Rowan
Firstly let me state that I'm a volunteer for one of the Air Ambulances so not a professional in any way but based on my (admittedly limited) knowledge of this world, I would suggest the following answers to your questions:
1. How would you optimise aircraft utilisation?
The simple answer at the moment is that it's a decision that is made by the 999 call centres or by professionals on the scene. On the basis of my real job (which I will not go into here) you cannot say that there will always be an accident that needs an AA at a certain place at a certain time so utilisation is always as and when.
2. How would you square costs and benefits?
You cannot based on the answer to question 1 and also my final point in this reply
3. How would you deal with the hours of darkness?
I can't answer this - needs a professional pilot to do so. However from my charity volunteer perspective it would need a lot more people to get involved to help raise money to be able to afford it.
4. How would you distribute operating bases?
At the moment it is done by county and it is down to them. Personally I think that local knowledge is best here.
5. How would you integrate (if at all) with NHS and private healthcare?
It is already intergrated with the NHS as detailed above, private healthcare doesn't tend to involve trauma victims so in the main it isn't applicable.
6. Would you utilise capacity available on SAR and Police aircraft?
Best left to the professionals to answer this one
7. Would you perpetuate the current airframe (apparent) preferences?
At the moment it is down to the charities that run the individual AA's. For reasons given below (that also relate to point 1), my personal belief is that it should stay that way.
8. Would you perpetuate the current crew configurations?
Not sure what you mean by this, I will let the professional pilots answer from their perspective but I think that I am right in saying that some AA's only carry Paramedics whilst some have Paramedics and Doctors on board.
In terms of your final paragraph, I would suggest that you read up on the Golden hour. Every time I do a talk or attend an event and talk about it I always have a dialogue with a Medical professional (which I am not) who agrees how important it is.
There is no (to my knowledge) control over the NHS in terms of tasking etc - it is down to them and as they dont have to pay for anything except the Paramedics wages, it could be argued that it is a cheap/get out of jail option for them. As everything but the Paramedics wages is paid for by the respective charities who respond when they are called out, I'm not sure how you can judge cost effectiveness.
Having read your post again, I'm of the opinion that you are probably a journalist given your inflamatory tones. If so, I've bitten but, as stated earlier, I'm just a volunteer albeit someone that knows a little bit about how AA's work and the constraints that they are under. Every single AA in the country does a great job with little or no government support and long may that continue.