When a patient calls 999, they expect an ambulance to be available when they need it. Behind that seemingly simple expectation sits a complex network of people, vehicles, equipment, technology, infrastructure and supply chains.
For ambulance services, keeping vehicles on the road increasingly requires more than effective fleet management. Rising operational demand, supply chain pressures, developing technology and the transition to net zero are changing what ambulance fleets need to deliver.
In episode three of Voices of Public Procurement, Martin Taylor, Assistant Director of Procurement – Ambulance and Training at the East of England NHS Collaborative Procurement Hub, speaks with Lem Freezer, Director of Fleet and Operational Support Services at South Central Ambulance Service NHS Foundation Trust.
Their conversation highlights a simple but important principle. No single organisation, team or supplier can address these challenges alone.
Ambulance availability is bigger than fleet
An ambulance responding under blue lights is the visible end of a much longer process.
Behind every operational vehicle are manufacturers, bodybuilders, procurement professionals, fleet teams, technicians and operational colleagues. Each contributes to making sure crews have a safe, reliable and appropriately equipped vehicle when they begin a shift.
As Lem explains:
“There’s no one single party in all of those elements that can solve all of the problems.”
This is why vehicle availability cannot simply be understood as reducing vehicle off-road time.
Ambulances need planned periods away from operational duties for cleaning, restocking, equipment checks, maintenance and charging. The more meaningful question is whether enough vehicles are available when operational teams need them most.
For Lem, that changes the measure of success.
“I focus on how many available vehicles we have for our peak operating and whether actually the number of vehicles we have available meets the operational plan.”
It is an important distinction. Instead of viewing downtime in isolation, fleet leaders can look at availability through the needs of the wider service.
And ultimately, availability is about confidence. Frontline crews need to know that when they enter an ambulance, the vehicle works, the right equipment and consumables are present and they can begin responding to patients.
Collaboration must start before the ambulance reaches the road
The inaugural national Double-Crewed Ambulance (DCA) Symposium brought ambulance trusts, NHS England, manufacturers, bodybuilders and other stakeholders together to examine these challenges.
The value of bringing the whole system into one room was not simply the opportunity to share information. It allowed different parts of the supply chain to understand how decisions made in one place can create consequences elsewhere.
Martin gives a deceptively simple example: the colour of an ambulance.
A design decision may appear straightforward from an NHS perspective. For a manufacturer, however, choosing specialist paint can affect lead times. Understanding those connections earlier can help organisations make better-informed decisions.
That principle extends far beyond specification.
Manufacturers face electric vehicle targets, production timelines and supply chain pressures. Bodybuilders work within their own operational constraints. Ambulance trusts must balance changing demand, vehicle availability and the transition towards net zero.
Understanding those different perspectives matters because all parties are ultimately working towards the same outcome.
As Lem puts it:
“Everybody understands each other’s pressures, challenges, difficulties and [is] working towards that common cause. That is 90% of the job.”
For procurement, this creates an opportunity to act as a connector across the system. Good commercial decisions depend on understanding operational requirements and supplier constraints, then translating them into contracts and specifications that work in practice.
The pressures on ambulance fleets are changing
Operational demand is increasing and changing when and how vehicles are used. Ambulances can be driven harder and for longer, creating different maintenance demands and increasing the potential for unplanned downtime.
At the same time, fleet teams continue to manage pressure within supply chains.
Lem describes parts availability as an increasing challenge. A relatively standard component can leave an ambulance unavailable for an extended period, demonstrating why resilience cannot begin only when something goes wrong.
Technology adds another dimension.
Modern ambulances are increasingly interconnected environments. Clinical equipment can communicate digitally, vehicle systems provide more information and automated checks can give crews greater assurance that equipment is present and compliant.
This complexity creates challenges, including keeping technical skills current. Yet it also creates an opportunity to shift from reactive fleet management towards a more predictive model.
From fixing failures to anticipating them
Perhaps the biggest opportunity lies in the data modern vehicles and equipment can generate.
Traditionally, vehicle maintenance has relied heavily on periodic schedules. Yet ambulance usage rarely follows a predictable pattern. As Lem explains, one vehicle might travel 50 miles one day and 700 miles the next.
That makes predictive maintenance particularly valuable.
Instead of waiting for a component to fail or relying solely on fixed servicing intervals, increasingly connected vehicles could identify developing problems before they result in unexpected downtime.
Equipment can also contribute to that picture. A defibrillator could indicate that its battery requires attention. A stretcher could identify a developing fault. Fleet teams can then intervene sooner.
The result is not technology for technology’s sake. It is increased availability.
“The less time you’ve got off the road fixing unforeseen problems is more time available on the road going to a patient.”
Artificial intelligence could take this further. Lem sees potential for artificial intelligence to analyse large volumes of fleet data, recognise trends and support workload prioritisation and maintenance planning.
The key will be turning growing volumes of information into useful decisions rather than creating additional complexity.
Net zero is an organisational challenge
The transition to net zero adds another layer of change.
Fleet has a pivotal role, but treating electrification solely as a fleet or estates project risks overlooking the wider transformation required.
Battery electric vehicles bring different requirements. Charging infrastructure, operational planning, finance, estates and vehicle usage all need consideration alongside the vehicles themselves.
Lem argues that these differences should not automatically be seen as limitations.
“A lot of people talk about the limitations of EV. I don’t think [they are] limitations. I think it’s just different and it’s how we adjust to that.”
That mindset is important.
Moving towards net zero provides an opportunity to reassess how ambulance fleets operate rather than simply replacing one type of vehicle with another.
A coordinated national approach could also help services learn from each other rather than developing different solutions to the same challenges independently.
Standardisation can create space for innovation
Innovation and standardisation can sometimes appear to pull in opposite directions. The experience of ambulance specification suggests they can reinforce each other.
National specifications have helped create clearer expectations across trusts and bodybuilders. This gives teams common standards against which vehicles can be designed, delivered and checked.
Against that common foundation, technology continues to develop rapidly.
Integrated information screens can reduce clutter in the cab. Connected equipment can support assurance checks. Automated lifting systems can reduce some of the physical demands placed on crews.
Connectivity could also help clinical information reach hospitals before an ambulance arrives, supporting preparation for the incoming patient.
The lesson is not to adopt every new technology available. It is to make sure technology contributes to a common purpose.
As Lem warns, organisations can experience “technology overload” if different systems do not align.
For procurement teams, the question should therefore extend beyond what a technology can do. They also need to consider how it contributes to operational requirements and patient outcomes.
Keeping the patient at the centre
For all the discussion around vehicles, supply chains, electrification and artificial intelligence, the strongest message from the conversation is also the simplest.
“In our world, the most important thing always has to be the patient and everything we do needs to be focused on that outcome.”
That principle provides a useful test for future decisions.
Does a procurement decision improve the service available to crews and patients? Does technology make the fleet more reliable or resilient? Does a specification reflect operational reality? Are organisations sharing their challenges early enough to solve them collectively?
The future of ambulance fleet will undoubtedly be more connected, data rich and technologically sophisticated. But technology alone will not determine its success.
People will.
As manufacturers, bodybuilders, ambulance trusts, operational teams and procurement professionals navigate these changes, strong partnerships will become increasingly important.
Because beneath all the complexity, the goal remains straightforward: bringing everything together, in the right place at the right time, so crews can be ready when patients need them.