The 'whole-system' model for emergency care is an unprecedented opportunity for emergency services to enjoy the same 'stature and importance' as areas covered by national service frameworks, says the leader of the Department of Health's out-ofhours review.

Dr David Carson told delegates at the Ambex conference last weekend that the new model - which would aim to end 'inappropriate' use of accident and emergency services - will require wide-ranging change, extending far beyond ambulance trusts and hospital emergency services. 'The primary care trusts will have roles in mapping demand in primary care and co-ordinating response across all parts of the primary care service, ' he said. 'NHS Direct is likely to become much busier and to take on a greater role of coordinating telephone access across providers, certainly out of hours, and perhaps in hours as well.'

Dr Carson called for improvements in managing accountability and risk across boundaries:

'One way to help achieve this is to set out a clear quality and performance framework with appropriate standards which would apply across the whole system, regardless of which organisation delivers the service.'

Despite support for an overall need to integrate emergency care services and increase creativity and flexibility from staff, in particular paramedics, delegates raised concerns that ambulance services were being asked to take on too much organisational change on top of delivering the government's performance standards.

Junior health minister Hazel Blears announced an investment of£10m from the National Lottery new opportunity fund to enable ambulance services to buy 12 lead ECG machines to speed up the delivery of thrombolysis.

She also announced an additional£3.4m for the purchase of in-cab satellite navigation equipment in frontline vehicles.

The first priority had to be improving response times, said the minister. By the end of March this year fewer than half of the 32 ambulance services had achieved the government target of responding to 75 per cent of lifethreatening calls within 8 minutes. Ms Blears said she expected most services to have reached the target by the end of September.