Emergency medical services in the United Kingdom
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 of England, Scotland and Northern Ireland. Emergency care including ambulance and emergency department treatment is free to everyone, regardless of immigration or visitor status; the NHS commissions most emergency medical services through the 14 NHS organisations with ambulance responsibility across the UK. As with other emergency services, the public access emergency medical services through one of the valid emergency telephone numbers. In addition to ambulance services provided by NHS organisations, there are 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, as part of community provision of services such as community first responders. Air ambulance services in the UK are not part of the NHS and are funded through charitable donations.
Paramedics are seconded from a local NHS ambulance service, with the exception of Great North Air Ambulance Service who employ their own paramedics. Doctors are provided by their home hospital and spend no more than 40% of their time with an air ambulance service. Public ambulance services across the UK are required by law to respond to four types of requests for care, which are: Emergency calls Doctor's urgent admission requests High dependency and urgent inter-hospital transfers Major incidentsAmbulance trusts and services may 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 fulfilled by private and voluntary providers; 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 last St John Division, to be so contracted is reputed to have been at Whittlesey in Cambridgeshire, where the two-bay ambulance garage can still be seen at the branch headquarters. The Regional Ambulance Officers’ Committee reported in 1979 that “There was considerable local variation in the quality of the service provided in relation to vehicles 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, consolidated into 53 services under regional or area health authorities. This led to the formation of predominantly county based ambulance services, which 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 and Northern Ireland. Following further changes as part of the NHS foundation trust pathway, this has further reduced to 10 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; 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 held by a public NHS body, of which there are 11 in England, 1 each in the other three countries. 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 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 TrustThe English ambulance trusts are represented by the Association of Ambulance Chief Executives, with the Scottish and Northern Irish providers all associate members. On the 14 November 2018 West Midlands Ambulance Service became the UK's first university-ambulance trust; 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 publi
St Mary's Hospital, Isle of Wight
St Mary's Hospital is a 477-bed hospital located on the outskirts of Newport on the Isle of Wight run by the Isle of Wight NHS Trust. The hospital, designed for low energy consumption, was designed by Ahrends and Koralek and opened in 1990. An archaeological investigation was carried out on the site in 2009 but found no features or artifacts of archaeological interest. A new Medical Assessment Unit with 24 beds and space for 6 ambulant patients opened in August 2015. Services provided at the hospital include urology, ophthalmology, ear nose and throat, gastroenterology, respiratory, care of the elderly, gynaecology and paediatrics; the hospital contains a private wing, which holds 11 beds. Public transport is provided by the Southern Vectis route 1 bus, which runs every 6 minutes in the daytime to Newport and Cowes, along the main road. Isle of Wight NHS Trust Hampshire & Isle of Wight Air Ambulance Earl Mountbatten Hospice List of hospitals in England Isle of Wight NHS Trust
Newport, Isle of Wight
Newport is a civil parish and the county town of the Isle of Wight, an island off the south coast of England. The civil parish had a population of 23,957 at the time of the 2001 census, which rose to 25,496 at the 2011 census; the town lies to the north of the centre of the Island. It has a quay at the head of the navigable section of the River Medina, which flows northward to Cowes and the Solent. Mousterian remains, featuring tools made by Neanderthals at least 40,000 years ago, were found at Great Pan Farm in the 1970s. There are signs of Roman settlement in the area, known as Medina, including two known Roman villas, one of which, Newport Roman Villa, has been excavated and is open to the public. Information about the area resumes after the Norman Conquest; the first charter was granted in the late 12th century. In 1377 an invading French force burnt down much of the town while attempting to take Carisbrooke Castle under the command of Sir Hugh Tyrill. A group of Frenchmen were captured and killed buried in a tumulus nicknamed Noddies Hill, a "noddy" being medieval slang for a body.
