I read with interest the Audit Commission's conclusions on achieving better value for money in emergency services (News Focus, page 10, 24 September). The report has its good points, but also weaknesses. We have implemented many recommendations to help us exceed ORCON standards.

But I take issue with its call to reduce the average length of each job-cycle by six minutes, increasing productivity by about 5 per cent. I do not question the commission's ability to do its sums and manipulate vast quantities of data; I do think it may lack experience of what this may mean for a paramedic in practice and the potential impact on other perceived 'costs' in the system - for example, sickness absence.

During a recent four-hour wait in casualty, I approached a paramedic, who I knew quite well, slumped over the ambulance desk, his face grey and weary. He and his relief crewman (his regular partner was off sick after hurting his back lifting a 16-stone woman) had brought in a patient with cardiac arrest. It had taken them over an hour from a remote rural area. Throughout, this paramedic had been working hard to maintain life. He had the dual stress of physical exhaustion and not knowing whether the patient would survive. Being a paramedic is physically and emotionally demanding. Unlike the other emergency services, or branches of nursing, there are no options for early retirement on full pension - paramedics have to work until 65.

How different if the imperative had been more towards productivity and less towards a hard-working staff member's health and well-being. What would be the long-term effects - higher sickness absence? What chance the 5 per cent productivity increase then?

I don't have rose-tinted spectacles about our crews. Some try it on a little. But mostly our emergency staff deliver a lean and efficient service.

They know there are lives at stake; what more motivation do they need?

Ambulance services in my part of the world are less about 'life in the fast lane' and more about the 'loneliness of the long-distance runner'. The service we deliver, like a marathon runner, is lean and efficient. It is time somebody out there woke up to this.

Lynn Massey-Davis Non-executive director Humb e rs ide Ambulance Services trust