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Confirmation that the NHS is facing spiralling demand for emergency treatment in summer as well as winter has come from an HSJ survey.

Ambulance trusts are battling with up to 11 per cent increases in 999 call-outs compared with last summer.

The survey of a third of England's 26 ambulance trusts found the highest increases at either end of the country.

The figures reflect only those calls to which a crew responded.

Westcountry Ambulance Services trust recorded an 11 per cent increase overall. North East Ambulance Service trust found calls from the public rose 11 per cent in the Durham district, previously covered by Durham County Ambulance Service trust.

Senior managers blamed rising public expectations for the increase. Steve Whinfield, acting chief executive of North East Ambulance Service, said: 'The national trend is that 999 demand is increasing. The work that we do, given the pressures that are on us, speaks volumes for our staff. Often people look at the winter crisis and forget that the pressure is still there in summer.'

Mr Whinfield said total call-outs rose 4.5 per cent in July compared with the same month last year. But the overall figure hid a 6.4 per cent decrease in urgent requests from GPs and an 11 per cent increase in responses to 999 calls.

In East Anglia, July call-outs are up 7.5 per cent on last year.

John Ashbourne, chief executive of East Anglian Ambulance trust, said: 'I am concerned about the ever-escalating number of 999 calls. Our frontline staff have responded magnificently to this increase in demand - but it has not been easy. Some are totally appropriate, such as patients with respiratory problems like asthma, but far too often we have been called to incidents involving alcohol-related problems.'

Mersey Regional Ambulance Service trust recorded an increase of up to 4 per cent this July compared with last year. Emergency planning manager Kevin Mulcahy said: 'There has been a significant increase in the number of calls, and it is not unusual for major A&E units to tell us they are operating emergency triage and closing their doors. It used to be a winter problem, but now it is becoming all year round.'

Crews were dealing with 16 to 18 emergency calls in one shift and were just as busy on nights as during the day, he added. 'There is constant pressure on our staff.'

Ambulance Service Association acting director Alan Parker said: 'There are significant pressures in the summer which are not recognised in the same way as winter pressures. The ambulance service is constantly under pressure, and unlike the acute hospitals we cannot run a waiting list - we have to respond in 19 minutes. We need to educate the public, develop call prioritisation and migrate callers into NHS Direct instead of automatically reaching for 999 when there is a minor problem.'

Mr Whinfield called for NHS Direct telephone helpline to go nationwide.

The West Midlands manages to escape the trend. A West Midlands Ambulance trust spokesperson said: 'We have a reduction in calls over the summer because everyone leaves us to go on holiday.'

Percentage increase in 999 call-outs July 1998 to July 1999

Westcountry Ambulance Services 11

North East Ambulance Service 11

London Ambulance Service 9

East Anglian Ambulance 7.5

Cumbria Ambulance Service 6.7

Mersey Regional Ambulance Service 3.8

East Midlands Ambulance Service 2.5

Essex Ambulance Service 1.8

West Midlands Ambulance 0