Emergency medical services in the United Kingdom

Emergency medical services in the United Kingdom, to provide immediate care to people with acute illness or injury, 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.

Role of the ambulance services

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 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 ambulance work in all NHS bodies and most voluntary and private firms is based on the guidance published by the Joint Royal Colleges of medicine Ambulance Liaison Committee (JRCALC).

England

Emergency medical services are provided through local ambulance services, known in England and Wales 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 Police.

In England there are twelve ambulance 'Trusts', 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 1 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, Wiltshire and SW Oxfordshire
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 and 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 (except NE Hampshire), Milton Keynes, Oxfordshire (except SW Oxfordshire), Portsmouth & Southampton
South East Coast Ambulance Service NHS Trust Banstead Brighton and Hove, Kent, Medway, Surrey, NE Hampshire, 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

Scotland

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 airborne medical initiative is based at Glasgow City Heliport and, staffed by consultants, uses various 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 both helicopters and fixed-wing aircraft.

Scotland has Britain's only publicly funded Air Ambulance service, comprising 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 wing 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:

Scottish Ambulance Service Divisions
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