45. Here what was being provided was a health service. In the case of health services under the 1977 Act the conventional situation is that there is a duty of care. Why should the position of the ambulance staff be different from that of doctors or nurses? In addition the arguments based on public policy are much weaker in the case of the ambulance service than they are in the case of the police or the fire service. The police and fire services’ primary obligation is to the public at large. In protecting a particular victim of crime, the police are performing their more general role of maintaining public order and reducing crime. In the case of fire the fire service will normally be concerned not only to protect a particular property where a fire breaks out but also to prevent fire spreading. In the case of both services, there is therefore a concern to protect the public generally. The emergency services that can be summoned by a 999 call do, in the majority of situations, broadly carry out a similar function. But in reality they can be very different. The ambulance service is part of the health service. Its care function includes transporting patients to and from hospital when the use of an ambulance for this purpose is desirable. It is therefore appropriate to regard the LAS as providing services of the category provided by hospitals and not as providing services equivalent to those rendered by the police or the fire service. Situations could arise where there is a conflict between the interests of a particular individual and the public at large. But, in the case of the ambulance service in this particular case, the only member of the public who could be adversely affected was the claimant. It was the claimant alone for whom the ambulance had been called.

46. Cases could arise where an ambulance is required to attend a scene of an accident in which a number of people need transporting to hospital. That could be said to be a different situation, but, as the numbers involved would be limited, I would not regard this as necessarily leading to a different result. The result would depend on the facts. I would be resistant to a suggestion that the ambulance service could be regarded as negligent because by an error of judgment a less seriously injured patient was transported to hospital leaving a more seriously injured patient at the scene who, as a result, suffered further injuries. In such a situation, on the facts, it is most unlikely that there would be conduct which could be properly regarded as negligent. The requirement to establish that there has been a lack of care provides the [London Ambulance Service] with the necessary protection.

47. An important feature of this case is that there is no question of an ambulance not being available or of a conflict in priorities. Again I recognise that where what is being attacked is the allocation of resources, whether in the provision of sufficient ambulances or sufficient drivers or attendants, different considerations could apply. There then could be issues which are not suited for resolution by the courts. However, once there are available, both in the form of an ambulance and in the form of manpower, the resources to provide an ambulance on which there are no alternative demands, the ambulance service would be acting perversely ‘in circumstances such as the present’, if it did not make those resources available. Having decided to provide an ambulance an explanation is required to justify a failure to attend within reasonable time.