This was corrupted to Nodehill, the present-day name for a part of central Newport – a name confusing to many as the area is flat. In 1648 Charles I and a group of Parliamentary Commissioners concluded the Treaty of Newport, an attempt at reaching a compromise in the Civil War, undermined by Charles's negotiations with the French and Scots to intervene on his behalf; the Treaty was repudiated by Oliver Cromwell upon returning from defeating the Scots at the Battle of Preston. This led to Charles's execution; the town had been incorporated as a borough in 1608. The town's position as an area of trade accessible to the sea meant it took over from nearby Carisbrooke as the main central settlement absorbing the latter as a suburb; the borough ceased to exist in 1974 when it was incorporated into the larger Borough of Medina, itself superseded in 1995 by a single unitary authority covering the whole of the Isle of Wight. The Drill hall in Newport opened as the headquarters of the Isle of Wight Rifle Volunteers in 1860.
Newport since the 1960s has acquired new shopping facilities, a pedestrianised central square, through road traffic redirected off many of the narrow streets. Newport Quay has been redeveloped with art galleries such as the Quay Arts Centre and new flats converted from old warehouses; the Queen Victoria Memorial was designed by local architect Percy Stone. Geographically located in the centre of the Island at 50.701°N, 1.2883°W, Newport is the principal town in the Isle of Wight, to which there are transport connections from all the island's major towns. It is the island's main shopping location for public services; the main A3020 and A3054 roads converge as Medina Way between the busy roundabouts at Coppins Bridge and St Mary's Hospital. Newport railway station was the hub of the Island's rail network until the mid-20th century, but it closed in 1966 and the site is now occupied by the A3020 Medina Way dual carriageway; the nearest city to the town is Portsmouth, about 13 miles north-east on Portsea Island, adjoining the mainland.
More locally, the island's largest town, is to the north-east. The River Medina runs through Newport. North of its confluence with the Lukely Brook at the town's quay it becomes a navigable tidal estuary. Distance from surrounding settlements Cowes – 4.5 miles, 7 km East Cowes – 5 miles, 8 km Ryde – 7 miles, 11 km Shanklin – 9 miles, 15 km Sandown – 10 miles, 16 km Ventnor – 11 miles, 18 km Yarmouth, Isle of Wight – 10 miles, 16 km The town's suburb of Parkhurst is home to two prisons: the notorious Parkhurst Prison and Albany. Parkhurst and Albany were once among the few top-security prisons in the United Kingdom. Camp Hill was another prison in the area, but closed in 2013. Seaclose Park in Newport, on the east bank of the River Medina, has since 2002 been the location for the revived Isle of Wight Music Festival, held once a year. Newport is home to the Postal Museum the largest private collection of vintage postal equipment and post boxes in the world. Newport bus station is the town's central bus terminus and acts as the hub of the Southern Vectis network, with routes from across the Island terminating there.
St George's Park is the home of Newport Football Club, the most successful of the Island's football teams playing in the Wessex League. The stadium has a capacity of 3,000; the town is represented by Newport Cricket Club, which plays at Victoria recreational ground. Newport CC have two teams which compete in Harwoods Renault Divisions 1 and 2; the Isle of Wight County Cricket Ground is located on the outskirts of the town. The town of Newport and adjoining village of Carisbrooke together have seven primary schools, three secondary schools, a sixth-form campus, a further education college and two special schools; the primary schools located close to the town centre are Newport C of E Primary and Nine Acres Community Primary. Barton Primary is located on Pan estate, whilst Summerfields Primary is nearby on the Staplers estate, both to the east of the town. Hunnyhill Primary is situated on Forest Road to the north of the town, there are two primary schools in Carisbrooke: Carisbrooke C of E Primary on Wellington Road and St Thomas of Canterbury Catholic Primary in the High Street in the village centre.
