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Changing healthcare needs

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Changing healthcare needs
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Richard Diment, chief executive of the Ambulance Service Association, hghlights the transformation taking place in the NHS ambulance service

In June 2005 the Department of Health published ‘Taking healthcare to the patient’. This followed a 12-month review of the role of the ambulance service in England. The report made 70 recommendations across a wide range of operational, financial and workforce issues. All were focussed on ensuring that the service was best placed to deliver appropriate and timely care to patients needing urgent or emergency healthcare. The ambulance service, by increasing the clinical skills of its staff, would take a far greater role in delivering healthcare in the modernised NHS.

Increased capability and capacity
A major recommendation within the review was that to take on this wider role the capacity and capability of ambulance services would have to increase. Since their transfer to the NHS in 1974 ambulance services have been through a series of reconfigurations. In the 1990s a number of the mainly county-based services had been amalgamated to form regional services, for example in East Anglia. However, this process had never been completed and the majority of services remained county-based. Although some were sizeable organisation such as Greater Manchester others such as Cumbria were relatively small. Work was underway from early 2005 on bringing together the services in Avon, Gloucestershire and Wiltshire which merged as Great Western Ambulance Service from 1 April 2006.

Left with a decision on the rest of England, the Department of Health published proposals in late 2005 recommending that the other 27 ambulance services in England (excluding that in London which was already the largest public ambulance service in the world) should be reconfigured to match the existing Government regions that already existed for planning and other purposes (and became the model for the reconfigured SHAs in 2006). Ministers announced in May 2006 that the proposals had been accepted in most parts of the country and that from 1 July 2006, a further nine regional ambulance trusts would be established. These were to be:

North West (covering Cumbria, Lancashire, Merseyside, Greater Manchester and Cheshire); North East (Northumberland, Tyne & Wear, County Durham and Cleveland); Yorkshire (Yorkshire and Humberside Region but excluding the south side of the Humber); East Midlands (Derbyshire, Nottinghamshire, Leicestershire, Rutland, Lincolnshire, South Humberside and Northamptonshire); West Midlands (Shropshire, West Midlands, Warwickshire, Herefordshire and Worcestershire); East of England (Cambridgeshire, Norfolk, Suffolk, Essex, Bedfordshire and Hertfordshire); South East Coast (Kent, Surrey and Sussex); South Central (Buckinghamshire, Oxfordshire, Berkshire and Hampshire); South Western (Dorset, Devon, Cornwall and Somerset).

Outside of this structure were the Isle of Wight where Ministers decided that it would more appropriate to leave the service as part of the single health trust on the island. They also decided, following a strong campaign by local politicians and the community in Staffordshire, that the service in that county should remain though with the intention of merging it with the enlarged West midlands at some point in the future.

The leaders
Running parallel to the consultation period, the Department of Health and the NHS Appointments Commission had identified a pool of suitable candidates to take on the posts of chief executives and chairs of the new services if the decision was made to go ahead with reconfiguration.

As a result it was possible for those selected to take on acting roles with the shadow trusts almost immediately. Furthermore, each of the new chief executives was already an ambulance trust chief executive, in most cases for a service within their new region, and seven of the nine chairs had been chair of an existing ambulance service. Given that there were only seven weeks between the ministerial decision to go-ahead and vesting day, this was undoubtedly a considerable help in ensuring that the new organisations were ready to go on 1 July.

Almost six months on from the establishment of the new trust, or nearly nine in the case of Great Western, the new organisations are now key players in providing healthcare within their regions. Most of the senior management teams for the trusts have now been appointed but there are clearly considerable challenges remaining in bringing together a number of established organisations covering large populations and areas and employing substantial workforces. At the same time local links need to be maintained with the many partners and stakeholders who have interdependence with the ambulance service. Local managers, keeping and developing those links with their communities, are a vital part of the new ambulance structure.

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