Safely Reducing Avoidable Conveyance Programme

The NHS Long Term Plan (LTP) includes the ambition to deliver the opportunities for safe reductions in avoidable conveyance of patients to hospital emergency departments (ED).

Safe reduction in avoidable conveyance is a system-wide responsibility and challenge; it cannot be achieved by ambulance services working in isolation.

NHS England is working with lead commissioners, ambulance services and STPs/ICSs to develop and implement plans to safely reduce avoidable conveyance by 2023.

The NHSE Safely Reducing Avoidable Conveyance Programme aims to support STPs and ICSs by sharing models of response and alternative care pathways (ACPs) that can safely reduce the number of patients being unnecessarily taken to emergency departments.

Examples of where such initiatives are being introduced or are already working well are being monitored, evaluated and shared through this programme and will soon be accessed through our central repository.

NHS Long Term Plan


Ambulance services are at the heart of the urgent and emergency care system. We will work with commissioners to put in place timely responses so patients can be treated by skilled paramedics at home or in a more appropriate setting outside of hospital.

We will implement the recommendations from Lord Carter’s recent report on operational productivity and performance in ambulance trusts, ensuring that ambulance services are able to offer the most clinically and operationally effective response.

NHS Long Term Plan

Lord Carter Review of ambulance productivity:

“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… 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

Reducing avoidable conveyance could save £300 million across the wider health system by treating these patients at home or directing them to more appropriate health services. This requires significant improvements in the availability and accessibility of the urgent and emergency care system.

Delivering the best outcome for patients and helping them stay at home can be achieved by reducing avoidable conveyance and will also enable productivity improvements.

Ambulance trusts and CCGs must work together to co-design the system and develop effective pathways for urgent and emergency care. This includes integrated 999 and NHS 111 call handling and triage to ensure that the impact of decisions in local areas considers the effect on ambulance services. Through this collaborative approach trusts will be able to manage demand more appropriately and reduce avoidable conveyance to A&E.

Lord Carter Review of ambulance productivity

From Transport to Treatment with NEAS

In 2018/19 ambulance trust in England received over 11 million 999 calls.

8.4 million patients received a response from the ambulance service after dialling 999 or being transferred from 111. Of these:


Of the incidents dealt with:

7.89m (94%)
received a face-to-face response

4.96m (56%)
of patients were conveyed to an ED

2.5m (29%)
were seen and either discharged or referred to another clinician/specialist team (See & Treat)

509,000 (6.1%)
were managed over the phone (Hear & Treat)

456,000 (5.4%)
were conveyed to care destination other than an ED