Unreliable emergency-service incident grading and response-time coordination
First to latest report 1 Apr 2014 — 23 Mar 2026
Reports that mention this concern
8
Times this concern has been raised
9
Stated actions linked to this concern
18
What this concern includes
Includes failures of controls dedicated to grading emergency incidents, defining or communicating response-time requirements, and coordinating police and ambulance dispatch functions where inconsistent understanding can delay or misdirect emergency attendance.
What is not included
Excludes general emergency-service staffing, resource or attendance delays where no failure in incident grading, response-time requirements or dispatch coordination is identified.
Excludes failures confined to ambulance call triage or police incident allocation when the response-time coordination or cross-service understanding issue is not material.
Excludes generic training, communication or policy deficiencies that are not directly tied to emergency-service incident grading or response-time coordination.
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 England2
Association of Ambulance Chief Executives1
Department of Health and Social Care1
East Midlands Ambulance Service NHS Trust1
East of England Ambulance Service NHS Trust1
Essex Police1
HM Prison and Probation Service1
Independent Office for Police Conduct1
Isle of Wight NHS Trust1
Lancashire Constabulary1
Ministry of Justice1
Northumbria Police1
Nottinghamshire Healthcare NHS Foundation Trust1
Ofcom1
Recipient name withheld1
NHS trust5
Police force4
Executive non-departmental public body2
Ministerial department2
Economic regulator1
Executive agency1
Health-sector membership body1
Police oversight body1
Type not available1
Reports and published responses 8 reports
See individual reports that have raised this concern, and the actions taken in response
Teesside and Hartlepool
Concerns raised1
Lack of an immediate-response category for patients who require urgent ambulance attendance but do not meet Category 1 criteria
Linked response
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.1
NHS England
Implement national ambulance response standards to prioritise the sickest patients and provide appropriate responses.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
NHS England
Existing Category 1 and 2 ambulance categorisations are sufficient for effective triage and timely intervention for life-threatening and emergency conditions.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
NHS England
Development of 999 triage question sets and instructions is assigned to the approved triage system provider.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
NHS England
Whether call handlers stay on the line with deteriorating patients is an operational decision for each ambulance service.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Essex
Concerns raised1
Inconsistent ambulance response categorisation for Acute Behavioural Disturbance with active restraint
This report raised 6 other concerns. They are not shown here because they do not form part of this recurring concern.
Linked responses
Association of Ambulance Chief Executives
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.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Association of Ambulance Chief Executives
National ambulance response categories are determined by NHS England’s ECPAG, not by AACE.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Hampshire, Portsmouth and Southampton
Concerns raised1
Insufficient understanding of Category 1 response criteria for hanging incidents
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Linked response
Isle of Wight 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.3
Isle of Wight NHS Trust
Request national review of whether Category 1 disposition is appropriate for patients threatening to hang themselves.
Isle of Wight NHS Trust
Deliver mandatory refresher training and updated materials on suicidal-patient call management, escalation, response categories, information gathering, and risk assessment.
Isle of Wight NHS Trust
Continue working with national bodies to strengthen guidance and NHS Pathways for risks involving suicidal patients and potential hanging.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Isle of Wight NHS Trust
National NHS Pathways bodies are responsible for deciding whether Category 1 responses are appropriate for potential hanging incidents.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
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.
Surrey
Concerns raised1
Insufficient understanding between police and ambulance dispatch functions of each other’s triaging, dispatching processes and response times
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Linked responses
South East Coast Ambulance Service NHS Foundation Trust
Surrey Police
Stated actions An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.7
Surrey Police
Add NHS Pathways and response-time input from SECambs Clinical Operations to the online Mental Health training package.
Surrey Police
Train Contact Centre and Force Control Room staff on NHS Pathways, ambulance response categories, response times and surge arrangements.
Surrey Police
Conduct staff exchanges between Surrey Police and SECambs contact and dispatch functions.
South East Coast Ambulance Service NHS Foundation Trust
Prepare and distribute partner-organisation guidance on ambulance call categorisations and response targets.
South East Coast Ambulance Service NHS Foundation Trust
Create and disseminate guidance explaining the Surge Management Plan, call prioritisation, response targets, triggers and resulting actions.
South East Coast Ambulance Service NHS Foundation Trust
Notify police force control rooms by email when Surge Management Plan thresholds indicate substantial risk of missing target response times.
South East Coast Ambulance Service NHS Foundation Trust
Review the Surge Management Plan with the three local police forces to discuss joint actions and opportunities for closer control-room collaboration.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.3
South East Coast Ambulance Service NHS Foundation Trust
The first matter of concern concerns Surrey Police alone and is outside the respondent’s remit.
Outside remitThe respondent said that this matter was outside its role or authority.
South East Coast Ambulance Service NHS Foundation Trust
Existing EOC procedures and clinical oversight make staff knowledge of police dispatching processes sufficient for safe, appropriate functions.
Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
South East Coast Ambulance Service NHS Foundation Trust
Each police force is responsible for internally cascading the respondent’s ambulance processes and response information to relevant personnel.
Redirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Lancashire and Blackburn with Darwen
Concerns raised1
Deficiencies in initial grading of calls to identify initial responses
This report raised 10 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.
Lincolnshire
Concerns raised2
Failure to include time from the initial call to regrading in response-time measurement
Failure to meet response times
This report raised 2 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
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 Midlands Ambulance Service NHS Trust
Agree contract terms securing additional investment for clinical staff, ambulances and other response resources.
East Midlands Ambulance Service NHS Trust
Invest additional funding in clinical staff, ambulances and other resources to improve ambulance response times and consistency.
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.
Gateshead and South Tyneside
Concerns raised1
Lack of clear training and understanding of graded-incident response times
This report raised 9 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.
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.