Anthony Marsh has concerns about funding and definitions of mass casualty incidents.

A regional ambulance service leader has slammed NHS chiefs for making 'no progress' on a inquiry report's recommendations nearly 10 years after the Manchester Arena bombing.

Twenty-two people died and hundreds more were injured when Salman Abedi detonated a bomb at an Ariana Grande concert in May 22, 2017.

People were taken out of the arena on makeshift stretchers and one of the concerns is around how many stretchers should be considered enough.

Anthony Marsh, chief executive of West Midlands Ambulance Service University NHS Foundation Trust, has yet to receive a reply to a letter he sent to NHS England on May 6, 2026.

"I am sure you will understand we are nearly 10 years since the attack, and no progress has been made to address most of the recommendations," Mr Marsh wrote in a follow up letter at the start of this month (October).

A board meeting on Wednesday (October 28, 2026) was told that Mr Marsh has yet to receive a reply.

The board agreed to keep the issue on its "action log" to register their concerns.

Marsh's letter continued: "As I have previously informed you, other NHS senior colleagues and senior civil servants the ambulance sector in our country are not sufficiently trained, equipped or resourced to respond immediately to a similar incident to the Manchester Arena attack or London 7/7.

"Urgent action is required to address these issues."

Mr Marsh, the WMAS chief executive since 2006, also holds the national portfolio for emergency planning, response and resilience. He is also strategic ambulance advisor to the Department of Health and NHS England.

His letter to Jenifer Keane, a director at NHS England, added that he remains "deeply concerned that the definition of mass casualties equates to 24 stretchers only, based on WMAS holding two mass casualty vehicles."

He adds: "Can you please confirm this is now the definition of a mass casualty incident, and 24 stretchers is sufficient as per the national planning assumptions?"

Mr Marsh has also asked how many stretchers the fire service has and funding and has yet to receive a reply about those issues.

The trust holds a total of 524 specialist lightweight xtract stretchers in addition to any patient carrying kit on its mass casualty vehicles.

These were purchased to respond to any significant/major incident within the WMAS region. But they are at the end of their life with a total replacement cost of around £200,000.

A spokesperson for NHS England said it would continue to work closely with ambulance services.

“A huge amount of planning, practice and assurance takes place for major incidents – and plans to support NHS organisations can be quickly enacted, including providing mutual aid from neighbouring health systems and the voluntary sector." said the spokesperson.

"We will continue to work closely with ambulance services to implement the recommendations from Manchester Arena Inquiry as well as regularly reviewing the plans local NHS organisations have in place to respond effectively to major incidents - and taking action to make changes when appropriate.”