Following Lord Carter’s 2016 review into acute trusts, the ambulance sector requested a similar review to define what “good” looks like and to identify opportunities to improve quality, consistency and operational performance.

The recommendations continue to align with national guidance. The 10 Year Health Plan emphasises more integrated urgent care, better patient flow and improved system coordination, while the Medium Term Planning Framework reinforces effective use of resources and reduced unwarranted variation. The review also supports ongoing fleet modernisation, including the transition to zero-emission ambulances and the need for reliable electric vehicle charging infrastructure.

The report makes 9 recommendations to improve patient care, strengthen operational resilience and support frontline staff. It highlights the value of improved telephone triage, increased hear-and-treat and see-and-treat where appropriate, and ensuring patients are directed to the right care first time.

These principles remain central to NHS priorities, including:

• improving ambulance response times and reducing handover delays (Urgent and Emergency Care Plan 2025/26)
• strengthening integrated urgent care and digital support (10 Year Health Plan)
• improving productivity, fleet utilisation and consistency across systems (Medium Term Planning Framework 2025)
• transitioning to a fully zero-emission ambulance fleet supported by dependable charging infrastructure (Net Zero Travel and Transport Strategy 2023)

The review’s focus remains fundamental to modern ambulance service design: improving the quality and timeliness of care, supporting staff and ensuring emergency vehicles are available when and where they are needed.

‘Too many patients are being unnecessarily taken to ED by ambulances, putting further pressure on hospital services that are already on the back foot. Not only is this financially costly, but it takes up staff’s time and means patients are having to spend time waiting in ED when they should be recovering at home.

An ambulance is not a taxi to ED. Modern technology means that patients can often be treated at the scene. But an ageing ambulance fleet means that this is not always possible.

Paramedics and other staff have worked incredibly hard as demand for ambulances has soared. It is now vital that improvements are made in the infrastructure of the wider NHS to help frontline staff work as efficiently as possible.’

Lord Carter, a non-executive director at NHS Improvement and author of the report

‘We welcome Lord Carter’s report, which emphasises the adoption of new technology and innovation within the ambulance service as a key driver for reducing conveyance rates to hospitals. Whilst we accept there are variabilities in the numbers of patients conveyed to EDs in each region, this is often driven by local geography, patient demographics and the availability of clinically appropriate referral pathways.’

Martin Flaherty OBE, Managing Director of the Association of Ambulance Chief Executives