Demand and activity
Data for August shows that although demand for the ambulance service was slightly down compared to July, it was still an extremely busy month with nearly 754,000 calls answered. There was a total of 731,000 incidents recorded with 50.8% being conveyed to an emergency department and 29.6% 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, needing immediate intervention and/or resuscitation such as a cardiac or respiratory arrest. In August, there were 8.5% fewer ambulance category 1 incidents than in July, reaching 73,360. This is a similar level to the same time last year but 30% greater than five years ago before the pandemic, a significant increase of the most serious 999 calls the ambulance service receives.
Category 2 incidents accounts 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 370,341 category 2 incidents recorded in August, a decrease of 4.9% compared to the previous month. Demand for category 2 incidents fell by 1.8% compared to a year ago and by 3.4% compared to pre-pandemic levels.
In some parts of the country, ambulance trusts also provide NHS 111 services – an NHS service which helps the public identify where to seek medical help and check symptoms. In the last few weeks, NHS 111 has begun delivering 24/7 mental health crisis support to the public. Local teams of call handlers with mental health training, alongside nurses and clinicians are available. It is likely that over the coming months, the NHS 111 data may show an increase in activity.
The latest available data for July shows that 1.63 million calls were received by NHS 111, equating to 52,500 calls received per day in July. Of these, 1.53 million calls were answered.
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.
However, in August the ambulance sector delivered improvements and exceeded the revised average response time standard for category 2. The sector reduced the mean response time by six minutes reaching 27 minutes and 25 seconds. Six ambulance trusts recorded average response times under 30 minutes, with the West Midlands reducing its average to 18 minutes and 36 seconds, nearly reaching the original standard of 18 minutes.
The improvement in response times is positive with more ambulance trusts meeting the 30 minute target than last month and progress being made across the country.
Ambulance response times for category 2 incidents
The average response time across England for category 1 incidents was 8 minutes 3 seconds, an improvement of 12 seconds but missing the seven-minute target. This month two trusts met the target, including London Ambulance Service hitting seven minutes exactly, a significant achievement as the busiest service accounting for 17% of all category 1 incidents. This month, the number of trusts exceeding a nine-minute average response time, halved from four to two.
Patient flow
There was a total of 410,110 ambulance handovers in August 2024. Unsurprisingly, following the downward trend in activity, there were 1.8% fewer handovers compared to the previous month. Nationally, of the number of handovers where the time is known, 63.6% were more than 15 minutes, 23.7% were over 30 minutes and 7.0% were over 60 minutes.
The average time recorded nationally was 27 minutes and 16 seconds. In August, on average, patients waited the same amount of time to be handed over to hospital as they did for an ambulance crew following a category 2 call. There's significant variation country-wide, with three ambulance trusts reporting a mean handover time of over 30 minutes, with the longest average time exceeding 40 minutes. The lowest average handover time was 17 minutes and 49 seconds.
Reducing handover delays is essential to free up crews and vehicles to get back out into the community attending calls. All ambulance trusts are working hard with acute trusts and other health and care system partners to reduce handover delays. This indicator, a metric for patient flow around the wider system, will be a central focus for national stakeholders this winter.