Paul Westaway, director of customer services at Babcock Mission Critical Services Onshore – the former Bond Helicopters – has been working in the UK’s helicopter emergency medical services (HEMS) segment since its earliest incarnation 30 years ago.

Cornwall, in the far southwest of England, was the first region to set up a HEMS operation in 1987 and, from these “humble beginnings” using an MBB Bo 105 helicopter, the concept has slowly been adopted across the whole of the UK.

In fact, at the beginning of September the final piece of the geographical puzzle was dropped into place when it was announced that Babcock had been selected to provide two helicopters and crews to serve Air Ambulance Northern Ireland – previously the only region without HEMS coverage.

“It has been a great opportunity to be involved in the development of a market,” says Westaway, noting the increasing “maturity” of the charities that fund the air ambulance operations.

That maturity has manifested itself both in terms of the services provided and the level of sophistication with which aircraft are selected and specified.

In the early days, notes Westaway, helicopters like the Bo 105 or AS355 Twin Squirrel – made by predecessors to Airbus Helicopters – were predominant. He describes them as “start-up aircraft that delivered a VFR service”, which helped to “pump prime” the market.

From 2001, however, that began to change as the then Bond began to introduce a new light twin – the Eurocopter EC135. This has seen the gradual transformation of the UK’s HEMS fleet to “very sophisticated, instrumented-rated, glass cockpit-equipped, NVG compatible aircraft”.

That process is continuing, Westaway adds, pointing to the new-generation of helicopters now being added, notably medium twins such as the H145 and AgustaWestland AW169.

Babcock is very much part of that process, having taken delivery of the UK’s first HEMS-roled H145, which is currently operating along with a sister ship on contract to East Anglia Air Ambulance. It has since added a further pair of the German-built helicopters for the Scottish Ambulance Service, and for Wales Air Ambulance it will begin the introduction of an eventual three examples from the first quarter of 2017.

The most recent county to add the H145 is Yorkshire in the north of England, with its first of two brand-new helicopters starting operations at the beginning of September from its site at Nostell, near Wakefield.

Yorkshire Air Ambulance (YAA) is a bit of an outlier in the HEMS market, most obviously because it is only one of two counties – Devon is the other – to own and operate its helicopters.

The charity has held an air operator’s certificate since 2012, which, says director of flight operations Andy Lister, confers it a great deal of freedom and flexibility. “It does give us some cost savings, but they aren’t huge. The real benefit is the operational autonomy it gives us.

“We are all part of the same team now – we all own the helicopters and feel part of it; we are paid directly by the charity so we are not just turning up to drive the car for them,” he says.

“My biggest surprise when we went down that road in 2012 was that by and large no one else has followed suit.”

The only potential issue is that it has a much smaller pool of pilots to call on in case of sickness or absence than the likes of Babcock or Medical Aviation Services (MAS), the other big player in the UK market.

YAA is investing a touch under £12 million ($15.8 million) in the two new rotorcraft, which will replace a pair of MD Helicopters MD902s.

The latter have been in service with YAA since the mid-2000s and are now up for sale as the charity looks to recoup some of the outlay on the new pair; it hopes to bring in around £1 million per helicopter, either by selling the complete aircraft or through part-out.

Although YAA conducted a thorough analysis of all the options, the H145 came out on top. “There wasn’t a lot else out there,” says Lister. “I genuinely think it’s one of the finest utility helicopters on the market today. It’s exceptional and will deliver for us in every area we want.”

He cites the larger cabin, which allows the carriage of additional medical personnel, higher maximum take-off weight (MTOW) – 3.7t versus the MD902’s 2.95t – the more powerful 894shp (667kW)-rated Safran Helicopter Engines Arriel 2E powerplants and the digital Helionix avionics suite, including a four-axis autopilot. This, he says, is “fantastic – it almost flies itself”.

