NHSE admits ‘urgent’ ambulance target will be missed in capital

In a marked shift in emphasis, NHS England has signed up to a plan which will see London Ambulance Service Trust aim to deliver 35m 57s for category 2 calls, after the trust argued it is not being offered enough funding to meet the 30m national target.

HSJ understands some other ambulance trusts – a number of which have still to agree funding and performance targets with their commissioners – are making similar cases, including stressing they can only reach 30m if other parts of the NHS play their part, for example, through tackling hospital handover delays.

The change in tone from NHSE comes despite a commitment to 30m being included in this year’s planning guidance – and health and social care secretary Wes Streeting committing to meeting all ambulance targets by the end of this parliament. The actual target for category 2 responses is 18m, which has only ever been achieved at the height of the pandemic.

The 30m target was in place for 2023-24 but was missed, with the average performance being 36m 23s. It was then included in plans for 2024-25 but has been missed each month so far – although April came close with 30m 22s. Nationally, the performance in the first four months of this year was 32m 48s, very similar to last year.

At a trust level, the 30m target is being achieved some months by individual trusts but others are still recording averages of 40m or more. LAS is struggling on the category 2 target, which includes suspected strokes and heart attacks, but is generally a good performer on category 1 – the most immediately life-threatening cases, including cardiac and respiratory arrests.

Flat funding

Daniel Elkeles, chief executive at LAS, said: “We have seen continuous improvements in our category 2 performance compared to last year. This is despite seeing nearly a 10 per cent increase in 999 calls from April to August 2024 compared to the same time period last year.

“The level of funding that we have received this year from the integrated care systems and NHSE is essentially the same, once inflation is taken into account, which is why we agreed with NHSE and our commissioners a cat 2 trajectory for the year, that is a small improvement on what we achieved last year.”

Some ambulance trusts – South East Coast, South Central, North West, Yorkshire and North East – say they have agreed a plan with commissioners which should deliver a 30 minute or under response while East Midlands Ambulance Service and East of England are still in discussions with commissioners.

West Midlands – which has been achieving below 30m in recent months – is still in talks with NHS England and commissioners on its trajectory but had earlier said it needed more money to drive improvements. South Western plans to meet the 30m target but HSJ understands it will need continued improvement in hospital handovers to achieve this.

An NHSE spokesperson said: “Reducing ambulance response times is a priority for the NHS – we work closely with ambulance service commissioners and providers to identify realistic response times based on a range of factors including service pressures, resources, and demand.

“In 2023-24, category 2 response times across England were nearly 14 minutes lower than the previous year despite a six per cent rise in all incidents, and the NHS continues to face significant pressure, with accident and emergency experiencing their busiest June and July ever with 4.6 million attendances – so with winter approaching, realistic plans based on improving productivity across the system will help ensure services can meet patients’ needs.”