Ambulance response times

The Department of Health requires that the ambulance service reaches 75% of category A (life-threatening) calls within eight minutes. If onward transport is required a suitable vehicle should arrive on the scene within 19 minutes.

How has the proportion of Category A (Red 1 and 2) calls attended within 8 minutes changed?

Category A (Red 1 and Red 2) ambulance calls are those that are classed as life threatening and the national standard (A8) sets out that 75% of these calls should receive a response within eight minutes.

There has been a steady decline in the number of Category A calls attended within eight minutes over the past few years. In particular, there was a substantial decrease in performance from March 2014 to December 2014, although some of the change around this period was driven by London Ambulance Service (see the below chart 'How has the proportion of category A (red 1 and 2) calls attended within 8 minutes varied by commissioning region?'). Subsequent to this, there was some improvement, but this number fell again from May 2015. The national target of reaching 75% of Category A calls within eight minutes has not been met for 27 consecutive months (data not shown).

How have the number of calls resulting in an emergency response changed over time?

The number of category A calls that result in an emergency response rose from 2.5 million in 2011/12 to just under 3.4 million in 2015/16, an increase of 33%. Achievement of the target has declined over this period, which might indicate a link. For example, the sudden drop in performance in December 2014 and March 2016 were accompanied by a spike in activity during those same months. However, not all months experiencing falls in performance are associated with any sudden increase in call volumes. This suggests other factors are also influencing the ability of ambulances to meet their target of attending 75% of category A calls with 8 minutes.

Is the number of calls responsible for the standard breach in the month?

This can also be seen, by mapping the national performance of the 8 minute target against the volume of calls. There appears to be an inverse relationship between the total number of calls and the percentage that can be responded to within the eight minutes.

However, the total number of calls does not appear to be the sole reason for the breach of the national standard in a given month, as breaches are not always associated with increased call activity and increased call activity doesn't always result in a breach. Although there could be a tipping point whereby, a volume of calls over 250,000 nationally leads to a national breach in the target.

Further investigation of what is happening to cause breaches would be needed, as it is not down solely to activity in response to ambulance calls that are classed as life-threatening.

How have trusts breaching the 8 minute target for Red 1 and 2 calls changed over time?

This graph shows that in most months when there is a breach of the eight minute response target nationally, there is a corresponding breach in more than half of ambulance trusts. This suggests that a breach of the national target is due to common factors across areas rather than just poorer performance in a few outlier trusts.

How has the proportion of category A (Red 1 and 2) calls attended within 8 minutes varied by commissioning region?

The proportion of category A calls attended within eight minutes varies over time at the regional level in a similar manner to the national level, although London tends towards more extreme peaks and troughs. There have only been three occasions since April 2014 where an area has achieved the target of attending 75% of Category A calls within eight minutes. London's performance encountered a particularly challenging period after April 2014, falling below 50% in December 2014. In December 2015, the Midlands and East became the first region to perform worse than London in any given month since April 2014.

How has the proportion of category A calls attended within 19 minutes changed?

The Government requires that when onward patient transport is required in a life threatening situation an ambulance should arrive on scene within 19 minutes.

As with the eight minute target, there has been a steady decline over the past four years in the proportion of Category A calls with an ambulance on scene within 19 minutes. In particular, there has been deterioration in performance across all regions since March 2014. London was consistently the best performing region until March 2014, followed by a substantial drop in performance, going below 85% in December 2014. Performance did recover after this month, however performance remains below the target and after May 2015 this fell again.

About this data

NHS England measures response times for ambulances as patient outcomes can be improved by ensuring patients with immediately life-threatening conditions receive a defibrillator and timely response to ambulance calls.

Ambulance calls that are classed as life-threatening are categorised as Category A calls. From June 2013 these were further separated into Red 1 and Red 2 calls.

- Red 1 calls are the most time critical and cover cardiac arrest patients who are not breathing and do not have a pulse, and other severe conditions.

- Red 2 calls are serious but less immediately time critical and cover conditions such as stroke and fits.

Response time commitments are set out in the NHS 2010/11 Operating Framework as:

- A8: 75% of Category A (immediately life-threatening) calls should receive a response within eight minutes.

- A19: If a Category A patient requires transport, this should arrive within 19 minutes of the request for transport being made, 95% of the time.

For the purposes of the A8 standard, an emergency response may only be by:

- An emergency ambulance; or

- A rapid response vehicle equipped with a defibrillator to provide treatment at the scene; or

- An approved first responder equipped with a defibrillator, who is accountable to the ambulance service or, when a healthcare professional is at the location of the incident, equipped with a defibrillator and deemed clinically appropriate to respond by the trust.

Further guidance can be found at NHS England, Ambulance Quality Indicators


It would be interesting to correlate these results with the number of ambulance unit hours being produced nationally and by each trust over the same time series.

Ambulance trusts, in common with all other NHS trusts, have had to build, since 2011, towards an annual CIP of 17%-20%.

Average annual growth in the NHS budget has fallen from 4% (1948-2010) to 0.7% (2011-2016). Hospital CIP and deep cuts in adult social services have led to inability to discharge vulnerable adults and, in turn, to huge growth in ambulance handover times at EDs.

The prolonged freeze on NHS staff pay has squeezed both nurses and paramedics out of the system. For the first time in my 42 year career, there is a national shortage of paramedics.

Alan Murray (not verified)
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It would be interesting to correlate the apparent fall off in response with the increase of workload as a result of:

a) increase of 999 calls per annum
b) increase in workload coming in from the 111 service

General call volumes to the 999 service appear to rise 8-12% per annum.

Additional load on the ambulance service as a result of having the 111 service directly transfer work in to the ambulance call taking system as 'already triaged' and 'ready to dispatch' may, in some cases, be responsible for an additional increase in workload in the order of 15-20%

Mike Tubby (not verified)
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It would also be interesting to see the correlation between ambulance wait times over the same period to discharge patient into A&E's. Increased pressure on A&E's also plays a part. There is obviously from what Alan and Mike say many facets to these figures although the media will no doubt show it in more black and white terms. I also wonder about the impact moving from 2 stretchers on a vehicle to one, had on the number of ambulances required although this was long ago. Obviously much better care, but logistically there must have been an impact.

John Dale LLB(Hons) (not verified)
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Hi Mike, are you suggesting the 111 system has had an increase in patient journeys over and above what NHS Direct created?

John Dale LLB(Hons) (not verified)
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Dear Sir, I am more interested in the 25 to 30% of responses that did not meet the 8 minute target. Do you have any figures on the average response times in this respect and is there any marked difference between urban and rural response times? Many thanks.

Peter Burgess (not verified)
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Thank you for all of your comments and suggestions for further analysis. Some of these suggestions are being looked at in some of our other work, so keep an eye out on both of our websites for findings and
With regard to the question on average wait for the 25-30% of people who are not treated within 8 minutes. NHS England ambulance data does not publicly provide that data specifically, but does have data on the median, 95th and 99th centile for time to treatment for category A calls over time. There is variation across the three, with a general upward trend. I tweeted a rough graph here
Hope this helps.

Nora, QualityWa... (not verified)
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