The three secondary schools are Medina College and Christ the King College. Carisbrooke College is located on a large site on the outskirts of Carisbrooke village, whilst Christ the King is just down the road occupying two former middle school sites on
South Western Ambulance Service
The South Western Ambulance Service NHS Foundation Trust is the organisation responsible for providing ambulance services for the National Health Service across South West England. On March 1, 2011 SWASFT was the first ambulance service in the country to become a Foundation Trust; the Trust acquired neighbouring Great Western Ambulance Service on 1 February 2013. SWASFT serves a population of more than 5.47 million, its area is estimated to receive an influx of over 17.5 million visitors each year. The operational area is predominantly rural but has large urban centres including Bristol, Exeter, Bath, Gloucester and Poole; the headquarters for the service is in Exeter and the service has 96 ambulance stations and 6 air bases. The Chief Executive is Ken Wenman, appointed on 1 July 2006 on creation of the trust, having served as the Chief Executive of the former Dorset Ambulance Service NHS Trust; the Trust’s core operations include: Emergency ambulance 999 services Urgent Care Services – GP out-of-hours medical care NHS 111 call-handling and triage services Tiverton Urgent Care Centre.
It is one of ten Ambulance Trusts providing England with emergency medical services and employs more than 4,500 clinical and operational staff. In addition there are around 3,200 volunteers including community first responders, BASICS doctors, fire co-responders and patient transport drivers; the Trust is one of the largest in England. It covers 827 miles of coastline. In 2015/16 one in eight 999 calls to South Western Ambulance Service were treated over the telephone. "Hear and treat", where the patient receives clinical advice over the telephone, accounted for 12.7% of calls. For 36.4% of incidents the patients experienced "see and treat", when the patient receives treatment or advice at the scene of the incident. In a further 7.7% of incidents, the patient was taken to a non-emergency hospital department such as a community hospital or minor injuries unit. The remaining incidents resulted in a patient being taken to a hospital emergency department, thus the majority of incidents resulted in a patient not being conveyed.
SWASFT is the best performing ambulance service in the country for non-conveyance rates. In addition 62% of patients taken to hospital are admitted – this is again the highest performance for an ambulance trust in the country; this means that when SWASFT takes a patient to an emergency department they are to be admitted, not treated and discharged, therefore confirming, the right place for them to receive the care they need. There are 96 ambulance stations, six air ambulance bases, three clinical control rooms, two Hazardous Area Response Team bases and one boat across the South Western Ambulance Service operational area. In 2016 the Care Quality Commission told the South Western Ambulance Service to make significant improvements in the NHS 111 service; the inspection of the trust in 2016 identified several areas. In 2018 the trust said it would need an extra £12 million a year to meet the new ambulance performance standards; the number of compliments received by the Trust in 2014/15 increased by 41% to 2,055 while complaints rose by 20% to 1,268.
The Trust is split into three divisions: West Division: covering Devon and Cornwall, including its Headquarters at Exeter East Division: covering Somerset and Dorset North Division: consisting of the footprint of the former Great Western Ambulance Service as well as the Burnham-on-sea and Shepton Mallet stationsThe Trust has 96 ambulance stations among the counties that it serves: Cornwall Devon Dorset Somerset Avon Wiltshire Gloucestershire 306 - 999 Emergency Ambulances 57 Patient Transport Ambulances 234 Rapid Response Vehicles 7 Rapid Response Motorcycles 5 Bicycles 2 Hazardous Area Response Teams 1 Boat – ALN 043'Star of Life’ Wave Saver 1000 Class Ambulance Boat SWASFT provides the non-emergency 111 helpline and triage service for Dorset. In May 2014 the Trust won a contract to run a doctor-led minor injuries unit at Tiverton and District Hospital, open seven days a week. Patients do not need an appointment to visit the centre, which provides treatment for minor injuries and ailments including: Cuts and wounds.
