Emergency medical services in the United Kingdom
||It has been suggested that Emergency medical personnel in the United Kingdom be merged into this article. (Discuss) Proposed since May 2013.|
Emergency medical services in the United Kingdom provide immediate care to people with acute illness or injury, and are predominantly provided by the four publicly funded health care systems: the National Health Service (for England), Health and Social Care in Northern Ireland, NHS Scotland and NHS Wales.citation needed Emergency calls should be made via 999 or 112.
- 1 Role of the ambulance services
- 2 Public ambulance services
- 3 Measuring performance
- 4 Private ambulance services
- 5 Voluntary services
- 6 See also
- 7 References
- 8 External links
Public ambulance services across the UK are required by law to respond to four types of requests for care,1 which are:
- Emergency calls (via the 999 or 112 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.
Emergency medical responses are provided through local ambulance services, known in England and Wales as NHS trusts. Each service in England is commissioned and funded by local Clinical Commissioning Groups, often through a "lead commissioner" arrangement. English ambulance trusts cover large geographical areas and the country is covered by a number of ambulance services.
The National Health Service Act 1946 gave county (and county borough) councils a statutory responsibility to provide an emergency ambulance service, although they could contract a voluntary ambulance service to provide this.
In England there are now ten ambulance trusts, with boundaries generally following those of the former regional government offices. 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:
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 trusts followed government office regional boundaries. The Isle of Wight NHS Trust runs its own ambulance service. 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 1 October 2007. Great Western and South Western also merged. The current trust structure is as follows:
The Scottish Ambulance Service is a Special Health Board funded directly by the Health Department of the Scottish Government.7 Until 1974, ambulance cover in Scotland was originally provided by a combination of the British Red Cross and St Andrews Ambulance.8 In financial year 2008–2009, the service employed 3,797 staff across five divisions and attended to 599,052 accident and emergency incidents.
Complementing and working alongside the Scottish Ambulance Service is the Emergency Medical Retrieval Service.9 This unique medical initiative is based at Glasgow City Heliport and, staffed by consultants, uses various road and air assets to provide patients in remote and rural areas with rapid access to the skills of a consultant in emergency or intensive care medicine as well as facilitating transfers to larger, better equipped city hospitals. The team respond to calls 24 hours a day, utilising road vehicles, helicopters and fixed-wing aircraft.
Scotland has Britain's only publicly funded Air Ambulance service, consisting of two Eurocopter EC 135 Helicopters (based in Glasgow & Inverness) and two Beechcraft B200C King Air fixed-wing aircraft (based at Glasgow & Aberdeen). In 2008/09, the Air Ambulance Division flew 3,797 air ambulance missions.10
The national headquarters of the Scottish Ambulance Service are in Edinburgh and there are five divisions within the Service, namely:
|Division||Covering||Area in Square Miles|
|North||Highlands, Western Isles, Grampian, Orkney, Shetland 11||15,607|
|East Central||Fife, Forth Valley, Tayside 12||4,421|
|West Central||Greater Glasgow, Lanarkshire 13||1,054|
|South East||Edinburgh, Lothian and Borders 14||2,457|
|South West||Argyll, Argyll islands, Clyde islands, Ayrshire, Dumfries and Galloway 15||6,670|
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.16 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 and carries out non emergency patient transports in Northern Ireland with the 270 plus ambulances at its disposal. The Service employs approximately 1,044 staff based across 32 stations & sub-stations, Two Control Centres and a Regional Training Centre.16
The Welsh Ambulance Service NHS Trust (also called Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru) was established on 1 April 1998, and has 2,500 staff providing ambulance and related services to the 2.9 million residents of Wales.17
- 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 Vantage Point House, Ty Coch Ind Est, Cwmbran
Uniquely in the UK, The Welsh Ambulance Services NHS Trust is also responsible for the provision of NHS Direct, a nurse led telephone healthcare service which is provided by a separate Trust in England and by NHS 24 in Scotland.
The performance of every Ambulance Trust is measured by the government. Commonly called 'ORCON',19 after the consultancy used to formulate them, they are more properly called NAPS - New Ambulance Performance Standards. The Government's targets are to reach 75% of Category A (life-threatening) calls - as decided by the computerised AMPDS, the more recent NHS Pathways triage system used by some services, or the CBD (Criterion Based Dispatch) used in the Berkshire Division of South Central Ambulance - within eight minutes. A number of initiatives have been introduced to assist meeting these targets, including Rapid Response Vehicles and Community First Responders.citation needed The target in Wales is set by the Welsh Assembly Government (WAG). Currently the WAG requires 65% of category A calls to be reached within 8 minutes.
The performance of the Ambulance service is measured by the government, as part of a system called 'ORCON'.20 The Government's target is to reach 75% of Category A (life threatening) calls within eight minutes, as recorded by the computerised AMPDS triage system or, in some services, the newer NHS Pathways triage process. A number of initiatives have been introduced to assist meeting these targets, including Rapid Response Vehicles and Community First Responders.
