The area's health trusts are battling to revive their critical financial conditions. ED MEZZETTI reports on the perilous operation

THE poor performance of Wiltshire's ambulance service has forced bosses to consider merging the trust with two others, with a final decision due to be made today.

In 2004 Wiltshire Ambulance Service NHS Trust secured a zero star rating for the second year in a row after failing to meet response time targets.

The Government target is for ambulance crews to reach 75 per cent of 'life threatening' calls within eight minutes, but at one stage Wiltshire's performance slipped to 55 per cent.

This prompted the Avon, Gloucestershire and Wiltshire Strategic Health Authority, which manages 25 NHS trusts across the region, to take action.

Chief executive Trevor Jones said: "Last May the Wiltshire ambulance service probably had the worst performance in the country so we talked to them to see how that could be improved."

Adrian Lucas, chief executive of the Scottish Ambulance Service, was called in to review the situation in Wiltshire and decided "doing nothing was not an option".

Since the review started the SHA says Wiltshire ambulance service has improved its model of care and staff are receiving more training.

But the ambulance trusts in Wilts, Avon and Gloucestershire have been considering some form of merger as the most efficient way forward. Avon also had a zero rating in 2004. Gloucestershire has two stars.

Today's meeting is expected to see the three trusts vote on whether to keep the current system, create a single management structure or set up one service for the region.

Mr Jones said: "People have been talking about a single ambulance service for years. We just need to take a decision.

"At the moment if you are in Wiltshire you get sent a Wiltshire ambulance and if you are in Gloucestershire, a Gloucestershire ambulance.

"I live in Malmesbury near the border and it may be quicker for me to get a Gloucestershire ambulance."

Latest figures show the region's ambulance services are now meeting 74 per cent of 'life threatening' emergencies within eight minutes.

Zero tolerance

The financial difficulties facing Wiltshire's NHS trusts are no secret and 10 of the 25 trusts the SHA runs are in deficit.

The total deficit forecast is £24.4m about one per cent of the SHA budget.

West Wiltshire Primary Care Trust has a forecast overspend of £2.162m while the Kennet and North Wiltshire figure is £8.694m.

Chief executive Trevor Jones said the SHA had already saved £143m, but he is determined the £24.4m deficit will be wiped out.

He said: "We are confident that we'll break even. What I'm saying is that deficit will be zero at the end of March.

"We've borrowed significant sums from the NHS bank and that borrowing was dependant on us breaking even.

"In the current year we have received £40m from the bank and in the next year we'd like to receive £20m, but we won't get that if we can't break even."

Whether the £10.5m savings needed in north and west Wiltshire will mean service cuts remains to be seen, but Mr Jones said cash could be shifted from trusts in surplus. He said that there was good news in terms of patients' access to GPs.

The national target is for all patients to see a doctor in 48 hours and a healthcare professional within 24 hours. Kennet and North Wiltshire PCT had been the worst in the region with only 88 per cent of patients receiving this service.

Mr Jones said: "By the end of December everybody was being seen within the 24 or 48 hours."