First reported 16 Dec 2013•Latest report 2 Feb 2026
Definition
What this concern includes
Includes failures in ambulance-service arrangements for defining, communicating, applying or reviewing response-time standards and prioritisation criteria for urgent calls, including Amber-category calls, where unclear targets or grading can delay appropriate emergency attendance.
Not included
Excludes actual ambulance attendance delays where no deficiency in response-time standards or prioritisation is identified.
Excludes ambulance dispatch communication, hospital handover and downstream treatment failures unless they directly concern the response-time-standard or prioritisation process.
Excludes condition-specific clinical triage systems where the assertion does not identify an ambulance response-time or prioritisation control.
Excludes generic staffing or resource shortages unless they are directly linked to failure to establish or meet a defined response-time standard.
Reports
13
Distinct published reports
Individual concerns
13
A report can raise multiple concerns
Date range
2013–2026
First to latest report issue date
Stated actions
17
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 England3
Association of Ambulance Chief Executives2
Department of Health and Social Care2
NHS Pathways2
Welsh Ambulance Services NHS Trust2
Advanced Medical Priority Dispatch System (AMPDS)1
Aneurin Bevan University LHB1
College of Paramedics1
East Midlands Ambulance Service NHS Trust1
East of England Ambulance Service NHS Trust1
Essex Police1
London Ambulance Service NHS Trust1
NHS Greater Manchester Integrated Care Board1
Nottinghamshire Healthcare NHS Foundation Trust1
Ofcom1
NHS trust7
Executive non-departmental public body3
Health-sector membership body2
Ministerial department2
Sub-organisation2
Company1
Devolved government1
Devolved legislature1
Economic regulator1
Fire and rescue service1
Health professional body1
Integrated care board1
Local health board1
Police force1
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.
Essex
Concerns raised1
Failure to apply consistent ambulance response coding based on clinical presentation rather than sectioning status
This report raised 6 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.2
Action
Implement a standalone procedure for suspected or confirmed Acute Behavioural Disturbance, removing “excited delirium” terminology and requiring Category 1 escalation with clinical review for possible downgrade.
Stated by East of England Ambulance Service NHS TrustStated completedThe respondent said that this action was complete when they made their response on 16 February 2026.
Action
Update, approve and disseminate the detained-patient procedure and Emergency Operations Centre escalation guidance to reflect the Acute Behavioural Disturbance procedure.
Stated by East of England Ambulance Service NHS TrustStated completedThe respondent said that this action was complete when they made their response on 16 February 2026.
Gwent
Concerns raised1
Failure to revise ambulance priority when a patient is deteriorating and in extremis
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.3
Action
Establish a national group of clinical and operational leads to review measures for incidents outside the purple and red categories.
Stated by Welsh GovernmentStated in progressThe respondent said that this action was in progress when they made their response on 20 February 2025.
Action
Undertake a review of whether measures are required for incidents outside the purple and red categories, including relevant amber conditions.
Stated by Welsh GovernmentStated plannedThe respondent said that this action was planned when they made their response on 20 February 2025.
Action
Seek assurance at the next integrated quality planning and delivery meeting on call categorisation and provision of clinically appropriate responses.
Stated by Welsh GovernmentStated plannedThe respondent said that this action was planned when they made their response on 20 February 2025.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Position
Welsh Ministers do not deliver health services or make WAST’s operational decisions on emergency ambulance call categorisation.
Stated by Welsh GovernmentOutside remitThe respondent said that this matter was outside its role or authority.
Position
WAST is responsible for operational emergency ambulance call categorisation and is best placed to respond to required action.
Stated by Welsh GovernmentRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Manchester South
Concerns raised1
Failure to adhere to national ambulance response-time targets
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.2
Action
Issue a national directive requiring clinical validation of Category 3 and Category 4 ambulance responses in NHS 111 and 999 services.
Stated by NHS EnglandStated completedThe respondent said that this action was complete when they made their response on 6 November 2024.
Action
Support the NHS, including ambulance services, to achieve safe operational response-time standards.
Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 6 November 2024.
North Wales (East and Central)
Concerns raised1
Failure of the MPDS system to remain fit for purpose for response prioritisation
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.2
Action
Embed new clinical roles in control rooms to triage 999 calls earlier and support better care decisions.
Stated by Welsh Ambulance Services NHS TrustStated in progressThe respondent said that this action was in progress when they made their response on 1 November 2024.
Action
Use the deployed Emergency Communication Nurse System and Call Priority Streaming System to support the Trust’s clinical and call-prioritisation strategy.
Stated by Welsh Ambulance Services NHS TrustStated completedThe respondent said that this action was complete when they made their response on 1 November 2024.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Position
Developing an alternative call-prioritisation system would require significant in-house work beyond the Trust’s capacity and capability.
Stated by Welsh Ambulance Services NHS TrustUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
MPDS remains the best available call-prioritisation product for the Trust, supported by linked ECNS and CPSS systems.
