Unreliable criteria for transferring Category 3 ambulance calls
First to latest report 5 Jan 2026 — 6 Jan 2026
Reports that mention this concern
2
Times this concern has been raised
3
Stated actions linked to this concern
6
What this concern includes
Includes failures in the dedicated process for defining, communicating, interpreting, applying or reviewing criteria for transferring Category 3 ambulance calls between EMAS and NEMS, including ambiguity about the effect of prior clinical validation.
What is not included
Excludes general ambulance call triage, dispatch, response-time or resource-capacity failures where Category 3 call-transfer criteria are not the deficient control.
Excludes failures in clinical assessment or treatment after a transfer decision has been reliably made.
Excludes referral or transfer pathways involving other ambulance categories, services or receiving organisations unless the assertion explicitly concerns the same EMAS-to-NEMS Category 3 transfer process.
Excludes generic inter-service communication or governance deficiencies that do not directly affect Category 3 call-transfer criteria.
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.
East Midlands Ambulance Service NHS Trust2
NEMS Community Benefit Services Limited2
NHS England2
NHS Nottingham and Nottinghamshire Integrated Care Board2
Company limited by guarantee2
Executive non-departmental public body2
Integrated care board2
NHS trust2
Reports and published responses 2 reports
See individual reports that have raised this concern, and the actions taken in response
Nottinghamshire
Concerns raised1
Lack of agreed and unambiguous criteria for transferring Category 3 calls to NEMS
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
NEMS
NHS Nottingham and Nottinghamshire Integrated Care Board
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
NEMS
End manually pushed ambulance calls and use Directory of Services or automated ITK referrals meeting defined criteria.
NEMS
Improve CAD-to-Adastra transfer formatting, structure, legibility and visibility of prior clinical validation through ongoing technical engagement.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
NEMS
Interception or re-triage of EMAS calls is assigned to EMAS, while NEMS provides urgent primary care within appropriate admission-avoidance pathways.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
NEMS
Current DoS and automated ITK referrals use nationally defined NHS Pathways criteria, so additional locally derived screening criteria are not required.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
NHS Nottingham and Nottinghamshire Integrated Care Board
The manual push pathway will remain paused, with no reinstatement planned while agreed safety actions remain incomplete.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Nottinghamshire
Concerns raised2
Inclusion and exclusion criteria for transferring Category 3 calls open to interpretation
Lack of agreed criteria between EMAS and NEMS for transfer of Category 3 calls
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
East Midlands Ambulance Service NHS Trust
NEMS Community Benefit Services
NHS England
NHS Nottingham and Nottinghamshire Integrated Care Board
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
NHS Nottingham and Nottinghamshire Integrated Care Board
Join the clinical governance meeting established between NEMS and EMAS to support their continuing joint work.
NEMS Community Benefit Services
End manually pushed calls and route referrals through Directory of Services or automated ITK pathways.
NEMS Community Benefit Services
Continue joint work to formalise transfer principles preventing routine re-validation of clinically validated NHS 111 calls.
East Midlands Ambulance Service NHS Trust
Require clinicians to review available information and make all Category 3 transfers through the clinical push model.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.4
NEMS Community Benefit Services
DoS-driven and automated ITK referrals use nationally defined NHS Pathways criteria, so additional locally derived screening criteria are unnecessary.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
NHS England
Concerns about the urgent care pathway, CAD information, Category 3 call handling and transfer criteria should be addressed by EMAS, NEMS and the ICB.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
NEMS Community Benefit Services
Interception or re-triage of EMAS calls is assigned to EMAS, whose clinical expertise and statutory responsibility cover ambulance triage functions.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
NEMS Community Benefit Services
NEMS cannot reliably identify prior NHS 111 clinical validation because CAD-to-Adastra transfers do not consistently provide advisor skillset information.
Unable to actThe respondent said that a constraint prevented them from taking the relevant 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.