One in three life-or-death 999 ambulance calls in some parts of England are not attended by a paramedic, NHS figures obtained by the Guardian reveal. The disclosure has prompted fears that seriously unwell or badly injured patients may receive inadequate care from a less-qualified member of ambulance staff lacking a paramedic’s skills. Healthwatch, the health and social care services watchdog, voiced concern that patients were facing a “postcode lottery” in their chances of being treated by a paramedic. The situation is being blamed on staff shortages across NHS ambulance services. Daisy Cooper, the Liberal Democrat health spokesperson, said: “When you call 999 in a life-or-death situation you expect a rapid response from a fully qualified paramedic, so many people will be shocked to learn that this isn’t always the case. “It’s deeply worrying that the NHS staffing crisis has reached such a point that people cannot even be certain that a fully trained paramedic will be able to attend life-threatening emergencies. In times of need, patients shouldn’t be left wondering if the person treating them has the skills to do so.” NHS ambulance trusts in England said they often did or did not send a paramedic to attend a category 1 call, the most serious type of call that involve life-threatening emergencies such as someone having collapsed, stopped breathing or gone into cardiac arrest. The East Midlands ambulance service said paramedics attended 105,325 of the 155,239 category 1 calls it had during 2022-23 – just 68% of the total. In the other 49,914 calls – which represents 32% of the total – someone other than a paramedic arrived to help. That 32% was the highest proportion of life-or-death calls not attended by a paramedic. Two other ambulance services do not send a paramedic to a significant minority of category 1 calls, freedom of information requests showed. In 2022-23 the Yorkshire ambulance service did that with 20% of its most critical calls – double the 10.5% seen just two years earlier. And the South Western ambulance service used another type of resource than a paramedic to attend 11,396 category 1 calls last year – 9.4% of the total and almost double the number in 2020-21. Emergency medical technicians (EMTs) and emergency care assistants, both of which have clinical skills but are not qualified paramedics, are thought to attend most of the calls that paramedics do not. The union Unison, which represents thousands of ambulance staff, warned that patients could be harmed if the NHS-wide lack of paramedics led to EMTs and others having to deal with emergencies. “Paramedic shortages mustn’t be used to justify staff continually working beyond their clinical competency. Ultimately patients will suffer,” said Sara Gorton, Unison’s head of health. “The huge pressures facing ambulance services are well recognised, but these figures are alarming.” The College of Paramedics, which represents the profession, said paramedics should always attend a medical emergency to ensure that patients get the best care and lives are saved. First responders, usually volunteers who have received training in first aid and potentially life-saving skills, can play a role in helping patients before an ambulance arrives, it said. A spokesperson added: “However, the college would expect arrangements to be in place for paramedics to be able to attend to all those emergency calls and therefore patients where the paramedics’ knowledge, skills and competence will provide the patient with the best outcome. “Category 1 and category 2 calls represent the most critically and severely ill patients where a timely and high-quality clinical intervention is required. “Paramedics can provide this high-quality care to patients to save lives and prevent deterioration.” Large and rising numbers of category 2 incidents – which include suspected heart attacks and strokes – are also not attended by a paramedic, the ambulance trusts’ figures also showed. For example, last year 36% % of category 2 calls answered by the East Midlands ambulance service did not involve a paramedic – again the highest proportion in England. It did send a paramedic to 318,200 of the 475,488 such calls it attended but not the other 157,288. Similarly, 28% of the category 2 calls answered by the Yorkshire ambulance service did not involve a paramedic. It was the same for one in six or one in seven such calls which the South East Coast ambulance service (17.8%), South Coast ambulance service (17.3%), South Western ambulance service (17.1%), East of England ambulance service (15.6%) and London ambulance services (15.4%) attended. Louise Ansari, Healthwatch’s chief executive, said: “These figures are likely to be of concern for patients, especially as they show a ‘postcode lottery’ when it comes to the level of fully trained paramedics attending category 1 and 2 calls.” She urged NHS England and the Department of Health to monitor the impact of someone other than a paramedic attending such calls may have “on patient experience, safety or health outcomes... [and] ensure there is transparency on the level of care being provided for the most serious ambulance callouts”. Nine of England’s 11 regional ambulance services provided the data, which they routinely collect, to the Guardian. However, the North East and Isle of Wight services, and those covering Scotland, Wales and Northern Ireland did not. Martin Flaherty, the managing director of the Association of Ambulance Chief Executives, denied that patient safety was being compromised by paramedics not attending 999 calls. “AACE has no particular patient safety concerns around this data and our committed, mixed crews attend thousands of incidents every day, saving many lives, with the support of paramedics and specialists always available,” he said. “This data reflects how ambulance services across the UK have different response models, each utilising different staff mixes made up of highly skilled ambulance crews formed of paramedics, emergency medical technicians, emergency care assistants, ambulance support crews and volunteers. “The most important aspect of responding to any life-threatening emergency is to get a clinician, and the life-saving equipment on board our vehicles, to the patient as quickly as possible so they can deliver life-saving interventions such as defibrillation. This does not always require a paramedic,” Flaherty added. An NHS spokesperson said: “This misleading story fails to account for the fact that while most ambulance call outs will be attended by a fully qualified paramedic, there will be occasions where other dedicated healthcare professionals such as a doctor will arrive instead, so a patient can be promptly treated at the scene – this happens in health systems around the world. “Thanks to hardworking staff, waiting times for ambulances has reduced for three consecutive months and are now 10 minutes quicker than a year ago, even as the NHS faced record levels of demand over summer.”