First reported 7 Oct 2019•Latest report 6 Jan 2026
Definition
What this concern includes
Includes failures in category 3 ambulance assessment and response arrangements, including undefined or unmet assessment and response timeframes, inadequate prioritisation, pathway design that creates cumulative delay, and insufficient arrangements for seriously ill patients whose condition is serious but not immediately life-threatening.
Not included
Excludes general ambulance response-capacity, dispatch or attendance delays where the category 3 assessment or response pathway is not the identified concern.
Excludes ambulance call-handling, clinical triage or re-triage failures that do not specifically concern category 3 assessment or response arrangements.
Excludes hospital handover, admission or treatment delays occurring after the category 3 ambulance response pathway has operated adequately.
Excludes generic urgent-care pathway deficiencies without a material category 3 ambulance assessment or response connection.
Reports
7
Distinct published reports
Individual concerns
9
A report can raise multiple concerns
Date range
2019–2026
First to latest report issue date
Stated actions
30
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
East Midlands Ambulance Service NHS Trust3
NEMS Community Benefit Services Limited2
NHS Nottingham and Nottinghamshire Integrated Care Board2
Competition Appeal Tribunal1
Department of Health and Social Care1
NHS Greater Manchester Integrated Care Board1
NHS Pathways1
West Midlands Ambulance Service University NHS Foundation Trust1
Executive non-departmental public body5
NHS trust4
Integrated care board3
Company limited by guarantee2
Ministerial department1
Sub-organisation1
Tribunal1
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
Failure of the urgent care pathway to adequately serve patients with serious, non-immediately-life-threatening systemic illness requiring a Category 3 ambulance response
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.11
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
Share recurring themes and concerning cases with EMAS, request review outcomes and learning, and participate in joint After Action Reviews.
Stated by NEMSStated in progressThe respondent said that this action was in progress when they made their response on 8 January 2026.
Action
Participate in a system After Action Review with the ICB, EMAS and DHU covering information transfer, deterioration recognition and role boundaries.
Stated by NEMSStated completedThe respondent said that this action was complete when they made their response on 8 January 2026.
Action
Deliver specialist teaching on appendicitis, evolving intra-abdominal sepsis, differential diagnosis and escalation for uncertainty.
Stated by NEMSStated completedThe respondent said that this action was complete when they made their response on 8 January 2026.
Action
Provide enhanced sepsis training and structured competency assessments for UCCH clinicians.
Stated by NEMSStated completedThe respondent said that this action was complete when they made their response on 8 January 2026.
Action
Use structured reflective practice and digital sepsis-screening prompts within Adastra to support clinical assessment.
Stated by NEMSStated in progressThe respondent said that this action was in progress when they made their response on 8 January 2026.
Action
Review transferred call codes with comparable East Midlands services to assess whether wider removal is appropriate.
Stated by NHS Nottingham and Nottinghamshire Integrated Care BoardStated in progressThe respondent said that this action was in progress when they made their response on 8 January 2026.
Action
Review and redefine the UCCH service specification to incorporate learning from the report.
Stated by NHS Nottingham and Nottinghamshire Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 8 January 2026.
Action
Develop joined-up analytics to understand patient journeys and outcomes across the pathway from March 2026.
Stated by NHS Nottingham and Nottinghamshire Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 8 January 2026.
Action
Develop a technological solution with partner organisations to transfer complete patient information across urgent-care services.
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
Require clinicians to review available information and make all Category 3 transfers through a clinical-only process, ending manual pushes to NEMS.
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.1
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.
Nottinghamshire
Concerns raised1
Failure of the urgent care pathway to safely serve patients with serious, non-immediately-life-threatening systemic illness requiring a Category 3 ambulance response
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.8
Action
Review and redefine the UCCH service specification in the NEMS contract to incorporate learning from the report.
Stated by NHS Nottingham and Nottinghamshire Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 8 January 2026.
Action
Develop joined-up analytics capability to assess patient journeys and outcomes across the entire pathway.
Stated by NHS Nottingham and Nottinghamshire Integrated Care BoardStated completedThe respondent said that this action was complete when they made their response on 8 January 2026.
Action
Strengthen governance, clinical oversight and operational boundaries for urgent care pathway referrals.