However, the learning curve to transition to the new platform has been “quite steep,” says Lister, and will see the new aircraft initially used for visual flight rules operations, before the pilots are instrument rated.

Training using night vision goggles (NVG) will begin in January 2017, with the aim of introducing NVG operations from April or May. Another Yorkshire-specific modification is the addition of an external winch and trials of Human External Cargo operations are to be conducted during 2017, says Lister.

Other options considered by YAA included the smaller Airbus Helicopters H135 and Bell Helicopter 429 light twin as well as the AW169, which at some 4.6t MTOW is almost one tonne heavier than the H145.

“When we had a look we felt there was a lot more bang for your buck with the H145 than the 429, not least that the four-axis autopilot was standard,” says Lister.

The AW169, meanwhile, was rejected as too large for its requirements and the lack of skid landing gear – vital for the rough ground found in Yorkshire’s upland areas – was another downside. In addition, one popular feature of the MD902 is its NOTAR rotorless tail, and while the H145 still has a tail rotor, its shrouded design was perceived as safer than the open – albeit high-mounted – design of that on the AW169.

There was also, he admits, the desire not to be the first to plump for the new type, with all the risk that entails, both from delivery delays and potential teething troubles.

However, a number of air ambulance trusts are waiting to introduce the AW169; it should enter service with Kent, Surrey and Sussex Air Ambulance, operated by MAS later this year following delivery in February. In all, at least eight AW169s are to enter HEMS operations in the UK in the next 12 months.

The Bell 429 has also found its place in the market, with a solitary HEMS aircraft – G-WLTS – operating in the UK for Wiltshire Air Ambulance (WAA) from the small market town of Devizes.

As with many of the new arrivals, the 429 replaces an MD902 that WAA shared with the local police force as a dual-role helicopter. But with police air units centralised under the National Police Air Service (NPAS) system, the Wiltshire helicopter was a casualty of the shake-up.

“It became clear that as a charity we would have to stand on our own,” says its head of operations Kevin Reed.

As a result, from 1 January WAA became totally independent, starting with the new aircraft eight days later. Although it has gained increased operational freedom and a new, more capable helicopter, those benefits have come at a price – annual funding requirements have increased from £700,000 to £3.25 million.

In addition, thanks to the end of the contract with the police, from the end of 2017 the charity will move from its current base at the rear of the Wiltshire Constabulary headquarters to a purpose-built facility in a nearby town.

But cost and logistical aggravation aside, the people of Wiltshire are benefitting from the higher levels of service provided by the new platform.

Giorgio Bendoni, head of aviation and compliance at WAA, says it examined all the available options before selecting the 429. “It ended up that the H135 was the only feasible alternative – a larger aircraft would have been out of our budget,” he says.

“It’s fair to say there was a very decent brief from the charity on what the requirements were, based on an analysis of 2,500 missions carried out with the joint-role aircraft.”

It needed to have a larger cabin to improve the clinical care available, NVG compatibility, a modern digital cockpit, plus it had to be able to perform three back-to-back missions, Bendoni explains.

Measured against those criteria the 429 came out “as a clear winner,” he says. “It has been a very successful airframe for us. We will continue to operate it long into the future.”

The helicopter is actually operated by Kent-based Bell dealer Heli Charter; Wiltshire is its first, and so far, only, HEMS contract. WAA has an engineer on site for day-to-day maintenance, while heavier overhaul tasks are carried out at Heli Charter’s facility in Manston. The contract does not provide a spare helicopter in case of unscheduled downtime, so reliability is key, adds Bendoni.

Although both Wiltshire and Yorkshire have vastly different operating models, what is clear is the level of sophistication that has gone in to specifying their aircraft.

As Babcock’s Westaway notes, that is a shift that has happened across the sector. “Years ago if you asked the customer if they wanted to spec a new aircraft, the response would be something like ‘we just raise the money, you tell us’.”

