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Emergency medical services in Scotland
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Emergency medical services in the United Kingdom, to provide immediate care to people with acute illness or injury, are predominantly provided through a system of regional government ambulance services, funded by the National Health Service or its regional equivalents NHS Scotland, NHS Wales and Health and Social Care in Northern Ireland.
Remit of the Ambulance Services
NHS 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.
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 British 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] |
Ambulance Trusts
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 |
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 were 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.
Scotland
The Scottish Ambulance Service is a Special Health Board funded directly by the Health Department of the Scottish Government[8]. In 2006 the service responded to over 520,000 emergency calls. Scotland also 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).[9]
In financial year 2006/07, the service employed 3973 staff across 6 divisions and attended to 569,372 accident and emergency incidents.
The national headquarters are in Edinburgh and there are six divisions within the Service, namely:
Northern Ireland
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.[10] 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 in Northern Ireland with the 270 plus ambulances at its disposal. The Service employs approximately 1044 staff based across 32 stations & sub-stations, 4 Control Centres and a Regional Training Centre.[10]
Wales
The Welsh Ambulance Service NHS Trust (also called Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru) was established on April 1, 1998 and has 2,500 staff providing ambulance and related services to the 2.9 million residents of Wales.[11]
Its headquarters is located at H.M.Stanley Hospital, St Asaph, Denbighshire and it is divided into three regions [12]:
- 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 Caerleon House, Mamhilad Park Estate, Pontypool
Private Ambulance Services
Private ambulance services are becoming more common in the UK, 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.
Voluntary Ambulance Services
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 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 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.[13]
Big White Taxi Service
Big White Taxi Service is an informal term sometimes used by NHS ambulance staff in the United Kingdom 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.[14]
Materni-taxi
Another term used by NHS Ambulance Staff to refer to those expectant mothers who call an ambulance unneccessarily, rather than get a partner to drive them to the hospital. Mothers who are having problems during labour, or genuinely need an ambulance, are NOT deemed 'Materni-taxi punters'.
See also
References
External links
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