Are ambulances getting there in time?

England's ambulance services operate under two key targets: Category 1 calls — immediately life-threatening emergencies including cardiac arrests — should receive a response within 7 minutes on average. Category 2 calls, covering strokes and heart attacks, carry an 18-minute target. Both are being missed.^[1] Category 2 response times deteriorated from 18 minutes in 2017 to 48 minutes at their worst in 2022, before partial recovery to 38.6 minutes in 2024.^[1] For a stroke patient, 1.9 million neurons are lost for each minute without treatment — a 38-minute average means many patients routinely wait an hour or more. The primary structural cause is ambulance handover delays: over 1.8 million crew-hours were lost to queuing outside A&E departments in 2022/23 alone.^[1]

Performance variation between trusts is severe. The best-performing trust achieved a Category 1 average of 7.1 minutes in 2024; the worst reached 12.3 minutes — nearly double the target.^[1] Rural ambulance services are disproportionately affected: geography means a crew trapped at a distant hospital for hours can leave hundreds of square miles without emergency cover. The national average conceals a postcode lottery in emergency care that is, by definition, life-or-death. NHS England's ambulance recovery plan, launched in 2023, combined hospital discharge acceleration with additional call-handling capacity.^[2] Cat 2 times have improved but remain more than twice the target, and the underlying constraints — social care capacity, A&E crowding, workforce vacancies — have not been structurally resolved.