Chopjock,
Banging the same old drum I see (as you have re: police air operations). Do you have any evidence that more "cheaper" helicopters (and their crews- presumably first aiders would do) would be better than fewer more expensive setups? You need to bear in mind what the rules will allow you to do. For instance, most trauma centres with helipads in the UK are unavailable to singles, because they are in built-up areas.
There are pros and cons to central control or local control and I do not think either route has absolute advantages. A system that has "county by county" separate organisations, but with close liaison and communications and information exchange covers some of the bases. Central control tends to reduce the development of new ideas, kit and modes of operation, some of which may point the way forward. It may also be true (I think it probably is) that the best answer will vary depending upon geographical location (rural v major conurbation).
Cost effectiveness is not an easy thing to get an accurate handle on. If you start trying to place everything on a money basis, you need to take account of lots of factors, some of which are not amenable to that sort of treatment. It is the same argument that just because it is not easy to quantify something in terms of money, does not mean it is not significant. You would need to draw the boundaries of your analysis pretty widely, and you have some ethical questions to wrestle with too. In the London area, the NHS is sufficiently convinced of the value of the London HEMS to contribute a major part of its costs to the charity that operates it. I understand they believe it saves them money, as the length of stay in hospital is reduced. Other regions of the NHS do not do the same though. How do you evaluate the value of a life saved?
The RNLI is not all wonderful. They spent a lot of money on an expensive training hotel and a lot of effort in training their volunteer crews who currently usually have little knowledge of matters marine: pretty much a necessity now that the UK has no fishing industry to speak of. However, at present they are being left behind in many areas to do with lifeboats (by comparison with other charitable lifeboats societies) as they do not have the cash to develop better, new generation boats.
Last edited by Helinut; 1st October 2010 at 13:20.