First reported 16 Dec 2013•Latest report 15 Jun 2026
Definition
What this concern includes
Includes failures of communication dedicated to ambulance dispatch and response status, including misleading dispatch wording, unclear response expectations and inadequate updates after a call has been placed.
Not included
Excludes delays caused solely by ambulance resource shortages, staffing or hospital handover congestion where communication reliability is not the identified unsafe condition.
Excludes failures in clinical, mental-health, social-care or other discharge and referral communications not specifically tied to ambulance dispatch status or expectations.
Excludes failures of emergency call assessment or clinical prioritisation where the concern is the decision itself rather than communicating dispatch status or expectations.
Reports
13
Distinct published reports
Individual concerns
16
A report can raise multiple concerns
Date range
2013–2026
First to latest report issue date
Stated actions
12
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
NHS England5
South East Coast Ambulance Service NHS Foundation Trust3
Department of Health and Social Care2
East Midlands Ambulance Service NHS Trust2
NEMS Community Benefit Services Limited2
NHS Nottingham and Nottinghamshire Integrated Care Board2
North West Ambulance Service NHS Trust2
Aneurin Bevan University LHB1
Brother and next of kin1
Counsel1
NHS Pathways1
Rye Hill Prison1
South Central Ambulance Service NHS Foundation Trust1
Welsh Ambulance Services NHS Trust1
NHS trust9
Executive non-departmental public body5
Company limited by guarantee2
Integrated care board2
Ministerial department2
Local health board1
Prison or young offender institution1
Sub-organisation1
Type not available1
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
West Sussex, Brighton and Hove
Concerns raised2
Inability to provide callers with estimated ambulance attendance times
Failure to inform callers when no ambulance is being arranged
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Work with ambulance services to develop standard scripts for situations where Ambulance Response Programme standards will not be met.
Stated by NHS EnglandStated completedThe respondent said that this action was complete when they made their response on 14 August 2026.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Position
Operational information, including ambulance waiting times, falls outside the remit of NHS Pathways triage.
Stated by NHS EnglandOutside remitThe respondent said that this matter was outside its role or authority.
Position
Individual ambulance services are responsible for managing operational delays and associated caller information under local governance and procedures.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Manchester South
Concerns raised1
Absence of a follow-up communication system for significant unforeseen ambulance delays
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Explore SMS updates for patients awaiting an ambulance or further clinical assessment.
Stated by North West Ambulance Service NHS TrustStated in progressThe respondent said that this action was in progress when they made their response on 2 March 2026.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Finite resources prevent NWAS from providing callback updates because this would reduce capacity to answer other 999 calls and provide essential information.
Stated by North West Ambulance Service NHS TrustUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Nottinghamshire
Concerns raised1
Failure to inform waiting families when an ambulance will not be sent
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
Action
Introduce a standardised opening statement explaining NEMS’s role and that an ambulance may not be sent.
Stated by NEMSStated completedThe respondent said that this action was complete when they made their response on 8 January 2026.
Action
Audit call recordings for compliance with the standardised opening statement.
Stated by NEMSStated plannedThe respondent said that this action was planned when they made their response on 8 January 2026.
Action
Submit a supplier development request for automated text notifications when calls are transferred through the Interoperability Toolkit.
Stated by East Midlands Ambulance Service NHS TrustStated completedThe respondent said that this action was complete when they made their response on 8 January 2026.
Action
Implement automated text notifications confirming request status when calls are transferred through the Interoperability Toolkit.
Stated by East Midlands Ambulance Service NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 8 January 2026.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
Position
Concerns other than concern three are better addressed by EMAS, NEMS and Nottingham and Nottinghamshire Integrated Care Board.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
NHS England cannot comment on whether families were told an ambulance would not be sent because other services spoke to the patient.
