Richard Henderson,Chief Executive Officer (CEO) of the East Midlands Ambulance Service NHS Trust (EMAS) 

A 999 call in the East Midlands was answered, on average, in five seconds last September. Once a crew reached an emergency department, the average wait before a hospital clinician took over was 34 minutes and ten seconds. These two figures from the latest board report of East Midlands Ambulance Service describe the same pathway at opposite ends, and the distance between them accounts for much of the emergency care story in England this autumn.

That gap has taken on fresh significance as the NHS prepares for winter. On 8 October, the Health Service Journal reported that hospitals had repeatedly asked for a pause in the 45-minute ambulance handover limit, with EMAS not assured that the limit could be consistently maintained throughout winter. The discussion puts the focus on how ambulance services and hospitals can work together to protect emergency capacity during periods of sustained pressure. For EMAS chief executive Richard Henderson, the challenge is to build on the trust's operational strengths while supporting a consistent approach to handovers across the region. 

The trust controls the first end of that pathway and manages it well. The national standard for call answering is eight seconds. Vehicles were cleared and ready within 14 minutes and 57 seconds of handover, inside the 15 minute standard, and double-crewed ambulance hours came in 4.84 per cent above plan at 169,134 for the month. Rolling staff turnover of 6.36 per cent sits well inside a 10 per cent ceiling, in a sector where retention is a constant concern. Clinical indicators for August were encouraging too, with return of spontaneous circulation in cardiac arrest patients reaching hospital rising to 33.18 per cent and adherence to the heart attack care bundle improving to 88.1 per cent.

The picture is harder once the vehicle reaches the hospital door. In September, 13,350 ambulance hours were lost to handover delay, equal to nearly eight per cent of the double-crewed hours the trust delivered, and more than 74,300 hours have gone this financial year. Northampton General Hospital averaged almost 54 minutes per handover and accounted for 1,936 of the lost hours. At Lincoln County and Grimsby, around three in ten arrivals waited beyond 45 minutes, the maximum that national planning guidance has set.

Response times carry the consequence. Category 2 calls, which include suspected strokes and heart attacks, averaged 33 minutes and 59 seconds in September, up from 31 minutes and 52 seconds in August. The Medium Term Planning Framework asks for a 25 minute average in 2026/27, falling to 18 minutes by 2028/29, and national performance stood at just under 27 minutes in May. The East Midlands therefore has further to travel than the national average, and the Category 1 mean of 8 minutes and 41 seconds against a seven minute standard says the same.

That distance is also the reason for optimism, because the route to closing it is unusually plain. A trust that answers quickly and turns vehicles round promptly should be able to convert recovered hours into response capacity with little delay. Releasing even a fraction of those 13,350 hours puts crews back on the road without recruiting anyone.

The weight of that task falls on hospital executives and integrated care boards. Patient transport figures point the same way. Only 43 per cent of acute hospital discharge transfers were collected within two hours of the booked time, and 77 per cent within four hours against a 90 per cent benchmark. Delays at the back door of a hospital become delays at the front door, and the ambulance outside bears the cost.

The trust also holds a lever of its own. Hear and treat resolved 20.45 per cent of calls against a target of 22.5 per cent, and clinical staffing in the control room stood at 150 whole-time equivalents against an establishment of 158. Filling those posts offers a route to more calls resolved by telephone, and access to patient records at the point of dispatch would support clinicians in doing so. This is where health data and digital integration, so often discussed in the abstract, carry a measurable operational payoff, since every avoided conveyance is a handover that never has to be queued.

For NHS England and ministers, the East Midlands offers a useful test of where the next hour of management attention should go. An ambulance trust that has done its own homework on call handling, turnaround and staffing has earned hospitals that match it. If the 45 minute maximum holds at Northampton, Lincoln and Grimsby, the trust's record suggests it is ready to put every recovered hour to work.