Demand and activity
Data for July shows a national ambulance service in high demand in the middle of summer. The ambulance service answered over 822,000 calls in July, 22,000 more than the previous month.
Ambulance demand for life-threatening injuries and illnesses (category 1) has been unwaveringly high, with record levels of demand observed so far this year. In July, there were 80,400 ambulance category 1 incidents, 1.1% higher than last month and 6.2% higher than July 2023. To give a sense of the increase in demand, the month average from January to July in 2019 was 58,000, compared to an average of 79,650 category 1 incidents each month in 2024. This is a 37% increase of the most serious calls the ambulance service receives, which are prioritised over other types of calls.
Demand for category 2 calls also increased in July, reaching 389,250, an additional 12,000 calls since the previous month. This figure is 2.6% greater than a year ago but 1.4% lower compared to pre-pandemic levels, showing how service demand increase is proportionally much greater for category 1 calls.
In some parts of the country, ambulance trusts also provide NHS 111 services – an NHS touchpoint for the public to get help for symptoms and to be directed to the most appropriate service. The latest available data for June shows an average of 55,000 calls answered each day. This level of demand is down 7.2% on the previous month but is 8.5% greater than a year ago and 26.5% more than pre-pandemic, once again demonstrating the additional pressure on call handlers and crews across 111 and 999 services.
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, existing targets have been further out of reach. That said, there was a slight improvement in response times nationally in July.
The average response time for category 1 calls was 8 minutes 15 seconds, a six-second improvement, though missing the target. One ambulance trust met the target, with an average response time of 6 minutes 41 seconds. The remaining 10 services missed the target, with the four longest average response times exceeding nine minutes.
Ambulance response times for category 1 incidents
The average response time for category 2 incidents was 33 minutes and 25 seconds, an improvement of 1 minute and 13 seconds, but still missing the 30-minute target. The improvement is positive, with four ambulance trusts meeting the 30-minute target. The longest average response time reached 40 minutes for one trust, a five-minute improvement on the slowest mean response time last month by a different trust, showing a reduction in trust variation.
Patient flow
Patient handover time from ambulance to hospital is an indicator of wider system pressures. In July there were nearly 420,000 handovers. For most handovers, the time was recorded, and the average time nationally was 30 minutes and 56 seconds. However, there’s significant variation country-wide, with one ambulance trust reporting a mean time of 18 minutes and 49 seconds and the longest mean time at 51 minutes and 3 seconds.
All ambulance trusts are working hard with acute trusts and other health and care system partners to reduce handover delays and improve average response times, in the face of record high demand and a changing context for the ambulance sector.
The unrelenting and sustained high level of demand is a stark mismatch to current levels of fleet, workforce and funding. This ongoing and challenging context suggests that the underlying causes of current ambulance performance should be explored as part of the Lord Darzi investigation and in the development of the 10-year health plan.