The Scottish Ambulance Service was criticised in a case where a technician attended a call out within four minutes — well within the eight minute target — but not a paramedic who alone could administer certain cardiac drugs.21
Private ambulance services are becoming more common in the UK,22 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.citation needed
The most common type of private ambulance provider is in the patient transport role, with many commissioners choosing to outsource this function to a private company, rather than use the ambulance trust, although the policy differs from area to area. In some areas publicly provided patient transport services stops at 5pm leaving NHS hospitals reliant on private providers. It is alleged that monitoring by the Care Quality Commission is inadequate.23
Some companies have been contracted to provide additional emergency crews and vehicles to supplement the core NHS staff at busy times, with a quarter of the UK ambulance trusts contracting private companies to front line work.24
Since April 2011, all private ambulance providers operating in England have been required by law to be registered with the Care Quality Commission. These services are represented by the Independent Ambulance Association.
The main voluntary ambulance providers are the British Red Cross and St John Ambulance, which have 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 covers at events as an extension of their first aid contract.
Depending on their agreement/s 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.citation needed
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 (e.g. the 7 July 2005 London bombings), 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 on the very rare occasions when unionised NHS ambulance trust staff have taken industrial action.25
Volunteer community first responders (CFRs) are now common place resources for NHS Ambulance Service. CFRs are members of the public who have received training to answer ambulance 999 calls, and respond immediately within their local area, during their own time. The schemes originated to provide defibrillation in rural and remote areas, where ambulances could not quickly respond, although they are now present in both rural and urban areas.
CFRs are often operated by a local group, in partnership with the regional NHS ambulance trust, and carry a defibrillator and oxygen, along with other equipment as decided by the clinical governance arrangements. Some schemes have their own vehicles and actively fundraise to support their schemes.
The British Association for Immediate Care coordinates voluntary schemes, and individual medical and allied health professionals, providing immediate care throughout the UK.26 BASICS doctors, nurses or paramedics may assist NHS paramedics at the scenes of serious accidents or be on-hand at major sporting events.
Across Great Britain, there is a network of volunteer blood bike groups who provide motorcycle courier services for blood, tissue and organs which require transport to, or between, hospitals. In most cases, they carry blue lights and sirens which can be used when transporting blood or human tissue for transplant. There is a national organisation representing these groups, called the Nationwide Association of Blood Bikes (NABB).27
- Air ambulances in the United Kingdom
- Ambulance station
- Blues and twos
- Emergency Medical Retrieval Service
- Emergency medical services
- Fire service in the United Kingdom
- NHS ambulance services prior to 2006
- HSE National Ambulance Service (Republic of Ireland)
- NHS trust
- "Ambulance Service Definition". Retrieved 2007-06-15.dead link
- "NHS Ambulance Trusts Description". Retrieved 2007-06-15.
- "NHS Information on Ambulance Services". Archived from the original on 2007-06-11. Retrieved 2007-06-14.
- "Emergency ambulance calls 'peak'". BBC News. 21 June 2007. Retrieved 2007-06-22.
- "Taking Healthcare to the Patient". COI Communications for the Department of Health. June 2005. Retrieved 2007-06-15.
- "NHS Ambulance Trusts List". Retrieved 2007-06-15.
- "Scottish Ambulance Service Website". Archived from the original on 2007-06-04. Retrieved 2007-06-15.
- "St. Andrew's Ambulance - Our History". St Andrews First Aid. Retrieved 2009-08-05.
- "Emergency Medical Retrieval service". EMRS. June 2010. Retrieved 2010-06-12.
- "Scottish Ambulance Service Air Wing". Retrieved 2007-06-15.dead link
- Locations - North scottishambulance.com, accessed 9 May 2009
- Locations - East Central scottishambulance.com, accessed 11 February 2009
- Locations - West Central scottishambulance.com, accessed 11 February 2009
- Locations - South East scottishambulance.com, accessed 11 February 2009
- Locations - South West scottishambulance.com, accessed 11 February 2009
- "Northern Ireland Ambulance Service Trust". Archived from the original on 2007-05-19. Retrieved 2007-06-15.
- "Welsh Ambulance Services NHS Trust". Retrieved 2007-06-15.
- "Welsh Ambulance Services NHS Trust Contact Details". Retrieved 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" (PDF). Pre-hospital Immediate Care 3 (71–75).
- 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).
- 'Tea break' paramedic criticised BBC News, 22 September 2008
- British Ambulance Association and National Association of Private Ambulance Services
- "Would the NHS fall apart without private providers?". Open Democracy. Retrieved 26 November 2013.
- Donnelly, Laura (2009-02-21). "NHS bosses send 'ill-trained' private ambulance crews to 999 calls". The Telegraph.
- "Ambulance Staff strike over pay". This is Cheshire. 20 July 2006. Retrieved 2007-06-14.
- BASICS website
- Blood Bikes UK