Ambulance services have changed significantly in the past decade, with big improvements in response times for 999 calls, in training and quality of care, vehicle standards, equipment and technology. Demand for ambulances is also continuing to rise by an extra 250,000 responses a year.

These major changes are being shaped by a 10 year strategy, Reforming Emergency Care, which was launched in 2001. In January 2006 the White Paper, Our Health, Our Care, Our Say made a commitment to develop an urgent care service strategy, and in October 2006 the publication of Direction of Travel for Urgent Care, has initiated the discussion on the future of these services.

The intention is to transform ambulance services from focusing mainly on resuscitation, trauma and acute care to providing more diagnosis, treatment and care in people's homes, helping to avoid unnecessary A&E admissions.

If approval is given to proceed with foundation status for ambulance trusts, this would provide trusts with additional financial and performance management freedoms to develop services. The governance structure would also enable trusts to increase local involvement.

They will do this through:

Smarter call handling and better patient assessment

Anyone calling 999 will receive the right response for their needs, and receive the most appropriate care. Ambulance service call handlers will initiate treatment for patients through a number of different options from an emergency ambulance, to a minibus, to telephone advice on how to deal with their problem, to a referral to a healthcare partner for care.

Tailoring responses to ensure patients receive the care that is right for their need

Patients will receive care in the most appropriate setting. The options that the ambulance service will make available for patients will include being treated in their own home, being taken to community walk-in centres, minor injury units or acute A&E departments.

Ambulance services will build strong relationships with local community services to ensure that when patients with long term conditions dial 999, they receive a service that understands their need and can link with their local community care services.

Ambulance services will help reduce the unnecessary admissions to acute A&E services.

Developing the skill mix of ambulance staff

Through developing a wider mix of skills, the ambulance service will develop their staff to become more empowered with increasing competence, qualifications and skills to support them in becoming more autonomous. The service will have a positive direct impact on patients' lives.

To achieve this they will need:

• Strong partnership working across the system
• Integrated systems of care based around seamless care pathways
• Full mobilisation of the skills of the existing workforce and encouragement of the development of new skills

As well as aiming to support the needs of the specific parts of our membership wherever possible, as a membership organisation the NHS Confederation represents all parts of the NHS. Our work for ambulance trusts feeds into the voice for the whole NHS, and supports solutions that benefit the whole system for patients and the public.