Though ambulance services are given extra cash to help them cover the countryside, making a prompt response to emergencies in rural areas is not without difficulties.

Gloucestershire is perhaps typical of such problems. There are two major hospitals - in Gloucester and Cheltenham - and the towns are well served because ambulances are often nearby.

But as Tony Morgan, director of emergency services at Gloucestershire Ambulance Service trust, says: 'In rural areas the calls are sparsely situated and they are more difficult to get to.'

Since 1952 the service has placed ambulances at judicious points around the county, known as standby points, in order to make its service more effective. But the distance ambulances have to travel can sometimes be complicated by a lack of information about the location of the incident. 'If the call comes on a landline we are able to track their location, but the increasing use of mobile phones causes problems because people don't know where they are.'

While these problems are faced by all rural ambulance services, Gloucestershire has to surmount a unique natural barrier. 'We have a practical problem that makes it more expensive to deliver these services. It's called the River Severn,' Mr Morgan says.

'We have one crossing in Gloucester and the next one isn't even in the county, so we have to duplicate services on either side of the river. On both sides there are rural areas.'

But the ambulance trust has no axe to grind with its HA. 'We have a very good working relationship with the HA and we are looked upon quite favourably. In fact it is hoping to give us some funding so we can get additional first responders to meet the new response standards.'