First reported 5 Jan 2026•Latest report 6 Jan 2026
Definition
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.
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.
Reports
2
Distinct published reports
Individual concerns
3
A report can raise multiple concerns
Date range
2026–2026
First to latest report issue date
Stated actions
6
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.
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
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.
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.
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
End manually pushed ambulance calls and use Directory of Services or automated ITK referrals meeting defined criteria.
Stated by NEMSStated completedThe respondent said that this action was complete when they made their response on 8 January 2026.
Action
Improve CAD-to-Adastra transfer formatting, structure, legibility and visibility of prior clinical validation through ongoing technical engagement.
Stated by NEMSStated in progressThe respondent said that this action was in progress 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
Interception or re-triage of EMAS calls is assigned to EMAS, while NEMS provides urgent primary care within appropriate admission-avoidance pathways.
Stated by NEMSRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Current DoS and automated ITK referrals use nationally defined NHS Pathways criteria, so additional locally derived screening criteria are not required.
Stated by NEMSExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Position
The manual push pathway will remain paused, with no reinstatement planned while agreed safety actions remain incomplete.
Stated by NHS Nottingham and Nottinghamshire Integrated Care BoardExisting 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.
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
Join the clinical governance meeting established between NEMS and EMAS to support their continuing joint work.
Stated by NHS Nottingham and Nottinghamshire Integrated Care BoardStated plannedThe respondent said that this action was planned when they made their response on 8 January 2026.
Action
End manually pushed calls and route referrals through Directory of Services or automated ITK pathways.
Stated by NEMS Community Benefit ServicesStated completedThe respondent said that this action was complete when they made their response on 8 January 2026.
Action
Continue joint work to formalise transfer principles preventing routine re-validation of clinically validated NHS 111 calls.
Stated by NEMS Community Benefit ServicesStated plannedThe respondent said that this action was planned when they made their response on 8 January 2026.
Action
Require clinicians to review available information and make all Category 3 transfers through the clinical push model.
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.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.4
Position
DoS-driven and automated ITK referrals use nationally defined NHS Pathways criteria, so additional locally derived screening criteria are unnecessary.
Stated by NEMS Community Benefit ServicesExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Position
Concerns about the urgent care pathway, CAD information, Category 3 call handling and transfer criteria should be addressed by EMAS, NEMS and the ICB.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Interception or re-triage of EMAS calls is assigned to EMAS, whose clinical expertise and statutory responsibility cover ambulance triage functions.
Stated by NEMS Community Benefit ServicesRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
NEMS cannot reliably identify prior NHS 111 clinical validation because CAD-to-Adastra transfers do not consistently provide advisor skillset information.
Stated by NEMS Community Benefit ServicesUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Pin
Get email alerts
Request correction
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.
