Association of Ambulance Chief Executives and All England Ambulance Services - Ambulance services and emergency department capacity

Response to the House of Lords, Parliamentary Committee Call for Evidence (AMB0002)

The Association of Ambulance Chief Executives (AACE)

AACE is the membership body for all UK NHS ambulance services in England, Scotland, Wales, Northern Ireland, plus the Republic of Ireland. This response reflects the collective experience of English NHS ambulance trusts.

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• View how ambulance services contribute across all levels of health systems, and what is needed to support successful integration across urgent and emergency care
• Read our response to the Fit for the Future: 10-year health plan, and the vision for the ambulance sector

Summary

English ambulance services are under severe and growing pressure. Answering around 27,000 999 calls per day - a figure rising year on year - March 2026 recorded the highest ever Category 2 daily volume for that month. Demand is driven by an ageing population, rising comorbidities, mental health and frailty presentations, gaps in primary and community care, and seasonal pressures.

Ambulance and ED performance are structurally interdependent. Around 49% of incidents result in conveyance to ED, and when hospital flow stalls, handover delays remove ambulances from the operational fleet. The national mean handover time in March 2026 was 26 minutes against a 15-minute standard, with over 20,000 patients estimated at risk of harm from delays exceeding one hour. The number of Preventing Future Deaths reports from coroners citing ambulance delays has risen, with 18 already received in 2026 alone.

Evidence demonstrates that ambulance conveyance to ED is largely appropriate. The realistic scope for reduction lies within specific cohorts - frail older people, falls, mental health, end-of-life and care home residents - and is already being realised through care closer to home initiatives. Hear and treat volumes have more than doubled since 2021. Multi-disciplinary clinical hubs bring together paramedics, GPs, mental health nurses and palliative care nurses to navigate patients to appropriate out-of-hospital care at neighbourhood level. Mental health co-response vehicles reduce inappropriate ED conveyance for patients in crisis. Specialist and Advanced Paramedic Practitioners, including independent prescribers, enable more patients to be safely treated at home or referred into community services. Diagnostics brought to the patient, including mobile X-ray and point-of-care blood testing, extend the conditions manageable without hospital attendance. Virtual ward integration and video-enabled clinical consultation further strengthen community-based decision-making. Realising the full potential of these models depends on consistent commissioning, trusted assessor referral rights for paramedics, and genuine availability of alternative pathways.

Current NHS structures impede progress. Block contracts do not incentivise non-conveyance, the lead commissioner model lacks delegated authority, and annual funding settlements prevent strategic planning.

AACE calls for integrated 999/111 services at regional level with multi-disciplinary care -coordination hubs; a shift to outcome-based performance frameworks; handover accountability within the National Oversight Framework; and multi-year funding settlements to support innovation and sustain the community-based ambulance care models that keep people safely at home and away from ED.

1. Ambulance service demand, capacity and response times

1.1              English ambulance services are currently answering approximately 27,000 ‘999’ calls per day (around 10 million annually), with demand continuing to rise year on year.

• March 2026 saw 854 more calls per day than the same month in 2025.
• Category 1 (immediately life-threatening) mean response time stands at 7 minutes 55 seconds nationally - above the seven-minute national standard, with the slowest three trusts averaging 8 minutes 44 seconds.
• Category 2 (emergency) mean response time was 30 minutes 04 seconds in March 2026 - just above the 30-minute recovery, but still far above the 18-minute national standard, with the slowest three trusts averaging 30 minutes 31 seconds.
• March 2026 also recorded the highest ever Category 2 daily volume for any March to date, averaging 13-thousand each day, 388 more incidents per day than March 2025.
• In the 12-months to March 2026 there were 4.7-million Category 2 incidents, 113-thousand more incidents than in the 12 months to March 2025.

1.2              Key drivers include: population growth with an increasing proportion of over 85year olds; rising acuity and complexity of patient conditions; growth in mental health, frailty and social crisis presentations; increases in seasonal viruses impacts; workforce pressures including vacancy rates and sickness absence and capacity issues in other sectors.

1.3              Urgent care activity for ambulance services includes ‘failure demand’ where there are unmet needs in terms of primary and community services. Demand on NHS 111 services has increased in recent years due to lack of timely general practice (GP) care. Availability and scope of out-of-hospital services varies across the country, and where alternative pathways are limited, inconsistent or difficult to reach, in some instances ambulance clinicians will have no choice but to convey a patient to an emergency department (ED) if it is not deemed safe to leave them at home.              