Stated by NEMS Community Benefit ServicesStated completedThe respondent said that this action was complete when they made their response on 8 January 2026.
Action
Review transferred EMAS cases, monitor monthly UCCH themes, escalate risks and participate in joint governance and After Action Reviews.
Stated by NEMS Community Benefit ServicesStated in progressThe respondent said that this action was in progress when they made their response on 8 January 2026.
Action
Host specialist clinical teaching on appendicitis, evolving sepsis, differential diagnosis and escalation.
Stated by NEMS Community Benefit ServicesStated completedThe respondent said that this action was complete when they made their response on 8 January 2026.
Stated by NEMS Community Benefit ServicesStated in progressThe respondent said that this action was in progress when they made their response on 8 January 2026.
Action
Develop a technological solution with partner organisations to transfer complete patient information across urgent care services.
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
Upgrade the CAD system to automatically transmit 999-call information to receiving systems and support comprehensive referral information.
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.1
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.
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.
Manchester South
Concerns raised2
Failure to account for actual category 3 ambulance response times when accepting call categorisation
Delays in category 3 ambulance responses
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.4
Action
Publish the Delivery Plan for recovering urgent and emergency care services, including actions to improve ambulance response times and capacity.
Stated by NHS EnglandStated completedThe respondent said that this action was complete when they made their response on 14 May 2024.
Action
Maintain ambulance capacity increases achieved during 2023/24 to support improved response times.
Stated by NHS EnglandStated in progressThe respondent said that this action was in progress when they made their response on 14 May 2024.
Action
Continue developing alternative referral pathways, including urgent community response, to provide timely and appropriate care.
Stated by NHS EnglandStated in progressThe respondent said that this action was in progress when they made their response on 14 May 2024.
Action
Monitor achievement of all Ambulance Response Programme standards through the North West Ambulance Improvement Plan and regional urgent-care governance arrangements.
Stated by NHS Greater Manchester Integrated Care BoardStated in progressThe respondent said that this action was in progress when they made their response on 14 May 2024.
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.
Staffordshire South
Concerns raised2
Lack of a prioritisation system for category 3 ambulance call assessments
Lack of time limits for category 3 ambulance call assessments
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
Have senior clinical navigators risk-assess patients awaiting clinical assessment, arrange ambulance dispatch for unsuitable patients, and upgrade incidents when indicated.
Stated by West Midlands Ambulance Service University NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 12 June 2023.
Action
Prioritise category 3 and 4 clinical-assessment callbacks in incident-category time order, targeting contact within 60 minutes.
Stated by West Midlands Ambulance Service University NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 12 June 2023.
Action
Highlight patients waiting over 120 minutes, and every subsequent 120 minutes, for further clinical-navigator risk assessment.
Stated by West Midlands Ambulance Service University NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 12 June 2023.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Existing clinical validation, prioritisation, risk assessment and escalation arrangements are considered sufficient to manage category 3 and 4 delays safely.
Stated by West Midlands Ambulance Service University NHS Foundation TrustExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Lincolnshire
Concerns raised1
Failure to escalate category 3 ambulance requests to category 2 when the 120-minute call-out time is exceeded
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.
Buckinghamshire
Concerns raised1
Failure of overdose call categorisation to ensure timely ambulance response
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.2
Action
Deploy Release 18, including the Dx0124 disposition code, to identify higher-risk suicide cases for early clinical review.
Stated by NHS EnglandStated in progressThe respondent said that this action was in progress when they made their response on 7 October 2019.
Action
Develop a disposition code for symptomatic accidental-overdose patients, subject to National Clinical Governance Group review, to enable urgent clinical risk assessment.
Stated by NHS EnglandStated in progressThe respondent said that this action was in progress when they made their response on 7 October 2019.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2
Position
Ambulance response standards and category mappings are set by NHS England, not by NHS Pathways.
Stated by NHS EnglandRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
NHS Pathways cannot automatically identify higher-risk overdoses from drugs taken because closed questions cannot safely capture the relevant variables.
Stated by NHS EnglandUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
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Includes failures in category 3 ambulance assessment and response arrangements, including undefined or unmet assessment and response timeframes, inadequate prioritisation, pathway design that creates cumulative delay, and insufficient arrangements for seriously ill patients whose condition is serious but not immediately life-threatening.
