Demand and activity
After the busiest summer and September on record, data for October shows high levels of demand for the ambulance service as we approach the winter months, with nearly 874,600 calls answered. There was a total of 759,000 incidents recorded, with 49.9% being conveyed to an emergency department and 29.2% receiving a ‘see and treat’ intervention, reflecting the ongoing pressures on emergency response systems.
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 October 2024, there were 84,100 category 1 incidents, 8.3% more than in September. This is 1.4% higher (1,150 more incidents) than the same time last year but 36.6% greater than five years ago, before the pandemic, showing a staggering increase of the most serious 999 calls the ambulance service receives.
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 including sepsis, major burns, heart attacks, and strokes. There were 397,800 category 2 incidents recorded in October, an increase of 6.3% compared to the previous month. While this figure is 1.1% higher than the same month last year, it has fallen by 2.7% compared to pre-pandemic levels, indicating that service demand increase for category 1 incidents is proportionally much greater.
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 September 2024, NHS 111 services continued to play a vital role in supporting the public’s healthcare needs, including physical and mental health concerns. With seasonal pressures approaching, it is likely that the service will see growing demand in the coming months.
The latest available data for September shows that 1.49 million calls were received by NHS 111, equating to 49,800 calls received per day in September. Of these, 1.42 million calls were answered. This level of demand is down 1.3% compared to the previous month and down 0.6% compared to a year ago. However, this figure is 23.1% greater than pre-pandemic levels.
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, NHSE 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, existing targets have been further out of reach.
The ambulance sector saw a deterioration in average response times for both call categories in October, recording their highest monthly averages of 2024 to date. For category 1 incidents, the average response time reached 8 minutes 38 seconds, exceeding the national target of seven minutes and marking the most challenging month for category 1 response times so far this year.
Figure 4
Ambulance response times for category 2 incidents
After meeting the 30-minute target for the first time this year in August 2024, response times for category 2 incidents have deteriorated over the last two months. The average response time in October reached 42 minutes 15 seconds, indicating an increase in demand for category 2 incidents. None of the regions met 30-minute category 2 target this month. However, one trust came close to meeting the 30-minute target with an average response time of 30 minutes and 9 seconds. Seven out of the 11 ambulance trusts had response times of between 30 and 40 minutes, and four trusts had response times of between 40 and 60 minutes.
Patient flow
Patient handover time from ambulance to hospital is an indicator of wider system pressures. There was a total of 418,300 ambulance handovers in October 2024. Reflecting the overall upward trend in activity and increase in demand, there were 4.3% more handovers compared to the previous month. Nationally, of the number of handovers where the time is known, 70.4% took longer than 15 minutes, 34.2% were over 30 minutes and 14.3% were over 60 minutes.
In October, the average handover time across England was 40 minutes and 21 seconds, almost matching the average response time for category 2 calls during the same period. Wide regional variations persist, with seven ambulance trusts reporting a mean handover time of over 30 minutes, with the longest average time reported for two trusts exceeding 1 hour. The shortest average handover time was 19 minutes and 59 seconds.
The extreme pressure on the ambulance sector is a growing concern as the seasonal challenges set in, especially with the recent cold snap that has swept across England. As winter approaches, there is often a rise in emergency calls for respiratory problems, falls, and other weather-related incidents. The ambulance sector will be working closely with acute trusts and other health and care system partners to manage the increased demand and mitigate the impacts of seasonal pressures to ensure timely handover of patients.