London Ambulance Service
The London Ambulance Service is a NHS trust responsible for operating ambulances and answering and responding to urgent and emergency medical situations within the London region of England. The service responds to 999 and 111 phone calls, providing triage and advice to enable an appropriate level of response, it is one of the busiest ambulance services in the world, the busiest in the United Kingdom, providing care to more than 8.6 million people, who live and work in London. The service is under the leadership of chief executive Garrett Emmerson; the service employs around 4,500 staff. It is one of 10 ambulance trusts in England providing emergency medical services, is part of the National Health Service, receiving direct government funding for its role. There is no charge to patients for use of the service, as every person in the UK has the right to the attendance of an ambulance in an emergency; the LAS responded to over 1.8 million calls for assistance, over 1 million incidents in 2015/16.
Incidents rose by 20,000 in 2015/16. All 999 calls from the public are answered at one of the two Emergency Operations Centres in Waterloo or Bow who dispatch and allocate the appropriate resources. To assist, the service's command and control system is linked electronically with the equivalent system for London's Metropolitan Police; this means that police updates regarding specific jobs will be updated directly on the computer-aided dispatch log, to be viewed by the EOC, the resources allocated to the job. In 1818, a Parliamentary Select Committee had recommended that provision be made for carrying infectious patients in London "which would prevent the use of coaches or sedan chairs" but nothing was done. In 1866, a Hospital Carriage Fund provided six carriages to hospitals in the metropolitan area, for the use of patients suffering from smallpox or other infectious diseases, provided that they pay for the hire of the horses; the first permanent ambulance service in London was established by the Metropolitan Asylums Board in 1879, when a new Poor Law Act empowered them "to provide and maintain carriages suitable for the conveyance of persons suffering from any infectious disorder".
The first became operational at The South Eastern Fever Hospital, Deptford, in October 1883. In all, six hospitals operated horse-drawn "land ambulances", putting the whole of London within three miles of one of them; each ambulance station included accommodation for a married superintendent and around 20 drivers, horse keepers and attendants, laundry staff and domestic cleaners. A fleet of four paddle steamer "river ambulances" transported smallpox patients along the River Thames to Deptford, where they could be quarantined on hospital ships, departing from three special wharves at Rotherhithe and Fulham. At Deptford, in order to transfer patients between the hospitals at Joyce Green and Long Reach near Gravesend, a horse-drawn ambulance tramway was constructed in 1897 and extended in 1904. In 1902, the MAB introduced a steam in 1904, their first motor ambulance; the last horse-drawn ambulances were used on 14 September 1912. Although the MAB was supposed to be transporting only infectious patients, it also carried accident victims and emergency medical cases.
The Metropolitan Ambulance Act, 1909, empowered the London County Council to establish an emergency ambulance service, but this was not established until February 1915 and was under the control of the chief of the London Fire Brigade. In 1915, the MAB Ambulance Section were the first public body to employ women drivers, due to the number of men who had volunteered for military service. By July 1916 the London County Council Ambulance Corps was staffed by women. By 1930, the MAB was the largest user of civil ambulance services in the world, however the Local Government Act 1929 meant that work of the MAB was taken over by the London County Council, which took charge of the modern fleet of 107 MAB motor ambulances, together with 46 ambulances which were run by local Poor law unions. Taken with the 21 ambulances operated by the LCC, this provided a comprehensive service for all kinds of illness and accident, under the direction of the Medical Officer of Health for the County of London; the LCC took control of the River Ambulance Service, but it was disbanded in 1932.
During World War II, the London Auxiliary Ambulance Service was operated by over 10,000 auxiliaries women, from all walks of life. They ran services from 139 Auxiliary Stations across London. A plaque at one of the last to close, Station 39 in Weymouth Mews, near Portland Place, commemorates their wartime service. In 1948 the National Health Service Act made it a requirement for ambulances to be available for anyone who needed them; the present-day London Ambulance Service was formed in 1965 by the amalgamation of nine existing services in the new county of Greater London, in 1974, after a reorganisation of the NHS, the LAS was transferred from the control of local government to the South West Thames Regional Health Authority. On 1 April 1996, the LAS left the control of the South West Thames Regional Health Authority and became an NHS trust. In late 2017 LAS adopted the Ambulance Response Program which altered the targets for response times to reflect patient outcomes by removing hidden waiting times after a successful trial by the Yorkshire Ambulance Service, West Midlands Ambulance Service and South Western Ambulance Service.
