The improvement in response times at certain ambulance trusts has been described as 'a miracle'.Paul Smith sees the benefits of the simple approach

Perhaps religious terminology may seem out of place in the no-nonsense world of the ambulance service, but there have been rumours of performance miracles. It comes at a time when the government targets are tough - since April, 75 per cent of lifethreatening calls (category A) are supposed to be dealt with within eight minutes - and when trusts themselves are fighting against ever-rising demand from the public.

Just 14 of the 32 ambulance services in England which introduced prioritisation met that target in April. Since then, the performance of two of the trusts which missed the targets have stood out - Tees, East and North Yorkshire Ambulance trust (TENYAS) and Greater Manchester Ambulance Service trust (GMAS). Both have been dragged from the doldrums, transforming morale among frontline crews and generating a more intangible feeling of confidence for the future.

When chief executive Trevor Molton pulled up at its York headquarters in June for his first day at work, TENYAS was reaching 55 per cent of category A calls within eight minutes.

Last month that figure, according to the trust, had risen to 76 per cent. It is already being described as the '100-day miracle'.

He is modest in explaining why: no complicated management theories, no expensive consultants.

'It was simply about asking the staff what the problems were and how things could be changed, 'Mr Molton says. 'There is this idea that ambulance crews, when they arrive at accident and emergency, want nothing more than to sit down, put on the kettle and have a natter for 10 minutes. But what you find is that they are often frustrated by the way the system operates and they just want to get on to the next job.'

He is the first to dedicate the trust's success to the staff. In part, it was a result of an open-door policy at the York HQ, allowing staff at all levels to raise issues with him. It was also, in part, due to the wide-ranging consultation where staff were asked what changes were needed to improve their work - the majority of their ideas were considered, most taken on board.

'As soon as you start listening to staff, you quickly realise there are many ways to improve the service and you quickly understand the enthusiasm and level of dedication they have.'

More staff helped, too. But though the approach may seem simple, technology - which is bringing in a quiet revolution across the service - has also been exploited in the drive for improvement.

Mr Molton's team has access to minute-by-minute updates on performance. Satellite navigation systems have been installed in vehicles, with complete coverage across the 4,500 square miles covered by the trust due to be achieved this month. And mapping software has also been updated.

A similar success story is also found at GMAS. Under the leadership of John Burnside, the trust has gone from reaching 46 per cent of category A calls in eight minutes to 78 per cent - in the space of a year.

Again, the recipe is familiar: an extra£4.1m investment, 112 student paramedics joining the GMAS, and also the introduction of a comprehensive rapidresponse vehicle service and an intermediate ambulance service.

It is also the result of better investment in IT. The chief executive's seminar presentation at the NHS Confederation conference this year should have won an award for graphic wizardry, if nothing else.

But importantly, the transformation has raised morale in the service - one indicator is staff sickness, which has dropped from 7 per cent to 5 per cent since March.

Human resources director John Williams says: 'I do not think it would be fair to say that we are at the forefront of developing services. But we are certainly up there.

We have made progress with things in the past being pretty bad, but there is a new confidence.

'We had to change work patterns, change our approach and, to be honest, Unison has been brilliant in that. I do not think industrial relations have been better. It has also resulted in better local media coverage about the work we have been doing, which is no bad thing.'

Though it recognises there is still some way to go before every trust hits the government targets, the Ambulance Service Association believes such stories suggest trusts are improving delivery. But the black cloud of ever-increasing demand remains.

In the five years ending April 2000, patient journeys increased by 48.5 per cent, emergency responses by 52.4 per cent and 999 calls by 70 per cent, figures from the Department of Health show. Over the same period, expenditure has risen in real terms by 17.5 per cent. In the following year, the number of 999 calls increased by a further 6 per cent. But the number of urgent journeys dropped by 5 per cent over the course of that 12 months.

Many managers are now asking how far they can go with reform without extra resources if the national trend continues.

Take East Anglian Ambulance trust. It says it saw a massive 13.5 per cent rise in calls in October, compared with the same period last year. Over the past six years, it has seen an 86 per cent rise on the average number of 999 calls. In response, crews have managed to improve response times for category A calls - up to 64 per cent from 53 per cent last October.

Number-crunching never gives the full picture, but with a visit from the Commission for Health Improvement due, and an extended deadline to next April to meet the government's targets, director of operations Paul Sutton hints at the pressures involved.

He says: 'Staff deserve tremendous credit for recording the October figures, at a time when they are working harder than ever.We are doing everything we can to put extra ambulance resources and technology in place to achieve these new clinically driven targets.'

He adds: 'We keep making progress, but every time we do, the carrot appears to be dangled a little further away from us.'