1.4              Ambulance services are managing significant numbers of patients with mental health issues. There is no national figure collated for this volume or percentage of demand, although there was a Freedom of Information request from the Health Services Journal that indicated that England's ten ambulance services received 652,720 mental health-related 999 calls in 2021-22, (up nearly a quarter from 524,485 in 2018-19), with crews spending approximately 1.8 million hours per year on mental health callouts. This figure will have increased exponentially since then.

1.5              The absence of a routinely published national figure for mental health demand on ambulance services is itself a commissioning and data gap - one that limits system capacity and workforce planning.

1.6              The Home Office’s Right Care, Right Person policy shows promise in redirecting non‑medical crisis calls—particularly those involving mental health—to more appropriate services. However, implementation remains inconsistent and is heavily dependent on the capacity of partner organisations, including police and mental health crisis teams, which are themselves under significant pressure. While AACE is broadly supportive of the aims of RCRP, important lessons have emerged during implementation, including themes highlighted in coroners’ inquests. We are keen to work with Police locally, alongside other partner agencies, to address these issues and strengthen the approach.

1.7              Mental health crisis teams are experiencing significant staffing pressures, often taking considerable time to respond and, in many areas, lacking the ability to provide a 24/7 urgent face‑to‑face assessment. As a result, some calls default to the ambulance service for an ‘eyes‑on’ review. This can lead to prolonged waits for patients, extended time on scene for ambulance crews, and the diversion of resources away from other emergencies. There is also a heightened risk of conveyance to ED, as ambulance clinicians may not have access to patient records or suitable alternative pathways. We therefore welcome the ambition in the Fit for the Future 10‑year plan to establish dedicated mental health emergency departments, which are urgently needed. As with other initiatives—such as same day emergency care (SDEC) and urgent community response (UCR) teams—consistent models across systems will be essential to ensure equitable and effective care for patients.

2. How ambulance and A&E demand and capacity interact

2.1              Approximately 48–50% of ambulance incidents result in a patient being conveyed to an ED. When ED flow stalls, ambulances cannot offload patients, removing vehicles from available resource and compounding response time failures.

In March 2026 (latest available data) the response outcomes for 999 patients were:

• 49% conveyed to ED
• 29% managed through See & Treat (S&T)
• 18% managed through Hear & Treat (H&T)
• 5% conveyed to other destination (e.g. Primary Percutaneous Coronary Intervention (PPCI), stroke unit, frailty unit, SDEC etc)

2.2              Ambulance and ED performance are structurally interdependent: hospital handover delays directly remove ambulances from the operational fleet, suppressing response capacity in ways that cannot be offset by resourcing decisions alone.  The mean hospital handover time in March was 26 minutes nationally - the standard is 15 minutes - but there is wide variation in different parts of the country, with West Midlands and East of England regions consistently having the highest volumes of delays and the longest waits. Data analysis shows there is clear correlation between handover delays and Cat 2 response times. in simple terms, when handover delays are greater, response to Cat 2 patients in the community is slower.

2.3              Locally, patient flow through the system, backing up through hospitals into ED - driven by inpatient bed availability and discharge delays (exit block) - is the primary variable determining the severity of ‘corridor care’ in ED and whether ambulance handover performance is acceptable or not on any given day.

2.4              Patients face material risk of harm. Our estimations based on clinical judgement reviews of handovers would suggest that, in March, over 20-thousand patients were at risk of harm from being held in handover delays exceeding one hour. 22% of all handovers nationally took 30 minutes or more, and the disparity between the fastest and slowest trusts (17 minutes versus 40 minutes mean handover time) means that outcomes are significantly influenced by geography rather than clinical need alone.

2.5              For Category 2 patients - who include those with stroke, sepsis and serious cardiac conditions - average waits of nearly 30 minutes against an 18-minute standard represent a persistent and quantifiable patient safety risk that has not been resolved since the pandemic.

2.6              Sadly, in many cases, delays in getting an ambulance to a patient—often caused by a lack of available resources during periods of prolonged hospital handover queues—have had a significant impact on patients’ conditions and outcomes, including instances of avoidable death. The number of ‘Preventing Future Deaths’ (PFD) reports issued by coroners relating to ambulance response delays has risen in recent years. In 2023, of the 32 PFDs received by ambulance services, 16 referred to the impact of ambulance delays. In 2025, 7 of the 41 PFDs related to delays, and 18 PFD reports have already been received so far in 2026.

2.7              The workforce impact from both corridor care and handover delays is compounding. Working relationships can be put under immense pressure at the handover point; crews held at hospital are unavailable for new incidents thus increasing workload pressure on colleagues in the field and dispatch, with delays in getting to very sick patients waiting in the community for an ambulance response. Sustained demand, combined with exposure to handover queuing, is a recognised driver of moral injury, paramedic burnout, sickness absence and attrition - further reducing the operational capacity available to meet demand.

