The London Ambulance Service (LAS) moved to its highest level of escalation, REAP 4, in the week beginning 25 November 2024 as a result of increased demand on its 999 service1. The Trust said Monday 25 November saw more than 7,000 calls into its 999 services, a number it says is usually only seen on New Year's Eve1.
Call volumes have risen by almost 10 per cent and now hover around 6,000 a day, similar to the pressure seen in winter 2020, according to the Trust1. In October alone, LAS received 650 more 999 calls a day than in the same month in 20231. The Trust attributes the recent spike to the combined impact of wintry temperatures and rising rates of viral infections and respiratory illnesses, and says these are expected to rise further in the weeks ahead1.
Alongside the escalation, LAS set out a 999 Winter Plan for 2024, developed with NHS system partners including integrated care boards and the capital's hospitals1. The measures it lists are:
| Measure | Detail given by LAS |
|---|---|
| More ambulances and control room staff | Numbers up by more than 10 per cent throughout the week, with up to 60 additional ambulances on the road at peak times |
| More clinicians to "hear and treat" | Expert medical assessment and advice over the phone to reduce unnecessary A&E attendance wherever possible |
| Other forms of care | Smoother access into local non-A&E services and more use of specialist mental health cars and community response cars, which pair paramedics with nurses to reach vulnerable people |
| Pan-London coordination | A special control centre at LAS to monitor emerging issues and work with NHS partners |
| Protocols for times of pressure | Pan-London protocols so all parts of the system understand their role and prioritise essential actions for the sickest patients |
"As a result of this increase in demand, the Trust this week moved to its highest level of escalation (REAP 4)."
Pauline Cranmer, LAS Chief Paramedic, said winter is always a tough and busy time for the NHS and for many people in the city, and that the service would do everything it can to ensure patients get the right care1. She said the service was going into the winter with "the clearest plan we have ever had", created in partnership across the NHS1.
Why it matters for households
The escalation applies to ambulance demand across the capital, and the Trust says pressure is expected to increase further in the weeks ahead1. LAS asks Londoners to use 999 only for serious medical emergencies so clinicians can prioritise the most seriously ill and injured patients1. It says NHS 111 online should be the first port of call for anyone unsure what to do or unsure whether to go to A&E, with 111 by phone if online access is not possible1. It also points to urgent treatment centres, also known as walk-in centres or minor injury units, for conditions including sprains, suspected broken limbs, cuts and grazes and minor scalds and burns1. NHS London Medical Director Dr Chris Streather said people are encouraged to use NHS 111, pharmacies or their GP in the first instance for urgent care that is not a serious medical emergency1.
Cranmer urged Londoners to look after themselves, their families, friends and neighbours this winter1. She encouraged those who are eligible to have their flu and COVID-19 vaccinations, and urged people to stay warm, take their medications and seek medical help if needed without ignoring symptoms1. She also asked the public to drink responsibly, plan their journeys home at night and look after their friends1. The Trust notes that many of the patients its crews attend are struggling financially, with loneliness and with long-term conditions1. Households can read more in the health emergencies hub.
What happens next
No date has been reported for when the REAP 4 escalation will end or be reviewed. LAS says the winter plan measures, including additional ambulances at peak times and extra control room staff, are in place for the winter period, and that call volumes are expected to rise further in the weeks ahead1.