Now it is “very much a partnership” where both sides “express an opinion”. Westaway adds: “It has to be the right airframe, but with the right features on it.”

He points to its work with East Anglia Air Ambulance to develop NVG operations: “That was driven by the customer’s desire to operate extended hours with NVG.” Babcock had to develop the specification and certification and work with CAA to gain the approvals for the operation.

“We very much work with the customer to define what they want and how they want to operate,” he says.

As you might expect, Westaway is a firm believer that the third-party model Babcock operates is the right one: “Ultimately it’s our business – it’s what we do, day in and day out. We believe we can manage the risks associated with the service and de-risk the charity.

“It’s about being appropriate and relevant in the marketplace. Flexibility comes with that – the ability to innovate and introduce new services.” Financially it makes sense too, he argues: “A large operator, be it MAS or ourselves, can probably deliver best value for customers.”

Instead of concentrating on fund-raising, the charity becomes focussed on managing an operation and assuming a degree of risk in terms of safety and residual value of the aircraft, Westaway argues.

“A charity has to be sure it’s the right route for them and will save them money. But I understand why they are doing it and it’s an exciting world to have these different models, just to explore where we are.”

Although the Babcock HEMS fleet in the UK is entirely comprised of Airbus Helicopters products – the H135 and H145 – Westaway is confident that it will soon adopt other models.

“We are particularly interested in market developments and where the AW169 or Bell 429 is appropriate. I think in future you will see us operating different aircraft in the same space.”

He believes that being part of a larger business – the broader Babcock group – means that it can also assume some of that risk with new types, which a smaller AOC holder might struggle with.

That said, the general public, who are funding the charities, and the ultimate recipients of the care the air ambulances provide, probably do not care whether the helicopter is made in Italy, Germany or the USA.

“As a member of the public putting his pound in each month, what I want to see is helicopter availability every day – I just want to know it’s there if I need it,” says Westaway.

One casualty of the ongoing modernisation process being undertaken by the UK’s HEMS operators is the slowly dwindling pool of MD Helicopters MD900s.

Most of the incoming AgustaWestland AW169s are due to replace the Mesa, Arizona-built type as a low – think virtually non-existent – production rate and poor spare part availability take their toll.

Soon, the only two air ambulance regions with full MD Helicopters fleets will be Cornwall and London. But with the former currently tendering for a new operation to begin in 2019, there is little chance the MD900 will survive into the next decade in England’s far southwest.

The situation in the UK is indicative of the MD900’s wider malaise, argues Tony Brooks, senior analyst at Flight Ascend Consultancy. He points to the fact that MD Helicopters last delivered an example of the light twin in 2013.

"The MD900 was a great helicopter, but is suffering from a level of under-investment by its manufacturer.

“Operators still love its versatility – particularly the NOTAR – but it is in urgent need of an update as it is looking increasingly dated, particularly in comparison with the competition.”

Although MDHI says it is working on a modernisation effort, including the addition of a Universal Avionics digital cockpit, details of flight-test progress have so far been light. As of March 2016, it said it was on track for certification of a new variant – the MD969 – by the fourth quarter of 2017.

“If it can successfully bring this to market, then operator interest may be rekindled in new-build examples, otherwise the MD900’s future will only be on the second-hand market,” says Brooks.

As Yorkshire Air Ambulance’s chief pilot Andy Lister notes, reliability and aircraft availability with its two MD902s has been declining.

“The trouble with the MD902s is that we have kept them too long and they are actually costing us money, too much money,” says Lister.

YAA’s chairman Peter Sutherland estimates that maintenance costs over the last six months were in the region of £1.2 million, with an annual service coming in at around £125,000-150,000.

Lister’s farewell to the MD902 is a mixture of sadness and anger, however: “I flew it this morning and I have to admit there was a little tear in my eye.

“But had MDHI invested in that product and given it a third-generation avionics suite I have no doubt they could have made a better go of that aircraft.”