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Overall, investment has risen from £33 billion to £67.4billion.  That money has increased the capacity of the NHS to serve patients.  It has dramatically improved unscheduled care services.  In 2001, only 77% of patients spent less than 4 hours in A&E.  Now 94% of patients wait less than 4 hours and 12-hour plus trolley waits have virtually been eliminated.  Nine out of ten patients see their GP or practice nurse within 24/48 hours of making an appointment.  We are not only reducing waits, we are making access easier.  NHS Direct handles over half a million phone calls and half a million internet hits every month.  By the end of March 2005, there will be 65 walk in centres.  Quality is also improving.

These improvements have been made possible by steady increases in the number of NHS staff - 4,500 extra ambulance service staff alone.  The growth in money and staff numbers has been accompanied by a period of modernisation - both of equipment and facilities, but also through new ways of working that make better use of the skills and potential of all staff.

That, in turn, has enabled the NHS to provide better quality care to patients.

But there is still more to do.  The NHS Improvement Plan, launched last week by John Reid, highlights that unscheduled care will be provided in a wider range of settings to provide efficient, convenient and effective services for patients.  Ambulance staff have a key role to play in this, and it is one of the key issues being considered by the current ambulance review - more of which later.

After just over a year in post I have visited many ambulance trusts.  I have seen a service on the move, improving with every step, with dedicated, professional staff who are responsive to change and highly regarded among patients and public alike.  These aren't opinions.  They're facts.  The evidence is there.  Over the last year 75.7% of category A calls resulted in a response arriving within 8 minutes.  This means ambulances are reaching more patients with life-threatening conditions faster than ever before - 50,000 more in 2003-04 than the previous year.

I'd like to congratulate everyone who has worked so hard to achieve this.  75% is a challenging standard, but it has helped drive improvements, and patients are reaping the benefits.  For example, on a recent visit to Surrey, I saw how patients are receiving help more quickly through the use of Community Responders - members of the public trained to a high standard of first aid, including advisory cardiac defibrillation skills.

As you know, it's not just about reaching patients faster, it's what you do when you get there.  Ambulance staff are now delivering an expanding range of healthcare interventions, such as clot busting thrombolytic drugs.  Staffordshire, over the last year, have successfully thrombolysed 155 patients and Dorset recently thrombolysed their 100th patient.

However, despite improvements over the last year, recent figures suggest we need to raise our game in other areas such as Category B and C calls and 'GP urgents'.  Although you reached 140,000 more Category B and C patients within the standard last year, compared to the previous year, there is more to do.  We know it's challenging, not least because demand continues to rise. 

I know from talking to staff the frustration they feel when people call an ambulance even though it's clear they don't need one.  But, over the last 12 months I have seen many trust take a proactive approach to tackling this, such as on a visit to West Yorkshire Ambulance Service.  There they have adopted the London Ambulance Service's award-winning Only One of These is a Taxi campaign and are re-directing patients to the NHS resource that most suits their needs.

Dealing with demand is not the only answer to improving the way we deal with non-life threatening calls.  Ambulance trusts have already begun to adopt other innovative approaches.  Hampshire have recently improved their performance against 'GP urgents' by 16%.  They have done this by changing their protocols, introducing checks in the system and re-classifying calls if necessary. 

To take another example, on a visit to South Yorkshire I learned about their paramedic practitioner scheme.  This means that medical treatment for falls and minor injuries can be administered by a paramedic in the comfort of the patient's home.  This scheme won the national frontline emergency care award.  Rigorous evaluation is ongoing, but the latest results show that over 60% of patients dealt with are not travelling to hospital.

Several trusts have co-located their control rooms with NHS Direct.  For example, I recently opened 'Navigation Point' at West Midlands Ambulance Service, where co-location is helping the ambulance service and NHS Direct work together to develop alternative pathways of care.

It's essential that trusts continue to work closely across all aspects of unscheduled care, from acute trusts to social care.  Only through such co-operation can underlying issues around service provision be tackled.  Emergency Care networks are a vital tool in achieving this.

I know there is fear in some quarters that the networks are talking shops and don't make decisions.  But a forum for dialogue is more than we have had previously, and is a positive start.

However, I do acknowledge that networks need more support, particularly in sharing learning around what makes a network effective.  I'm pleased to say the Department will be issuing an emergency care network checklist later this month.  The checklist will set out the key practical steps and actions that can make a network function effectively, and will make links to other useful resources.  It will be clear that ambulance trusts are core members of any network, and will focus attention on crucial issues like ambulance turnaround times and the role of paramedics in the community.

