On 1 February 2022, the House of Lords is due to consider the following question for short debate:

Baroness Barker (Liberal Democrat) to ask Her Majesty’s Government what assessment it has made of the current ambulance response times; and what action is being taken to reduce response times.

As health is a devolved matter this article relates to ambulance response times in England.

What are the current ambulance response targets?

Ambulance response times are measured from the time a 999 call is received to the time a vehicle arrives at a patient’s location. In 2017, NHS England introduced a new set of ambulance performance targets. The system uses four categories based on the severity of the patient’s injuries or illness. These range from life-threatening conditions (category 1) to non-urgent conditions (category 4). The response time targets are set out in the ‘Handbook to the NHS Constitution for England’. The table below summarises the four categories and their response time targets.

Table 1. NHS emergency call categories and ambulance response time targets

Category Example injuries/illness Response target
Category 1: Life-threatening Cardiac arrest
Severe allergic reaction
7 minutes on average, and 90% of calls in 15 minutes
Category 2: Emergency Stroke
Severe burns
18 minutes on average, and 90% of calls in 40 minutes
Category 3: Urgent Late stages of labour
Non-severe burns
90% of calls in 120 minutes
Category 4: Non-urgent Diarrhoea
90% of calls in 180 minutes

Source: NHS England, ‘Ambulance response programme’, accessed 19 January 2022; Department of Health and Social Care, ‘Handbook to the NHS Constitution for England’, 15 November 2021

Response time statistics

The graph below shows the average (mean) ambulance response times for category 1 incidents recorded between August 2017 and December 2021.

Between 2017 and 2019, average response times at first declined towards and then remained stable at approximately the 7 minutes target. In March 2020, at the start of the Covid-19 outbreak in the UK, there was then an increase in response times to over 8 minutes. This was followed by an improvement in response times between April and July 2020. The Nuffield Trust has noted this later improvement correlates with a general reduction in the number of calls being made at this time, and may also have been caused by a reduction in road traffic and other emergencies due to the lockdown.

Since the summer of 2021 response times have increased and both the average and 90th percentile targets have been missed. In December 2021, the average response time was 9 minutes 13 seconds and the 90th percentile average was 16 minutes 12 seconds.

Figure 1. Category 1 ambulance response times (mins): average (mean) and 90th percentile, 2017–2021

Figure 1. Category 1 ambulance response times (mins): average (mean) and 90th percentile, 2017–2021

Source: NHS England, ‘Ambulance Quality Indicators: AmbSYS Time Series to December 2021’, 13 January 2022

Response times for the same period for categories 2 to 4 show a similar trend to the category 1 data. Full details can be found in the NHS’s January 2022 ‘Ambulance Quality Indicators’ statistical note.

In December 2021, the average response time for category 2 emergencies was 53 minutes 21 seconds—almost three times the 18 minutes target. The category 2 90th percentile average was almost 2 hours, the longest ever recorded.

What is the Government doing to improve response times?

The Government has said it is taking a range of actions to reduce ambulance response times. On 1 December 2021, Parliamentary Under Secretary of State at the Department of Health and Social Care Lord Kamall said the following in the House of Lords in response to an oral question on the subject:

A £55 million investment by NHS England and NHS Improvement will provide 700 additional staff in control rooms and on the front line to improve response times. This is alongside £4.4 million to keep an additional 154 ambulances on the road this winter. NHS 111 is recruiting an additional 1,100 staff, alongside a £250 million winter GP capacity fund to avoid unnecessary ambulance calls and visits to A&E.

NHS England announced the £55m of additional funding to improve response times in July 2021. It said the money would be shared by NHS trusts “based on the number of patients they serve locally”. Trusts would be given discretion in how best to use the funding to increase staff numbers, such as by “offering part-time workers full-time roles, recruiting extra call handlers or offering staff incentives to help with retention”.

The Labour Party has called on the Government to do more to alleviate the increasing response times, including “drawing on support from the armed services if necessary”.

Members of the armed forces have been deployed to alleviate ambulance staff shortages related to Covid-19. In answer to a parliamentary question on the subject, the Ministry of Defence said that as of 10 January 2022, “543 personnel, the majority of whom are drivers”, were providing support to ambulance services in response to driver shortages in England, Scotland and Wales.

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Cover image by Ian Taylor on Unsplash.