Demand and activity
As winter draws closer, November 2024 saw continued pressure on the ambulance service, with 860,543 calls to 999 answered. This equates to over 28,700 per day, increasing from 28,200 calls per day in October. There were a total of 752,361 incidents recorded, with 49.7% being conveyed to an emergency department and 29.1% receiving a 'see and treat' intervention.
The ambulance service script helps call handlers determine how to classify calls. Calls are recorded as category 1 when a person is in a life-threatening condition, needing immediate intervention and/or resuscitation such as a cardiac or respiratory arrest. In November, there were 84,270 category 1 incidents, similar to the previous month. This is 6.3% higher compared to the same time last year and 33.3% greater than five years ago before the pandemic.
Category 2 incidents account for the greatest proportion of ambulance activity. This category of calls is still classed as an emergency or a potentially serious condition and includes sepsis, major burns, heart attacks, and strokes. There were 395,741 category 2 incidents recorded in November, a small decrease of 0.5% compared to the previous month. Demand for category 2 incidents has increased by 3.4% compared to a year ago but has fallen by 5.2% compared to pre-pandemic levels suggesting that the acuity of the demand has increased with more category 1 calls.
In some parts of the country, ambulance trusts also provide NHS 111 services – an NHS service which acts as a first point of contact for many, helping the public identify where to seek medical help and check symptoms. In October 2024, NHS 111 services continued to play a vital role in supporting the public’s healthcare needs, including physical and mental health concerns.
The latest available data for October shows that 1.64 million calls were received by NHS 111, equating to 52,758 calls per day. Of these, 1.55 million calls were answered. This level of demand is up by 9% compared to the previous month and is similar to levels seen last year. However, this figure is 25.8% greater than pre-pandemic levels, once again highlighting the additional pressure on call handlers and crews across the ambulance service.
Response times
The national ambulance response time targets are seven minutes for category 1 incidents and 18 minutes for category 2 incidents. As part of the plan to recover urgent and emergency care, NHS England adjusted the category 2 target to 30 minutes.
For much of 2019, the ambulance service met, or thereabouts, the national average response times. With significant changes in demand following the Covid-19 pandemic, particularly for category 1, targets have been further out of reach.
After the longest average response times seen so far this year in October 2024, the ambulance sector continued to face significant pressure this month, with average response times for both call categories at a record high for 2024 in November. For category 1 incidents, the average response time remained at 8 minutes 38 seconds. None of the regions met the 7-minute category 1 target this month, with the five longest average response times exceeding nine minutes. This sustained level of pressure demonstrates ongoing challenges despite measures aimed at improving emergency service performance amid rising seasonal demand.
FIGURE 4
Ambulance response times for category 1 incidents
In November, the average response time for category 2 incidents rose slightly to 42 minutes 26 seconds. Three trusts met the 30-minute category 2 target this month (Isle of Wight; the North East; the South-East Coast). This is an improvement from last month, where none of the trusts met the target.
Patient flow
Patient handover time from ambulance to hospital is an indicator of wider system pressures. There were a total of 413,240 ambulance handovers in November 2024, which is 5,103 fewer handovers compared to the previous month. Nationally, 69.5% of handovers took longer than 15 minutes, 33% exceeded 30 minutes and 13.5% were over 60 minutes.
In November, the average handover time across England was 38 minutes and 54 seconds, which is an improvement of 1 minute 27 seconds from last month. That said, wide regional variations continue to persist, with five out of 11 ambulance trusts reporting a mean handover time of over 30 minutes, and the longest average time reported for two trusts exceeding 1 hour. These figures highlight ongoing system challenges, including hospital capacity limits and delayed patient discharges. However, small improvements have been made with decreases in the proportion of the longest waits for handovers.
The continued spike in call numbers is likely due to the combined impact of cold temperatures, rising rates of respiratory illnesses and viral infections. As we move into winter, 999 call volumes are expected to rise in the weeks ahead. Ambulance services are urging the public to use alternative options such as NHS 111, GP services or pharmacies if they are not experiencing a serious medical emergency so that clinicians can prioritise responding to the most seriously ill and injured patients.