There is already plenty of good practice to draw on, with many Ambulance Trusts working with their network partners to improve services.  For example, in Essex the ambulance trust has helped to develop new approaches to avoiding unnecessary admissions, including joint work with Social Services to prevent falls in the home by determining what is causing someone to fall frequently and fixing it. 

Or, as I saw when I visited Mersey, paramedics are referring known mental health patients to the crisis team at the mental health trust, who will then undertake an emergency visit.  This means that patients get appropriate care, emergency admissions are avoided and ambulance resources can be allocated to where they're needed most.

I feel strongly about the importance of joined up working.  In fact I have recently decided that ambulance representatives should be present for all my future visits to A&E departments. 

Nevertheless, I'm sure you'll agree it's no use an organisation feeling an empowered and integral part of their local health system and expecting staff to adapt to new working practices, if those on the front line do not feel supported.  For this reason, I am pleased today to launch the new Improving Working Lives in the Ambulance Service toolkit. 

The toolkit, produced by the Ambulance Service Association in conjunction with the Department, is designed to help trusts work in partnership with staff to make improvements to staff's working lives.  For example, staff can be supported to obtain a healthier work / life balance, perhaps by agreeing more flexible working hours or promoting self-rostering.  I'd like to take this opportunity to thank the ASA for this piece of work and for their continued support and co-operation over the last year.

The ASA has been tremendously helpful in making us aware of issues concerning its members.  It's fair to say the Department has listened and is now acting on these issues.  Breaking down traditional barriers between trusts and sharing good practice was raised. 

This is one of the reasons why, in September last year, I launched the Improvement Partnership for Ambulance Services (IPAS).  Since then we have been working closely with IPAS, including providing £1 million to help facilitate the exchange of ideas and supporting Trusts in key areas such as leadership development.

You also told us that the administrative burden of having to deal with speeding tickets, issued to ambulances responding to emergency calls because of safety cameras, was causing many of you problems.  We have worked closely with the Home Office and the Association of Chief Police Officers to resolve this. 

I am happy to be able to announce that the police are introducing a new national protocol to deal with this issue throughout England and Wales.  From today, fixed penalty tickets for speeding and red light offences will not be sent to the ambulance trust if blue emergency lights can be seen in use on the vehicle in the photograph.  This procedure will substantially reduce the number of tickets issued to ambulance trusts.

The last year has been very positive.  But what can we expect from the coming 12 months?

It was felt national ambulance policy would benefit from additional specialist input, to help provide clear strategic direction for the future.  I recently appointed Peter Bradley as National Ambulance Adviser, to lead a review of the service, and am happy to announce the extension of his secondment to 12 months to ensure that direction and oversight of some of the more complex and longer-term issues such as education and training are maintained.

Peter, aided by the ambulance review's reference group, has identified and begun work on several key issues.  You will know that John Reid announced last week that we are looking, across the NHS, at new approaches to performance standards with the aim being to achieve an optimum balance between national standards and locally set standards.  As part of Peter's work we are considering what that means for ambulance trusts, and hope to make an announcement later this year.

Performance standards are not an end in themselves.  They are a means to a better service.  As part of the ambulance review we are also scrutinising the present standards to ensure they reflect current practice, and hope to announce a way forward later this year.

There are also other, longer-term pieces of work that will be set in train, such as education and training.  The ambulance service has evolved, both in the healthcare it provides and in its responsibilities in the wake of the new terrorist threats, and it's important that future training models reflect this.

Agenda for Change roll out is due in the winter.  As you know, this will convey substantial gains for ambulance staff, fully recognising their contribution to the NHS, particularly the unsociable hours aspect.  We will continue to work with the Early Implementer sites and recognise the valuable contribution they are making in advance of national roll out.

IPAS will be issuing good practice checklists in areas such as commissioning, and there will continue to be ongoing support for trusts through the Modernisation Agency.

The deadline for the new out-of-hours provision is approaching and already trusts such as Essex and East Anglia are demonstrating to commissioners the leading role ambulance services can play.  It's important we seize this new agenda as something positive, a catalyst for fostering further integration and a vehicle for illustrating the ambulance service's capability.

You should all be proud of your achievements over the last year - control room staff, Patient Transport Services staff, support staff, managers, technicians and paramedics.  As I mentioned, there are exciting times ahead.  But rather than continue speaking, I'd like to invite you to let me know the issues you feel are important and would like addressed over the next 12 months.