As an NHS Trust, the LAS has a Trust Board consisting of 12 members. The board includes; the chief executive and Chief
East of England Ambulance Service
The East of England Ambulance Service NHS Trust is the authority responsible for providing National Health Service ambulance services in the counties of Bedfordshire, Essex, Hertfordshire and Suffolk, in the East of England region. These consist of 7,500 square miles, it is one of 10 Ambulance Trusts providing England with emergency medical services, is part of the NHS, receiving direct government funding for its role. There is no charge to patients for use of the service, under the Patient's Charter every person in the United Kingdom has the right to the attendance of an ambulance in an emergency; as well as providing an emergency ambulance service, the Trust provides non emergency patient transport services, commercial services and special operations such as emergency planning, hazardous materials incident response. The service support a number of emergency charities, such as air ambulances, who provide doctors for serious incidents; the Trust controls the mobilisation of critical care charities throughout its area.
These include Magpas, Essex & Herts Air Ambulance, East Anglian Air Ambulance, BASICS Essex Accident Rescue Service, SARS, NARS and BASICS Hertfordshire. The service can if required, mobilise London's Air Ambulance and the Kent and Sussex Air Ambulance if there is a major incident requiring more than one critical care team, where other teams in the region are operating at maximum capacity; the trauma teams are dispatched by a Critical Care Paramedic at the Critical Care Desk, in their Control Room in Chelmsford, who filters through every call the ambulance service receives and makes a clinical decision on whether to dispatch a critical care resource. The trust was formed on 1 July 2006 following the three-way merger of the Bedfordshire and Hertfordshire Ambulance Service NHS Trust, the East Anglian Ambulance NHS Trust and the Essex Ambulance Service NHS Trust; the result was a service covering an area of over 7,500 square miles with a population of 5.8 million people, one which answers more than one million emergency calls per year.
The East Anglian Ambulance NHS Trust had been formed in 1994 from the three-way merger of Cambridgeshire and Suffolk Ambulance Services. In 2009, the Trust was censured by the Care Quality Commission after inspection of an ambulance depot and seven of its 100 ambulance stations found patient-carrying vehicles were "dirty" and that staff were "unsure of basic measures for infection prevention and control"; the service launched an "urgent and comprehensive review" of its ambulance cleaning programme and reiterated its stance on patient safety, adding that "ensuring consistent high standards of cleanliness is a challenge" with so many stations, covering six counties and an area of 7,500 square-miles. In 2015/16, the trust received 1,037,119 emergency calls and handled 500,620 non-emergency patient transport journeys; the trust arrived at 73.6% of emergency Red 1 calls within eight minutes, 69.4% of emergency Red 2 calls within eight minutes. EEAST has around 1,500 volunteers; as of July 2016, the Trust has the following resources in operation: 357 front-line emergency ambulances 201 marked rapid-response vehicles 164 non-emergency ambulances 52 major incident support vehicles Over 130 ambulance stations and response posts 3 emergency operations centers in Bedford and NorwichThe Trust has its own emergency driving school, which trains drivers in 999 emergency driving under blue lights and sirens.
