The current system comprises 14 NHS organisations: 11 ambulance services trusts cover the separate regions of England and; individual nationwide services cover Scotland, Wales and Northern Ireland respectively.
[1] The work of ambulance services included responsibility for patient transport, but in England this is now often covered by separate contractual arrangements, and often delivered by private providers.
The Regional Ambulance Officers' Committee reported in 1979 that: There was considerable local variation in the quality of the service provided, particularly in relation to vehicles, staff and equipment.
Under the provisions of the National Health Service and Community Care Act 1990 England was covered by 31 ambulance trusts, which were structured as below.
[3] The reduction can be seen as part of a trend dating back to 1974, when English 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.
Some firms had failed to obtain references or carry out criminal record checks and a lack of staff training was leading to serious patient harm.
[6] In May 2022 NHS England tendered a contract worth up to £30m for “auxiliary ambulance services”.
It covers both emergency and non-emergency ambulance crews “with the capacity to respond to callouts across categories one to four”.
Red 1 calls are for patients who have suffered cardiac arrest or stopped breathing and require two vehicles.
There are condition-specific measures which will track time from 999 call to hospital treatment for heart attacks and strokes.
A review conducted by Lord Carter of Coles found that the rate of sickness of ambulance staff was the highest in the NHS - 20 days per person.
Category one performance averaged 9 minutes 35 seconds, the same as in March 2022 and the joint lowest on record.
[22] In May 2018 several trusts told commissioners that they needed to spend many millions on extra staff and ambulances if they were to meet the response time targets.
[23] In November 2018 NHS Digital launched the National Record Locator Service which gives ambulance staff access to patient records of mental health trusts, initially for the North West, North East, Yorkshire and London Ambulance Services.