Government (Mil or semi mil like Coast guard) owned V Commercial Contract is always a contentious issue.
Govt advocates point to benefits of customer outcome (community, patient, etc) and the downsides of commercialism being static investment and development, no focus on profits at the expense of patient outcomes, etc.
Commercial advocates point at the benefits of leaner meaner operations converting into better equipment, the value to taxpayer per patient and the flexibility of being able to modify and adapt to changing requirements whilst pointing to the downsides of govt being enormous overheads and waste of the taxpayers money, inflexibility, a lack of accountability, management incopmetence, and old ingrained systems and methods.
I think there is little question that the type of funding model largely determines organisational outcomes and focus. Commercial companies ONLY exist for return on investment, and governement organisations will ALWAYS be competing for funds in a competitive and defined funding pool, and rarely be able to respond to change outside long term government funding cycles.
I will put forward a third model that sits in the middle. Having worked for the previous two models in my career, I put this model forward as the most appropriate for HEMS and SAR. I currently work for a NGO charitable organisation and I consider this model very effective, however I believe there is an even more effective model.
During a study trip of international HEMS SAR organisations, I became convinced that the model most suited to producing the most responsive patient outcome focussed and cost effective solution is this third model. Look to NOLAS (Norwegian Air Ambulance), OAMTC (Austria), Rega (Switzerland) and to a slightly lesser extent ADAC (Germany). These models are not the same, but are similar. They hold various levels of government funding (generally representing less than 30% of costs) and are topped up by some form of membership to a medical or automotive "club" with benefits beyond just the helicopter response.
Given that the typical patient load of a primary response based HEMS program is around 54% road trauma (car, bike, motorbike and pedestrian), then a very strong case can be made for a road registration increases to be diverted into the helicopter response system. This is a small contribution per person based on the number of road users, but its strength is that it burdens the primary customer with the costs. In the case of NOLAS who do not link funding to road registration costs, around 70% of the adult population have joined an association which offers free helicopter transport to members and a host of other benefits such as free overseas travel insurance and repatriation.
Either way, these models have achieved several of the positives that have been discussed above, with few of the downsides, but there are qualifications to this model being successful; the most important of this is objective and transparent governance, with management appointed independantly. So many charities suffer from management appointments that have been a reward to those whose passion and drive started the concepts (and without whom HEMS would still be a pipe dream), rather than those who are more suited to managing the growing organisations. An independant board with at least a couple of governement representatives is linked to this theme of appropriate governance.
Those organisations mentioned above have achieved both the funding model and the management transparancy - and our assessment was that they most certainly have produced world leading provision of HEMS. Is this a co-incident? I really dont think so.
Is SAR really that different as a role that we cannot look to the HEMS models? In Australia, our organisations do both, and we dont break them into separate roles - so I would see the possibility. But that may be a contrarian view to those of you whom have grown up with two separate roles as embedded in your cultures - indeed in Norway, NOLAS does not really do the SAR role, they are HEMS. No stress - it is the funding model that is the key, as I believe it does produce certain outcomes, unintended or otherwise. So lets look most closely at that aspect first.