Radgirl - speak for kiwiland but not the UK. One has to separate the operation if we are to address your views successfully.
The aviation side of the operation is a bolt on accessory (a necessary one obviously) which would survivie whether it was a national or regional operation.
The financing side would however be decimated by government interference. As has been said before in this thread, government only looks at the bottom line. Efficiency doesn't exist in government dictionaries.
For your information - NPAS (the police national airforce conglomeration) is a laughing stock in the UK. It has been ridiculed by the HMCC report and those who work inside the set up know that what was and what is - are two different beasts. It is a symbol of how NOT to run a national airforce.
Independent charities for HEMS are a necessary evil. It's been adopted by the local populace who are very proud of what they have created (touchy feely). And they don't want it diluted by external foces. Nationally it is very inefficent but who cares? It works and it works so well - the government are steering well clear! Thank the Lord.
You could be alluding to the medical side of things and yes maybe there is room for optimisation.