• Emergency medical service
• quality indicators, healthcare
• standards
• health policy
• evidence-based practice
• audit
• emergency ambulance systems
• management
• quality assurance

In 2005 the UK Department of Health published ‘Taking healthcare to the patient: transforming NHS ambulance services’.1 This insightful and imaginative report was intended to deliver ambulance services fit for the 21st century. It made 70 recommendations, most of which gave particular focus to addressing the (currently unmet) needs of the majority of users of the 999 service, up to 80% of which have a non-life threatening or even a non-urgent clinical condition. One of the report's recommendations, which was unrelated to patients with non-urgent unscheduled care needs, has since however dominated the attention of ambulance service managers to such an extent that it has had a negative impact on progress in most other areas.

In accordance with this recommendation, in 2008 a new definition for the key Department of Health performance measure of ambulance response times was introduced. Previously the ‘clock-start’ for measuring response times occurred when a patient's chief complaint had been confirmed: this was now moved back to the point at which the telephone call was received in the ambulance dispatch centre—hence the title ‘Call Connect’ for this policy revision.2 Consequently, responding emergency vehicles now have, on average, a 90 s reduction in the time available for them to drive to a patient within the otherwise unchanged 7 min and 59 s target. The premise of ‘Call Connect’ is based on the view that achieving this revised 8 min target will make ‘… a real difference to patients and the way we deliver patient care’, and has been publicised as a great advance in ambulance service delivery.2 It builds on previous technical analyses of how to measure call times accurately and to present …