Stated by Welsh Ambulance Services NHS TrustExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Manchester South
Concerns raised1
Failure to account for actual category 3 ambulance response times when accepting call categorisation
This report raised 3 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.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
The Category 3 ambulance categorisation was audited and considered safe and appropriate based on the patient’s presentation.
Stated by NHS EnglandDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Nottinghamshire
Concerns raised1
Failure of 999 call grading to trigger a category 1 ambulance response for confirmed ingestion of a potent poison
This report raised 6 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.3
Action
Issue overdose and suicidal-intent guidance requiring further clinical intervention or automatic response upgrades and TOXBASE review for overdose incidents.
Stated by NHS EnglandStated completedThe respondent said that this action was complete when they made their response on 6 March 2024.
Action
Update overdose guidance to include callers receiving a Category 5 disposition.
Stated by NHS EnglandStated completedThe respondent said that this action was complete when they made their response on 6 March 2024.
Action
Develop specific training and a protocol for first-party callers in crisis.
Stated by Department of Health and Social CareStated completedThe respondent said that this action was complete when they made their response on 6 March 2024.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.5
Position
Ingestion of a potentially fatal substance does not, by itself, justify assigning a Category 1 ambulance response.
Stated by NHS EnglandDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Position
Existing overdose protocols, intentional-overdose coding and clinical oversight enable appropriate prioritisation regardless of the substance ingested.
Stated by NHS EnglandExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Position
The relevant ambulance Emergency Operation Centre, including EMAS in this case, determines and applies the local response category.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Listing every potentially fatal substance for dispatcher-led response assignment is impractical and risks dangerous over-triage because caller information may be unreliable.
Stated by NHS EnglandUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
Existing intentional-overdose coding and clinician review are considered sufficient; listing every potentially fatal agent would cause over-triage and delays.
Stated by Department of Health and Social CareExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Birmingham and Solihull
Concerns raised1
Failure to allow a category 1 ambulance response for severe ABD involving restraint
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
Propose that NHS England and AACE consider an evidence-based review of Acute Behavioural Disturbance response categorisation.
Stated by College of ParamedicsStated plannedThe respondent said that this action was planned when they made their response on 31 January 2022.
Action
Write to ambulance services reminding them to provide senior-clinician oversight for ABD calls and upgrade to Category 1 when deterioration or restraint occurs.
Stated by NHS EnglandStated in progressThe respondent said that this action was in progress when they made their response on 31 January 2022.
Action
Conduct a joint police and ambulance review of suspected ABD presentations to assess deterioration risk and appropriate response categories.
Stated by Association of Ambulance Chief ExecutivesStated completedThe respondent said that this action was complete when they made their response on 31 January 2022.
Action
Consider whether restraint alone should trigger an automatic Category 1 response for suspected ABD.
Stated by Association of Ambulance Chief ExecutivesStated completedThe respondent said that this action was complete when they made their response on 31 January 2022.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.8
Position
NHS Pathways recognises ABD and restraint risks and complies with the nationally mandated Category 2 response standard.
Stated by NHS EnglandExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Position
Any change to ambulance response categorisation must be considered by NHS England and AACE groups and approved by ECPAG.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Responsibility for determining NHS ambulance response categories lies with NHS England, supported by AACE evidence and guidance.
Stated by College of ParamedicsRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Severe and mild ABD cannot be reliably distinguished during pre-hospital or telephone triage, so severity cannot determine the response category.
Stated by NHS EnglandDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Position
Suspected ABD appropriately receives a Category 2 response, with senior clinical oversight and escalation to Category 1 when the patient’s condition warrants it.
Stated by NHS EnglandExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Position
AACE cannot decide or mandate emergency response categories and therefore cannot undertake that decision-making work.
Stated by Association of Ambulance Chief ExecutivesUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
NHS England, through ECPAG, is responsible for deciding appropriate ambulance response categories.
Stated by Association of Ambulance Chief ExecutivesRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Existing evidence-based arrangements consider Category 2 appropriate for suspected ABD unless immediately life-threatening signs warrant Category 1; restraint alone does not require Category 1.
Stated by Association of Ambulance Chief ExecutivesExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Gwent
Concerns raised1
Lack of an indicated expected response time for Amber 1 calls
This report raised 3 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.
Buckinghamshire
Concerns raised1
Failure to implement the local overdose response override at the outset
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.
Lincolnshire
Concerns raised1
Failure to include time from the initial call to regrading in response-time measurement
This report raised 3 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.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
The response clock for re-categorised calls starts at regrading because this timing was decided from a national perspective.
Stated by East Midlands Ambulance Service NHS TrustRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Pin
Get email alerts
Request correction
Includes failures in ambulance-service arrangements for defining, communicating, applying or reviewing response-time standards and prioritisation criteria for urgent calls, including Amber-category calls, where unclear targets or grading can delay appropriate emergency attendance.