The Trust used the Mercedes Sprinter as front-line Double Staffed Ambulances, with the exception of a single Vauxhall Movano 4 wheel drive vehicle for use at Newmarket Racecourse. In 2009, the service started the transition to a brand-new Sprinter only fleet from a wide range of other brands - including Fords and older Mercedes vehicles; the scheme was finished in 2016, when the last brand-new Sprinter was delivered, although many of the older ones are now ending their cycle life. In March 2018, four new vehicles will be trialled across the East of England, with one concept vehicle being designed for and by the Trust. In May 2018 the trust bought 32 five-year-old vehicles decommissioned by the West Midlands Ambulance Service - described as "clapped out vehicles which colleagues in other trusts would have sent to the scrapyard" and contrasted with the luxury cars with which senior managers were provided in 2017. Ford Mondeos and Skoda Octavia Scouts are the most common amongst the fleet. In addition Land Rover Freelander and Land Rover Discovery Sport operate out of a limited number of bases.
Some Land Rover are used as Officer Cars. Renault Masters and Vauxhall Movanos are used for the Patient Transport Service. A number of these vehicles are fitted with blue sirens for High Dependency transfers; the Hazardous Area Response Team team uses Volkswagen Transporters and Mercedes Sprinters, all of which have 4x4 capability. The new fleet arrived in 2017, standardising these vehicles across the 10 ambulances services in England and Wales, it replaced Iveco Dailys. The trust provides Critical Care Paramedics to 3 local charity air ambulances in the region: Magpas, Essex & Herts Air Ambulance and the East Anglian Air Ambulance; these paramedics work alongside doctors to administer advanced treatment at the scene of the accident. Although the service uses the air ambulances, it does not fund the charit
North West Ambulance Service
The North West Ambulance Service NHS Trust is the ambulance service for North West England. It is one of 10 Ambulance Trusts providing England with Emergency medical services, is part of the National Health Service, receiving direct government funding for its role. NWAS was formed on 1 July 2006, it was created by the merge of 4 previous services as part of Health Minister Lord Warner's plans to combine ambulance services. Based in Bolton, the new Trust provides services to 7 million people in Greater Manchester, Merseyside, Lancashire and the North Western fringes of the High Peak district of Derbyshire in an area of some 5,500 square miles. There is no charge to patients for use of the service, under the Patient's charter, every person in the United Kingdom has the right to the attendance of an ambulance in an emergency. NWAS provides emergency ambulance response via the 999 system, as well as operating the NHS 111 advice service for North West England, they operate non-emergency patient transport services, in 2013/2014 carried out 1.2 million such journeys.
Since 2016, the PTS in Cheshire and Wirral has instead been carried out by West Midlands Ambulance Service. NWAS utilise a mixed fleet of emergency ambulances based on the Mercedes-Benz Sprinter or Fiat Ducato, the former consisting of a demountable box body on a chassis, the latter a van conversion; the Trust uses Skoda Octavia estates as the main Rapid response car although since 2017 begun using BMW i3 electric cars and use Renault Masters for Intermediate, Urgent care and Patient Transport vehicles. In Central Manchester, some paramedics respond on specially converted bicycles; the Trust operates from 104 ambulance stations across the North West. The most northerly station is at Carlisle, the furthest south is at Crewe, it maintains three Emergency Operations Centres for the handling of 999 calls and dispatch of emergency ambulances. Parkway Anfield Preston In 2017, NWAS signed an agreement to purchase a new EOC and area office for £2.9m at Liverpool International Business Park next to Liverpool John Lennon Airport As of 2019, this building has been converted and services are being moved from the Anfield site.
Over recent years, the Trust has combined many of their older ambulance stations into purpose-built facilities shared with other emergency services, including Greater Manchester Fire and Rescue, Lancashire Fire and Rescue and Greater Manchester Police. NWAS was the first ambulance trust to be inspected by the Care Quality Commission, in August 2014; the Commission found the trust provided safe and effective services which were well-led and with a clear focus on quality but it was criticised for taking too many callers to hospital and for sending ambulances when other responses would have been more appropriate. The Trust was subsequently inspected in 2018 and was found to have improved with a rating of "Good" Emergency medical services in the United Kingdom Healthcare in Greater Manchester North West Air Ambulance List of NHS trusts NWAS Website