Ambulance trusts across England have spent tens of millions of pounds in recent years to ensure very obese patients can be transported safely, a patchwork of Freedom of Information disclosures and official figures shows — a drain on resources that is occurring against a backdrop of rising demand and tightening response-time targets.

According to the original report, trusts have incurred roughly £27.5 million in extra costs to arrange specialist transport for bariatric patients, either by buying reinforced vehicles and lifting kit or by paying private contractors when standard ambulances cannot cope. North West Ambulance Service alone has paid almost £15 million in recent years to secure additional capacity, and said it plans to buy bespoke vehicles this year to reduce ongoing private-hire bills.

Other ambulance services have also invested heavily. London Ambulance Service is reported to be spending about £1 million to expand its own bariatric fleet after contracting out work that cost about £1.6 million a year over five years; South Central Ambulance Service and the East of England service have disclosed multi‑million pound outlays to meet similar needs. Trusts cite the cost of heavy‑duty stretchers, reinforced tail‑lifts and hoists as unavoidable if crews are to move patients safely and with dignity.

Those operational pressures are arriving while response performance remains under strain. Ambulance response times for the most urgent incidents have edged above target and longer waits for emergency and urgent calls were recorded in recent months, with patient handovers at hospitals contributing to vehicle unavailability. NHS England’s monthly operational statistics and sector briefings describe wide regional variation and persistent handover delays that reduce frontline capacity and increase the need for contingency arrangements such as private ambulance contracts.

The scale of the problem is underpinned by population health trends. Government statistics published in May 2025 show that around 64.5% of adults were overweight or living with obesity in 2023–24, with 26.5% classed as obese — an upward trend since the mid‑2010s. Public‑health authorities warn that excess weight increases the risk of heart disease, type 2 diabetes, certain cancers and musculoskeletal problems, all of which add to demand for urgent and planned NHS care.

Commentary from campaign groups and NHS representatives reflects the divide in public debate. John O’Connell, chief executive of the TaxPayers’ Alliance, told the Daily Mail that “taxpayers will be horrified to see the burden placed on NHS budgets by some irresponsible patients,” arguing the state should consider mechanisms to recoup costs from individuals whose lifestyles he described as placing an additional strain on services. By contrast, Daniel Elkeles, chief executive of NHS Providers, told the Daily Mail that “the NHS is there for everyone who needs it” and that treating the most obese patients requires “specialist skills, equipment and ambulances,” so it is appropriate for trusts to invest.

Health‑system leaders are pressing government for a two‑pronged response: immediate operational investment and stronger prevention. The NHS England Urgent and Emergency Care Plan for 2025/26 aims to address ambulance performance by tackling hospital handover delays — enforcing a maximum 45‑minute handover and rolling out measures such as Release to Rescue — while directing capital towards same‑day emergency care centres and bolstering community urgent care to reduce unnecessary hospital transports. The plan also recognises the need for targeted investment in ambulance capability and specialist equipment to cope with an ageing population and rising levels of obesity.

Local reporting based on Freedom of Information responses has tracked how quickly costs can escalate when trusts rely on private providers. An investigation into North West Ambulance Service showed spending on private ambulances rising sharply from around £3.6 million in 2019/20 to nearly £15 million in 2022/23, with continued high usage into 2023/24, illustrating the operational and financial impetus for trusts to acquire their own bariatric assets.

Frontline clinicians and safety experts stress that procurement is about more than cost. Reporting by public broadcasters and clinical sources describes investments in heavy‑duty trolleys, reinforced lifts and hoists as necessary both to protect patients’ dignity and to reduce musculoskeletal injury to staff. Ambulance trusts and hospital managers say these purchases, while expensive, are pragmatic responses to the realities of transporting very large patients safely and legally.

The financial and ethical consequences of the trend remain contested. Some campaigners call for stronger prevention measures and even regulatory steps on food policy to curb obesity rates over the long term; NHS leaders say being “bold” about prevention will reduce future treatment costs. Others, including taxpayer‑focused groups, argue for mechanisms that would require individuals to bear some of the financial consequences of lifestyle‑related demand. Policymakers face a fraught choice between immediate investment to support safe, dignified care and longer‑term public‑health interventions that will take years to yield savings.

For the foreseeable future ambulance trusts are balancing short‑term operational fixes with contributions to the national recovery plan. Sector briefings from NHS Providers and NHS England’s operational data underline that improved patient flow, enforced handover standards and targeted capital spending are central to reducing reliance on private providers and containing the additional costs associated with bariatric transport — but they also make clear that demographic and health trends mean the pressure is unlikely to abate quickly.

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Source: Noah Wire Services