When we think of healthcare all too often we think of our GP and local acute hospitals, West Cornwall and Royal Cornwall Hospitals. We rarely think about the ambulance service until we suffer an accident or a medical emergency, or when transport is needed for hospital appointments or discharge from hospital to home. Our emergency ambulance service is however now treating many more patients at home or on scene to avoid a hospital attendance or admission.

Sadly, gone are the days when the 999 and the Non-Emergency Patient Transport (NEPTS) services here in Cornwall were both provided by the South West Ambulance NHS Service, when the NEPTS, if needed, could back up the emergency service. A few years ago NEPTS was outsourced to the private sector and is currently being provided by E-zec Medical Transport.

Performance of our 999 provider continues to be cause for concern with the 7 minute response time for the most acute emergency not always being met and the county having the longest mean response time compared with our neighbours. Patients and families often report excessive waits for an ambulance. Healthcare professionals at West Cornwall Hospital and Minor Injury Units in Community Hospitals report having long waits for transfer of patients to A&E at Treliske, as these patients are considered to be in a place of safety and not a priority compared to the other demands being made on the ambulance service. These waits can go long into the night, sometimes beyond the closing time of an MIU and the end of shift for the doctors and nurses who man them.

A national major review of ambulance services, paints a grim picture of the sector, finding it has the highest sickness rates and complaints about bullying and harassment across the whole of the NHS. This translates into high vacancy rates, which means existing staff are under even more pressure to meet rising demand. But the review arguably does more to highlight the sector’s need for change and investment rather than the ease at which costs could be squeezed out. Overall the ambulance sector accounts for a modest £2.3bn of the NHS’s circa £125bn expenditure. All this should act as a timely reminder to system leaders as they approach the business end of the discussions around long term plans.

NHS Kernow CCG, the commissioner of healthcare services for Cornwall and Isles of Scilly, has recently been out to tender for the Non-Emergency Patient Transport service but despite an extensive procurement exercise, failed to attract any bidders for the work and was unable to make an award of contract. Efforts are now being made to seek an extension of the current contract with E-zec to ensure continuity of service but should those efforts fail, we could well be left with no Non-Emergency Patient Transport service at all.

Locally, the NHS and Social Care are working on ambitious plans for the integration of services. If we are really serious about integration then the future delivery of our ambulance service is vitally important and maybe, the time is right to bring emergency and non-emergency ambulance services back together again as a key player of an integrated care system. Decisions made about ambulances could well be felt right across the NHS here in Cornwall if our system leaders get them wrong.