Emergency medical services in the United Kingdom provide emergency care to people with acute illness or injury and are predominantly provided free at the point of use by the four National Health Services (NHS) of England, Scotland, Wales, and Northern Ireland. Emergency care including ambulance and emergency department treatment is free to everyone including overseas visitors but ongoing care including admission to hospital as an inpatient is chargeable unless meeting criteria for NHS care free at the point of delivery.

The NHS commissions most emergency medical services through the 14 NHS organisations with ambulance responsibility across the UK (11 in England, one each in the other three countries).

As with other emergency services, the public normally access emergency medical services through one of the valid emergency telephone numbers (either 999 or 112).

In addition to ambulance services provided by NHS organisations, there are also some private and volunteer emergency medical services arrangements in place in the UK, the use of private or volunteer ambulances at public events or large private sites, and as part of community provision of services such as community first responders.

Apart from one service in Scotland, air ambulances in the United Kingdom are not part of the NHS and are funded through charitable donations, although paramedics and doctors may be seconded from a local NHS ambulance services and hospitals.

Role of the ambulance services

Public ambulance services across the UK are required by law to respond to four types of requests for care, which are: Emergency calls (via the 999 or 111 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, although these contracts are increasingly fulfilled by private and voluntary providers.

History The National Health Service Act 1946 gave county and borough councils a statutory responsibility to provide an emergency ambulance service, although they could contract a voluntary ambulance service to provide this, with many contracting the British Red Cross, St John Ambulance or another local provider. 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. Most services were administered by local authorities through their Medical Officer of Health and his Ambulance Officer, a few were under the aegis of the fire service, whilst others relied upon agency methods for the provision of part or all of their services".

The 142 existing ambulance services were transferred by the National Health Service Reorganisation Act 1973 from local authority to central government control in 1974, and consolidated into 53 services under regional or area health authorities.

This led to the formation of predominantly county based ambulance services, which gradually merged up and changed responsibilities until 2006, when there were 31 NHS ambulance trusts in England.

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 led to the merging of the 31 trusts into 13 organisations in England, plus one organisation each in Wales, Scotland, and Northern Ireland. Following further changes as part of the NHS foundation trust pathway, this has further reduced to ten ambulance service trusts in England, plus the Isle of Wight which has its own provision.

Following the passage of the Health and Social Care Act 2012, commissioning of the ambulance services in each area passed from central government control into the hands of regional clinical commissioning groups (CCG). Following the passage of the Health and Care Act 2022, from 1 July 2022 clinical commissioning groups were abolished and replaced by integrated care boards.

Current public provision The commissioners in each region are responsible for contracting with a suitable organisation to provide ambulance services within their geographical territory. The primary provider for each area is currently held by a public NHS body, of which there are 11 in England, and one each in the other three countries.

England

In England there are now ten NHS ambulance trusts, as well as an ambulance service on the Isle of Wight, run directly by Isle of Wight NHS Trust, with boundaries generally following those of the former regional government offices. The ten trusts are: East Midlands Ambulance Service NHS Trust East of England Ambulance Service NHS Trust London Ambulance Service NHS Trust North East Ambulance Service NHS Foundation Trust North West Ambulance Service NHS Trust South Central Ambulance Service NHS Foundation Trust South East Coast Ambulance Service NHS Foundation Trust South Western Ambulance Service NHS Foundation Trust West Midlands Ambulance Service University NHS Foundation Trust Yorkshire Ambulance Service NHS Trust

The English ambulance trusts are represented by the Association of Ambulance Chief Executives (AACE), with the Scottish, Welsh and Northern Irish providers all associate members. On 14 November 2018 West Midlands Ambulance Service became the UK's first university-ambulance trust.

Scotland The service was operated before reorganisation in 1974 by the St Andrews Ambulance Association under contract to the Secretary of State for Scotland. The Scottish Ambulance Service is a Special Health Board that provides ambulance services throughout whole of Scotland, on behalf of the Health and Social Care Directorates of the Scottish Government.

Due to the remote nature of many areas of Scotland compared to the other Home Nations, the Scottish Ambulance Service has Britain's only publicly funded air ambulance service, with two Airbus Helicopters H145 helicopters and two Beechcraft B200C King Air fixed-wing aircraft. There is also a partnership to provide the Emergency Medical Retrieval Service which gives rapid access to the skills of a consultant in emergency or intensive care medicine using Scottish Ambulance Service road and air assets.

Northern Ireland The Northern Ireland Ambulance Service (NIAS) was established in 1995 by order in council, and serves the whole of Northern Ireland.

