultation was launched on 17 November 2006 to seek stakeholders’ views on draft eligibility and finance guidance to enable implementation of this change. 

Consultation concluded on 16 February 2007. A copy of post-consultation document and subsequent revised PTS guidance can be found on the Departmental website using the following link:

New ways of working

Ambulances are better equipped with technology such as ECG machines and telemetry, which let ambulance crews send information about a patient's condition directly to receiving hospitals. Paramedics now provide an expanding range of care outside of hospital, such as delivering clot busting drugs for the treatment of heart attack victims.

As well as deploying solo responders such as motorcycles and rapid response vehicles, which can make their way through heavy traffic/congestion more easily, ambulance trusts have introduced community responder schemes in a number of areas across the country. Any volunteer in a community responder scheme is equipped with a defibrillator, trained in basic life support and acts as part of an ambulance trust’s response system. The use of community responders can provide support to areas that may be more remote or inaccessible, allowing patients to receive urgent healthcare quickly from qualified volunteers until an ambulance arrives.

In addition, ambulance services are helping to develop new roles such as Emergency Care Practitioners (ECPs) and community paramedics, which are looking at providing more appropriate care in the appropriate setting. It is envisaged that ECPs will be able to work across different settings in emergency care and will provide opportunities for nurses as well as paramedics.

Incentive scheme

A capital incentive scheme was announced in June 2006, which provides extra investment for faster ambulance response times.

NHS ambulance trusts in England have been given a £25 million boost to help deliver further improvements to response times for the most urgent calls.

The scheme has been set up to deliver additional investment in new control room technology and vehicles that will allow ambulance trusts to achieve even higher standards in responding to life-threatening emergencies.

NHS ambulance service configuration

For the benefits outlined in ‘Taking Healthcare to the Patient’ to be realised, ambulance trusts should be of a size that enables appropriate investment in people and resources to underpin current and future services.  Larger trusts ensure resources are targeted at where they are most needed – improving patient care and supporting front line services. 

A fourteern-week consultation led by strategic health authorities, on behalf of the Secretary of State, considered the future configuration of these trusts.  Feedback from most areas did not indicate any significant reasons to change the original proposals.

From 1 July 2006 through to 1 October 2007, many of the existing 29 trusts merged to form 11 NHS ambulance truts in England (with separate management arrangements for the Isle of Wight). 

Taking healthcare to the patient: transforming ambulance services - human resource framework

Published: 14 December 2005

A national HR framework has been issued to support employers through the 'Transforming NHS Ambulance Service' process.  In addition to supporting employers, the framework will help maintain service continuity and avoid disruption in services for patients.

Improvement Partnership for Ambulance Services

The Improvement Partnership for Ambulance Services (IPAS) was launched in late September 2003 to help Ambulance Trusts improve their performance and to spread good practice. IPAS finished on the 31 March; however, the best practice guidelines it produced can be accessed here.

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