• HSJ investigation for the first time reveals ambulance response times by CCG area
  • Isle of Wight has longest average waits
  • Many areas with long waits were rural, although other rural areas performed well

The local areas where patients are waiting the longest for ambulances have been publicly identified for the first time by an HSJ investigation.

HSJ found the sickest patients in seven clinical commissioning group areas had to wait an average of more than 10 minutes for an ambulance during spring and summer last year.

This is significantly longer than the seven-minute target for “category one” calls — where the patient is thought to have a life-threatening condition, such as a cardiac or respiratory arrest. In some areas, one in 10 patients who should have been seen within seven minutes had to wait over 21 minutes (see table below).

The slowest average response to a category one call was on the Isle of Wight, at 11:44 minutes.

The quickest average response time of 4:56 minutes was in Brighton and Hove CCG. Overall, 24 CCG areas had average response times to category one calls of below six minutes; these were overwhelmingly in urban areas.

Rural waits

Although ambulance providers publish trust-level data each month, the information HSJ obtained, by using the Freedom of Information Act, breaks down waiting times on a CCG level. This provides a more granular picture and exposes longer waits in certain, often rural, parts of the country. 

Some parts of Norfolk and Lincolnshire, as well as all of Shropshire, had long average waits. 

However, some very rural areas, such as Northumberland, had average response times of under 8 minutes, while two of the longest response times were in relatively well-populated areas of southern England.

High Weald and Lewes Havens CCG in East Sussex had the second slowest response time of 11:29 and South Kent Coast CCG — which covers Folkestone and Dover — had a response time of 9:56.

Calls in the East Berkshire CCG area responded to by South East Coast Ambulance Service Foundation Trust also had average response times of over 10 minutes. However, HSJ has disregarded these as there were only 38 such calls in the period studied, while most calls in the area were answered by South Central Ambulance Service FT with an average response time of under 7 minutes. 


Average responses times by ambulance trusts are published each month by NHS England, but are not broken down by CCG area. However, many CCGs ask for this level of detail of their ambulance providers.

It is not clear how the upcoming slew of CCG mergers in April will affect the data available. 

For example, all eight CCGs in Kent and Medway will merge to form a single CCG. HSJ’s figures show average response times across the area varied from 5:17 in Thanet to 9:56 in neighbouring South Kent Coast.

A Healthwatch England spokesman said: “We will continue to provide this local understanding of how services are working for people regardless of the level at which the NHS publishes its performance data.

“However, in an age where data is becoming increasingly important in the way we plan and scrutinise services, the NHS needs to think about how it makes information available to ensure transparency.”

He added patients always spoke highly of the emergency response they received from ambulance trusts, but said, where there was variation, it was important CCGs explained how this affected patient outcomes and experiences.

Long waits

HSJ’s data also looks at the longest 10 per cent of waiting times in each area. Shropshire performed worst, with 10 per cent of category one callers waiting 21:32 or longer. Isle of Wight had the second worst performance at 21:25.

Ambulance trusts pointed out the difficulties of providing quick responses in rural areas where ambulances had to travel further to reach patients, particularly where there were poor roads and traffic fluctuations caused by tourist or agricultural vehicles.

The Isle of Wight Trust, which runs the ambulance service, said it only had an average of five ambulances a day in active service on the island, which also support patient transfers to and from the mainland.

“The small scale of our service and the geography of the Isle of Wight are significant and unique challenges but we are working with South Central Ambulance Service FT to help us continue to improve,” it added.

SECAmb said: “We are commissioned to meet performance targets across a larger area than individual CCGs and it can be challenging to meet response time targets at a more local level especially in more rural areas where the volume of category one calls is typically lower.”

North West Ambulance Service Trust said community first responders played an important part in starting lifesaving treatment but did not “stop the clock” in terms of response times. It has also invested in public access defibrillators and had put more crew and staff into key areas.

Delays in hospital handovers could also affect the ability of services to respond quickly. In the East Midlands, significant increases in staff on the road were almost wiped out by hours lost at local hospitals.

The ambulance trust said, however, it was managing to respond quicker to category one calls than two years ago.

A West Midlands Ambulance Service FT spokesman said: “We know from research from our commissioners that to substantially improve our performance in rural areas, such as Shropshire, we would need to almost triple our workforce in those areas.” He added performance had improved recently.

East of England Ambulance Service Trust said it had increased its staffing numbers in north and south Norfolk, to ensure more vehicles were on the road.

The 10 CCG areas in which the slowest average responses were reported 

CCGResponse time mins: seconds

Isle of Wight


High Weald and Lewes Havens




South Lincolnshire


South Norfolk


North Norfolk


Lincolnshire East


West Lancashire


South Kent Coast


Fylde and Wyre



The 10 CCG areas in which the quickest average responses were reported

CCGResponse time mins: seconds 

Brighton and Hove




Nottingham City


Bradford City




Leicester City


North Durham


Sandwell and West Birmingham




Birmingham and Solihull


HSJ asked each ambulance trust for data, broken down by CCG area, for April to September 2019. This included both average response times and the performance at the 90th percentile. HSJ will run future articles looking at performance for category two and three calls.