Wales The Welsh Ambulance Service NHS Trust (Welsh: Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru) was established on 1 April 1998. it had 2,500 staff providing ambulance and related services to the 2.9 million residents of Wales.

Isle of Man and Channel Islands The Isle of Man and the Channel Islands of Jersey and Guernsey each have their own independent ambulance service. The Isle of Man Ambulance Service provides for 83,000 residents using four sites across the island and 42 staff members. This service is operated by the local government. The States of Jersey Ambulance Service is run by the local government taking around 14,000 calls a year. The service operated with 4 crews in service during the day. Additionally they are supported with community first responders and a volunteer support group. Guernsey Ambulance and Rescue Service is operated by St John Ambulance Guernsey. This service responds to 5,000 calls per year and is supported by community first responders. Unlike the NHS services on mainland UK there is a charge for using the service, or residents can pay an annual membership.

Usage Calls to the ambulance services across England have been steadily increasing in recent years, with a significant increase over the last two decades, as shown in the table below:

Year Emergency calls 1994/95 2.61 million 2004/05 5.62 million 2006/07 6.3 million 2012/13 8.54 million2013/148.47 million2014/159 million2015/169.4 million2016/179.7 million2017/188.6 million2018/1911.7 million2019/2012.4 million

Calls where a Category A ambulance arrived at the scene rose from 6,856 per day in 2011–12 to 8,564 per day in 2014–15.

Call categories All ambulance services now operate under the Ambulance Response Programme, which enables dispatch of the most clinically appropriate vehicle to each patient within a timeframe that meets their clinical need. A set of pre-triage questions identifies those patients in need of the fastest response and then further triaging occurs to decide the severity of the injury or illness. Calls are categorised as such: This article contains quotations from this source, which is available under the Open Government Licence v3.0. © Crown copyright. +CategoryDescriptionExplanationAverage response target90th percentile response target1Life-threateningA time critical life-threatening event requiring immediate intervention or resuscitation.7 minutes15 minutes2EmergencyPotentially serious conditions that may require rapid assessment and urgent on-scene intervention and/or urgent transport.18 minutes40 minutes3UrgentAn urgent problem (not immediately life-threatening) that needs treatment to relieve suffering and transport or assessment and management at the scene with referral where needed within a clinically appropriate timeframe.None2 hours4Less-urgentProblems that are less urgent but require assessment and possibly transport within a clinically appropriate timeframe.None3 hours

Staffing

There are a range of clinical staff grades that work in emergency medical services in the UK. The majority of staff fall into four main professional groups: +TitleShorthandFPHC PHEMDescriptionEmergency Care Assistant Emergency Ambulance Crew

Emergency Care Support Worker

Intermediate Ambulance Practitioner

Ambulance Support CrewECA EAC

ECSW

IAPASCD or EUsually work in support of a paramedic or technician, as part of a crew. They perform duties such as driving, first aid and conducting observations. There is a variation in training levels between providers, but typically they fall under grade D or most commonly grade E under the PHEM competency framework. Staff working at this grade are typically covered under the NHS Agenda for Change at band 3.Emergency Medical Technician Ambulance TechnicianAssociate Ambulance PractitionerEMT TechAAPFEither support paramedics, or work autonomously as non-registered health care professionals. Technicians have no single definition or qualification and their skills vary by service, especially between NHS and private providers. The skills of a clinician working at technician or AAP level fall under grade F under the PHEM competency framework designed by the Royal College of Surgeons Edinburgh (Faculty of Pre-Hospital Care). Staff working at this grade are typically covered under the NHS Agenda for Change at band 4 or band 5.ParamedicParaGPre-hospital care practitioners, registered with the Health and Care Professions Council. Paramedics have autonomous practice and a range of skills including intravenous cannulation and advanced airway placement. , pay starts between £26,000 to £35,000 depending on experience, typically landing on the NHS Agenda for Change band 5 (for newly qualified paramedics) or band 6. They typically hold a BSc education.Ambulance NursePre-hospital PractitionerANPHPGNurses, registered with the Nursing and Midwifery Council. Ambulance nurses typically have experience working within an Emergency Department or Intensive Care Unit, or have completed an appropriate conversion course to pre-hospital practice. Nurses have autonomous practice and a range of skills as does a paramedic. Most nurses can administer the same mediation as paramedics, working under patient group directions. Ambulance nurses typically work at either band 5 or band 6 of the Agenda for Change.Specialist Paramedic Advanced ParamedicSP/SPCC/SPUC