Air Ambulance or not?

What I am about to say is controversial on the one hand and simple and straightforward on the other.

There has just been an article on the radio that came from mid Wales: on the unofficial border between North and South Wales, they said. Sorry but because of my unfamiliarity with the Principality and the accent, I didn't catch the name of the place.

Anyway, the point of this post is that they discussed the air ambulance service. This community is remote and they said that even by the fastest possible car, it would take an hour to get from the town/village to the nearest Accident and Emergency (A&E) Hospital.

I think this is something that now needs to be asked: merely because an air ambulance can be provided, should it be? By the same token, merely because very complicated microsurgery and its attendant after care can be provided, should it be?

Some of the arguments, rehearsed in the radio programme, include that without the air ambulance service, someone, say, suffering a stroke or heart attack would miss the golden hour opportunity. Therefore, if a victim of a stroke takes more than an hour to get to A&E, their chances of survival are significantly reduced. Alternatively, if they survive the golden hour they might have a poorer quality of life than otherwise.

The lady in the radio article argued as if there is a right to the air ambulance service. I don't agree: I don't agree that the air ambulance can be provided just because it can be. Why do I say this? I say it because of the opportunity costs: that is, if we provide an air ambulance service then, in the context of finite and limited budgets, something else is either not provided or is provided to a lesser extent than otherwise.

The extreme situation here is that I firmly believe that the National Health Service (NHS) should provide a preventive and primary care service first and foremost. The expensive additional services such as an air ambulance and microsurgery can appear fantastic and can save lives and limbs. However, without a major rationalisation of the budgeting system, the basic services that I have always expected to be provided may no longer be available to me.

I grew up with a General Practitioner service in which my parents could call the GP at any time of the day or night and that GP would attend us at home if necessary or would guarantee an appointment at his surgery. This type and level of service is no longer available.

I have had a limited number of conversations with a GP who defends his resistance to carrying out calls to patients' homes because some patients are perfectly ambulant and should make the effort to get to the surgery. To what extent is the GP here justified in his approach that it should be the GP who makes the assessment of whether to attend a patient on the basis that they can afford the time and effort to get to the surgery? One of the GP's arguments is based on the opportunity cost concept: that he could visit old and infirm people at their homes rather than "wasting his time" attending someone who could get to the surgery under his own steam.

Well, there you are: some of the arguments that came to me as I was listening to that radio programme.

DW