Unreliable ambulance response-time standards and prioritisation
First to latest report 16 Dec 2013 — 2 Feb 2026
Reports that mention this concern
13
Times this concern has been raised
13
Stated actions linked to this concern
17
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.
What is 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.
Trends
Reports over time
Reports mentioning this concern, 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
Reports and published responses 13 reports
See individual reports that have raised this concern, and the actions taken in response
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.
Linked response
East of England Ambulance Service NHS Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
East of England Ambulance Service NHS Trust
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.
East of England Ambulance Service NHS Trust
Update, approve and disseminate the detained-patient procedure and Emergency Operations Centre escalation guidance to reflect the Acute Behavioural Disturbance procedure.
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.
Linked response
Welsh Government
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
Welsh Government
Establish a national group of clinical and operational leads to review measures for incidents outside the purple and red categories.
Welsh Government
Undertake a review of whether measures are required for incidents outside the purple and red categories, including relevant amber conditions.
Welsh Government
Seek assurance at the next integrated quality planning and delivery meeting on call categorisation and provision of clinically appropriate responses.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Welsh Government
Welsh Ministers do not deliver health services or make WAST’s operational decisions on emergency ambulance call categorisation.
Outside remitThe respondent said that this matter was outside its role or authority.
Welsh Government
WAST is responsible for operational emergency ambulance call categorisation and is best placed to respond to required action.
Redirects 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.
Linked responses
Department of Health and Social Care
NHS England
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
NHS England
Issue a national directive requiring clinical validation of Category 3 and Category 4 ambulance responses in NHS 111 and 999 services.
Department of Health and Social Care
Support the NHS, including ambulance services, to achieve safe operational response-time standards.
North Wales (East and Central)
Concerns raised1
Failure of the MPDS system to remain fit for purpose for response prioritisation
Linked response
Welsh Ambulance Services NHS Trust
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.2
Welsh Ambulance Services NHS Trust
Embed new clinical roles in control rooms to triage 999 calls earlier and support better care decisions.
Welsh Ambulance Services NHS Trust
Use the deployed Emergency Communication Nurse System and Call Priority Streaming System to support the Trust’s clinical and call-prioritisation strategy.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Welsh Ambulance Services NHS Trust
Developing an alternative call-prioritisation system would require significant in-house work beyond the Trust’s capacity and capability.
Unable to actThe respondent said that a constraint prevented them from taking the relevant action.
Welsh Ambulance Services NHS Trust
MPDS remains the best available call-prioritisation product for the Trust, supported by linked ECNS and CPSS systems.
Existing 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.
Linked response
NHS England
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
NHS England
The Category 3 ambulance categorisation was audited and considered safe and appropriate based on the patient’s presentation.
Disputes 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.
Linked responses
Department of Health and Social Care
NHS England
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
NHS England
Issue overdose and suicidal-intent guidance requiring further clinical intervention or automatic response upgrades and TOXBASE review for overdose incidents.
NHS England
Update overdose guidance to include callers receiving a Category 5 disposition.
Department of Health and Social Care
Develop specific training and a protocol for first-party callers in crisis.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.5
NHS England
Ingestion of a potentially fatal substance does not, by itself, justify assigning a Category 1 ambulance response.
Disputes the concernThe respondent disagreed with part of the concern or the basis for it.
NHS England
Existing overdose protocols, intentional-overdose coding and clinical oversight enable appropriate prioritisation regardless of the substance ingested.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
NHS England
The relevant ambulance Emergency Operation Centre, including EMAS in this case, determines and applies the local response category.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
NHS England
Listing every potentially fatal substance for dispatcher-led response assignment is impractical and risks dangerous over-triage because caller information may be unreliable.
Unable to actThe respondent said that a constraint prevented them from taking the relevant action.
Department of Health and Social Care
Existing intentional-overdose coding and clinician review are considered sufficient; listing every potentially fatal agent would cause over-triage and delays.
Existing 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
Linked responses
Association of Ambulance Chief Executives
College of Paramedics
NHS England
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
College of Paramedics
Propose that NHS England and AACE consider an evidence-based review of Acute Behavioural Disturbance response categorisation.
NHS England
Write to ambulance services reminding them to provide senior-clinician oversight for ABD calls and upgrade to Category 1 when deterioration or restraint occurs.
Association of Ambulance Chief Executives
Conduct a joint police and ambulance review of suspected ABD presentations to assess deterioration risk and appropriate response categories.
Association of Ambulance Chief Executives
Consider whether restraint alone should trigger an automatic Category 1 response for suspected ABD.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.8
NHS England
NHS Pathways recognises ABD and restraint risks and complies with the nationally mandated Category 2 response standard.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
NHS England
Any change to ambulance response categorisation must be considered by NHS England and AACE groups and approved by ECPAG.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
College of Paramedics
Responsibility for determining NHS ambulance response categories lies with NHS England, supported by AACE evidence and guidance.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
NHS England
Severe and mild ABD cannot be reliably distinguished during pre-hospital or telephone triage, so severity cannot determine the response category.
Disputes the concernThe respondent disagreed with part of the concern or the basis for it.
NHS England
Suspected ABD appropriately receives a Category 2 response, with senior clinical oversight and escalation to Category 1 when the patient’s condition warrants it.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Association of Ambulance Chief Executives
AACE cannot decide or mandate emergency response categories and therefore cannot undertake that decision-making work.
Unable to actThe respondent said that a constraint prevented them from taking the relevant action.
Association of Ambulance Chief Executives
NHS England, through ECPAG, is responsible for deciding appropriate ambulance response categories.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Association of Ambulance Chief Executives
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.
Existing 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.
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.
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.
Linked response
East Midlands Ambulance Service NHS Trust
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
East Midlands Ambulance Service NHS Trust
The response clock for re-categorised calls starts at regrading because this timing was decided from a national perspective.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.
Actions and positions describe what organisations say in published responses. Implementation is not independently verified.