Stated by NHS EnglandUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
The Integrated Care Board is best placed to address concerns about the exit scripts informing families whether an ambulance will be sent.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Nottinghamshire
Concerns raised1
Failure to inform waiting families that an ambulance will be sent
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
Action
Use a standardised opening statement to explain NEMS involvement and ambulance arrangements to callers.
Stated by NEMS Community Benefit ServicesStated completedThe respondent said that this action was complete when they made their response on 8 January 2026.
Action
Audit call recordings for compliance with the standardised opening statement.
Stated by NEMS Community Benefit ServicesStated plannedThe respondent said that this action was planned when they made their response on 8 January 2026.
Action
Submit a development request to the CAD supplier for caller text notifications when calls are transferred through the Interoperability Toolkit.
Stated by East Midlands Ambulance Service NHS TrustStated completedThe respondent said that this action was complete when they made their response on 8 January 2026.
Action
Introduce CAD functionality that texts callers confirming the status of requests transferred through the Interoperability Toolkit.
Stated by East Midlands Ambulance Service NHS TrustStated plannedThe respondent said that this action was planned when they made their response on 8 January 2026.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
Position
The response cannot comment on whether families were informed because NHS 111 and NEMS, rather than the ambulance service, spoke to the patient.
Stated by NHS EnglandUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
The ICB is best placed to address concerns about the wording of exit scripts informing families whether an ambulance will be sent.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
The current CAD system cannot automatically notify families when an ambulance will not be sent, pending supplier development of this functionality.
Stated by East Midlands Ambulance Service NHS TrustUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Manchester South
Concerns raised2
Use of NHS Pathways call-handler script wording that misleadingly implies ambulance dispatch
Cancellation of ambulance responses without discussion with callers
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.4
Position
Local ambulance providers determine Category 3 and 4 exit-script wording rather than NHS England determining it nationally.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
NHS England is responsible for addressing concerns about the NHS Pathways script wording used by call handlers.
Stated by Department of Health and Social CareRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Ambulance validation and cancellation fall outside NHS Pathways’ remit.
Stated by NHS EnglandOutside remitThe respondent said that this matter was outside its role or authority.
Position
The Greater Manchester Clinical Assessment Service is responsible for investigating the ambulance validation and cancellation.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Manchester South
Concerns raised1
Failure of the call-handling script to support discussion of self-transport or provide a realistic ambulance-arrival timescale
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Explore adding advice to ambulance call scripts to direct callers to the nearest hospital with an emergency department when appropriate.
Stated by NHS EnglandStated plannedThe respondent said that this action was planned when they made their response on 15 February 2021.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Providing an accurate ambulance arrival time is impracticable because lower-priority responses may be diverted to higher-priority incidents.
Stated by NHS EnglandUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Gwent
Concerns raised2
Lack of an indicated expected response time for Amber 1 calls
Failure to advise callers of the expected emergency ambulance arrival time
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Manchester South
Concerns raised1
Lack of clarity about expectations for updates after call-centre calls to the ambulance service
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
The AACE cannot mandate or instruct ambulance services, limiting its authority to require implementation of responsive safety changes.
Stated by Department of Health and Social CareUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Brighton and Hove
Concerns raised1
Failure to explain the likely ambulance timing and estimated time of arrival
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Deploy a call-handler script advising callers of the ambulance’s estimated arrival timeframe to support informed decisions about waiting or travelling to hospital safely.
Stated by NHS EnglandStated in progressThe respondent said that this action was in progress when they made their response on 2 June 2019.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Position
The service cannot provide an ambulance arrival timeframe because multiple factors determine when a particular ambulance resource will arrive.
Stated by South East Coast Ambulance Service NHS Foundation TrustUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
Exact ambulance arrival times can only be provided by South East Coast Ambulance Service using its live operational information.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Northamptonshire
Concerns raised1
Failure to pass updated patient condition information to the ambulance service
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
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Includes failures of communication dedicated to ambulance dispatch and response status, including misleading dispatch wording, unclear response expectations and inadequate updates after a call has been placed.
