Figures for ambulance trusts in England showing sharp rise in spending on private operators add to concerns over NHS crisis

Ambulance services are increasingly calling in private firms to respond to 999 calls in the latest sign that NHS care providers are struggling to cope with the sharply rising number of patients who need urgent medical attention.

The London ambulance service (LAS) has had the biggest increase among England’s 10 regional ambulance trusts. The amount it spent on private ambulance providers soared from £700,000 in 2011 to £10.1m last year, a thirteen-fold increase.

Many other NHS ambulance services are also spending more of their budgets on private firms because of their growing reliance on them to meet demand.

For example, the amount paid out by South East Coast ambulance service (Secamb), which covers Kent, Sussex and Surrey, rose from £5.8m in 2012 to £11.6m last year, though it spent even more than that, £14.5m, in 2014.

Similarly, Yorkshire ambulance service paid private services £1.85m in 2014-15 to respond to 10,862 incidents. Last year that jumped to to £7m for attending 38,821 incidents.



The number of calls for assistance in London to which private ambulances have responded rose from 5,024 in 2011 to 59,749 last year. The figure includes both 999 calls and non-urgent journeys to hospital or other medical appointments.



The trend has sparked serious concern about the NHS’s chronic shortage of paramedics, which has coincided with big annual rises in emergency calls to all 10 ambulance services in England.

“Ambulance services are not something that should be flung out to the private sector,” said Tim Farron, the Liberal Democrats leader, who obtained the figures for London under a freedom of information request.

“We should not be offering this out to the lowest bidder. It’s not what people want or expect, and the NHS needs more paramedics.”

He said increasing demand was forcing NHS services to draft in private operators to ensure calls were answered on time. “Without the private providers we would currently not have enough resources to get to all the patients who need an ambulance.”

East Midlands ambulance service’s spending on private firms has also risen, up 15% from £4.47m in 2013-14 to £5.15m in 2015-16.

North West ambulance service used to pay only St John Ambulance and the British Red Cross to supplement its own services. But in 2014-15 it began using private providers for the first time, spending £998,741 on seven firms during that year, including QAS Ambulance (£244,365) and Trust Medical (£206,744).

Paul Woodrow, the director of operations at LAS, said: “We have seen a 45% increase in the number of life-threatening incidents in the last five years, responding to 504,685 category A incidents in 2015-16 compared with 347,659 in 2010-11. To continue providing a safe service to Londoners, we use three carefully selected providers in a similar way to hospitals employing agency nurses.”

Crews employed by all three providers “are appropriately trained at either paramedic or emergency medical technician level and carry the same equipment as our crews”, he said.

However, some NHS paramedics claim that private ambulance personnel are not always as well trained as them.

One Secamb paramedic said: “We as crews think they are not as well trained as us and we regularly have to travel with them and the patient to hospital because they cannot cope.



“They are good people but don’t have the same level of training as Secamb staff. This is not good for the patient as their skill set is well below ours. Often they call up asking for para backup, meaning they can’t manage that patient.”

LAS spending on private firms increased almost seven-fold inside one year, from £700,000 in 2011 to £4.8m in 2012, and then more than doubled inside the next 12 months to just under £10m in 2013. It fell slightly in 2014 to £9.2m but then rose to £12.2m in 2015, before falling to £10.1m last year.

Paul Evans, the director of the NHS Support Federation, a research group, said: “Ambulance services sit at the epicentre of the crisis in health and social care services and it’s not surprising they are struggling to cope with demand, but even so this is a shocking escalation in privatisation.

“Resorting to private providers is not the answer if we want to secure safe and effective emergency services. The evidence shows that they use fewer paramedics than NHS crews, which impacts upon patient safety as they will inevitably be sent to treat patients that they are not qualified for and leads to more situations where more experienced staff have to be sent to take over.”

Late last year Coperforma, a private transport firm, had to hand back the £63.5m contract it had held only since April for taking patients in Sussex to non-urgent hospital appointments after a series of blunders. Some of those involved cancer patients, and led MPs and others to describe its service as “a shambles”.

Doctor shortage left 4m patients without cover last year Read more

Evans said: “That shows that there are serious flaws in outsourcing theses vital services.”

Christina McAnea, the head of health at the Unison union, said: “Strained NHS finances have led to staffing shortages where shifts aren’t covered and ambulance services have no option but to call on private companies to fill the gaps.

“But the millions of pounds used hiring private ambulances would be better spent filling vacancies and holding on to those highly skilled staff who are leaving in droves.

“Ministers must accept that by continually slashing budgets they are forcing ambulance services into short-term solutions for urgent long-term problems. This helps no one.”