Most people (the general public and non-ambulance NHS colleagues) see the ambulance service very much as it was 30 years ago. Providing emergency response to those who have a life-threatening health need and at major incidents, and providing a clinical transport service, moving people to and from hospital.

That will always be at the heart of what we do, but today it is a relatively small proportion of the service we provide (around 10%). It is delivered alongside a much greater proportion of responses to urgent care needs ‘on scene’ in the out-of-hospital environment or via our 999 and 111 call centres (which receive nearly three million patient calls a year).

The ambulance service has a broader offer today. Over the last 20 years, it has diversified and is using clinicians with different skills to respond to urgent and emergency care demands. The service has professionalised, with a paramedic now expected to pass a three-year degree course and use a wider range of drugs and equipment to deliver more complex care than before. We also have a growing number of clinicians (paramedics, nurses and GPs) in our call centres. They support how we triage patients or ‘navigate them’ to the parts of the health and care system where their needs can be met most appropriately and effectively.

In thriving systems, leaders view the ambulance service as doing more than responding to emergencies. The service can also help to prevent ill health and keep people out of hospital. While pockets of best practice exist, there is now an opportunity for commissioners and partner providers to purposefully discuss with their ambulance service their potential to do more for patients. By proactively supporting other sectors, the ambulance service can help relieve some of the system pressures that seem impossible to control.

The ambulance sector interfaces with each and every part of the health and care system. This includes primary care, mental health, community services, allied health professions and secondary care, social care, other emergency services, voluntary services, local authorities, charities, private providers and our commissioning bodies.

In many cases we support other parts of the NHS where there are unmet urgent care needs. We often serve as a safety net for patients ‘falling between the gaps’ of other out-of-hospital services.

As the NHS moves forward with the ‘left shift’ and the urgent need for greater productivity, the ambulance sector has an enormous amount to offer, being both a key provider and a key integrator of out-of-hospital and pre-hospital care. It’s also one of the biggest contributors to keeping people out of hospital. People get more appropriate and more effective care in their local community and the NHS gets better value for money by spending less on inappropriate hospital care.

Last year AACE (the Association of Ambulance Chief Executives), along with NHS Confederation and NHS Providers, published A Vision for the NHS Ambulance Sector. It sets out how the ambulance sector could take on a greater role in leading and co-designing urgent and emergency care provision.

The report highlights the pivotal role ambulance trusts play in delivering urgent and emergency care and sets out a long-term vision for an enhanced role they could take in co-designing this care. It explores the case for change and highlights key case studies that demonstrate the vital contribution that ambulance services are already making by taking on greater responsibilities in leading and co-ordinating urgent and emergency care provision.

I love working for YAS. The last two years have reminded me again and again that no matter how much experience of the health service one may have, there’s always something new to learn. I learn something new every day at YAS, but above all, I’ve learned that if we are to make the NHS 10 Year Plan work and genuinely shift care from hospital to community and neighbourhood teams, our ambulance crews and our call centres must be central to all our thinking, planning and delivery. The out-of-hospital future is bright – that future has the ambulance service at its heart.