National health officials in England are considering a major reform of the ambulance response time targets, specifically for over half of all emergency 999 calls, according to the Health Service Journal. This push for change acknowledges that current, fixed-time targets no longer accurately reflect the complexities of modern urgent and emergency care (UEC) services and the varied clinical pathways ambulances now navigate.
The talks are a direct response to persistent delays, particularly for Category 2 calls—serious, but not immediately life-threatening emergencies like strokes, heart attacks, and sepsis. The traditional target for these calls is an 18-minute average response, a goal that is rarely met. The current NHS guidance sets an 18-minute average target for Category 2, contrasting with the seven-minute average for life-threatening Category 1 calls. In recognition of the challenges, NHS England introduced an interim objective of 30 minutes in 2023. However, even this softer target is routinely missed, with performance data for 2024/25 showing the average Category 2 response time was approximately 35 minutes.
Severe congestion in emergency departments, leading to frequent ambulance handover delays, is a major contributor to these rising delays. Handover delays tie up crews and vehicles, limiting their capacity to respond to new calls. Consequently, Category 2 response times have significantly increased, with some patients for conditions like heart attacks and strokes waiting up to an hour on average.
Officials believe that longstanding targets based on fixed time thresholds are losing their utility as emergency care evolves to include clinical triage, remote assessment, and alternative pathways, such as treating patients at home or in community teams. The discussions are therefore centred on new ways of defining performance that focus more on clinical outcomes and appropriate care pathways rather than simply the speed of arrival. This approach aligns with developments in other UK regions, such as Wales, which has already moved toward outcome-based measures. Advocates argue that rigid, clock-based targets can inadvertently encourage crews to prioritise rapid arrival over a more thorough clinical assessment or directing patients to alternative, potentially safer and more efficient care routes.
Future performance frameworks being explored may include clinical outcome-focused metrics instead of pure time thresholds, measures that incorporate triage and remote management, weighted targets based on case complexity and patient risk, and integration of digital triage tools and community urgent care metrics. This reform supports the broader Urgent and Emergency Care Plan, which promotes an integrated system with alternative care pathways to reduce unnecessary emergency department attendances.
While the move is supported by a desire for a more modern, clinically relevant system, it is not without controversy. Patient groups and some clinicians warn that removing or softening clear, time-based standards risks eroding public confidence and blurring accountability, as these targets have long served as a simple measure of performance. Health sector leaders stress that any target changes must be accompanied by significant investment in workforce, technology, and urgent care infrastructure; without addressing underlying capacity issues—such as staff shortfalls and handover delays—changes to the targets alone will likely have limited impact.
