Organization and planning of ambulance transport services in England and Wales

The ambulance service is the largest special needs transport operator in England and Wales and an important pillar of support to the National Health Service. In the last decade its size and role as a transport agency have been the subject of at least two government-inspired reviews which have questioned the efficiency of the ambulance service and examined in some detail its operational performance. The ambulance service also faces constraints on its funding, like the rest of the health service, which raises questions as to its ability in the future to meet all patient demands for transport, especially in the area of non-emergency outpatient services. The organization of the ambulance service is described from a number of perspectives: historical, institutional and managerial. These suggest that changes occurring in the approach to health care and management which are based on assumptions of cost-effectiveness and competition, will likewise affect the organization and provision of patient transport services. The ambulance service may become an even more specialist operator competing or co-operating in certain areas of work with other transport agencies especially in the area of non-emergency outpatient services. Scenarios are outlined on how this may be achieved and the likely implications for the delivery of health care.