2.8              Ambulance H&T and S&T activity substantially reduces ED arrivals; nationally, H&T volumes have more than doubled since 2021, reflecting significant investment in clinical hub capacity in ambulance call centres. However, H&T share varies markedly between trusts - from 16% to 21% - indicating further untapped potential.

2.9              Evidence broadly suggests that most ambulance conveyances to ED involve patients with genuine clinical need – whether for diagnostics or definitive treatment or admission. For example, analysis undertaken in London showed:

• “Patient outcome data from over half a million London Ambulance Service (LAS) patient conveyances to an ED since 2023 shows that 95.4% of patients conveyed to ED received tests or interventions prior to discharge. This suggests that the vast majority of patients conveyed to ED by LAS were conveyed appropriately, as additional diagnostics (that are outside of the scope or feasibility for ambulance clinicians) were required to inform the decision to discharge the patient.
• A multidisciplinary clinical deep dive into over 700 patients conveyed to ED also supports the broader data, showing that 93.3% of the patients who were reviewed were appropriately conveyed to an ED.
• This data indicates that, on average, there may be opportunities for LAS to reduce conveyances by 3 patients per ED per day.
• Furthermore, the findings identified the potential to find alternative outcomes for 19% of patients, if the wider system structure supported this, which correlates with the findings published in the Urgent and Emergency Care Plan 2025/26. There is a clear indication that more patients could benefit from accessing alternative care pathways if their hours of operation were increased. Broader access to senior clinical decision support for all healthcare professionals, both with ambulance service and the community, could also contribute to a reduction of avoidable ED conveyances.”

2.10              The potential to reduce ambulance conveyance to ED sits mainly within a small number of well‑defined patient groups: frail older people, those who have fallen, patients receiving end‑of‑life care, people experiencing a mental health crisis, and residents of care homes—particularly when they present with lower‑acuity Category 3 and 4 needs. It would therefore be misleading to suggest that ambulance conveyance overall is a major source of avoidable demand. Instead, the evidence points to targeted opportunities within these specific groups, many of which are already recognised in current NHS policy. Realising this potential depends on continued improvements in virtual care operating models, the development of multi‑disciplinary care coordination hubs linked to 999/111, earlier clinical decision‑making in the patient journey, and effective navigation into local alternative pathways. It also requires a sustained and consistent shift of activity from acute settings into the community—much of which is contingent on the left shift of funding.

2.11              The wider system capacity impacts on both ambulance and ED services:

• Primary care gaps (reduced GP access and out-of-hours capacity) increase 999 demand and ED self-presentations.
• UCR teams and SDEC services have provided some benefit, but their impact is limited by wide variation in how they operate—such as differences in scope and eligibility criteria, hours of availability, capacity, and whether ambulance clinicians can refer directly. As a result, they are not delivering the level of effectiveness they could. Access to SDEC for ambulance services also varies significantly and, in some areas, is only possible via the emergency department, which adds further delay and contributes to handover pressures.
• Delays in mental health crisis response due to their lack of capacity mean ambulances are tied up with patients who could be better managed in crisis care settings by those specialist services.
• Discharge processes, social care delays and bed shortages slow discharge, occupying inpatient beds needed to move ED patients, perpetuating ED crowding and the handover problem.
• Integrated urgent care (111/CAS) can play a crucial role in directing appropriate demand away from ambulances and EDs, but if the system is not well calibrated it can also generate unnecessary 999 dispatches. AACE continues to advocate for the integration of 999 and 111 services at a regional level, delivered by ambulance services—mirroring the model used by North East Ambulance Service, which operates within a single Integrated Care Board (ICB). This approach enables better management of demand across both access points, creates economies of scale, and improves resilience through a dual‑trained call‑handling workforce.

3. Geographic and socioeconomic variations

3.1              Geographic variation is marked. Rural and semi-rural areas face inherently longer travel times, making mean response time targets harder to achieve regardless of resourcing. Ambulance trusts serving predominantly rural geographies - such as South Western Ambulance and East of England - routinely face greater challenge in this respect than urban services, such as London and North West.

3.2              Socioeconomic deprivation is strongly associated with higher 999 call volume, higher rates of mental health presentations, frequent use by patients with unmet complex needs, and greater reliance on ambulances as a default point of contact with the health system. Deprived areas also tend to have higher rates of preventable serious illness, increasing the proportion of high-acuity Category 1 and 2 incidents.

3.3              Health inequalities mean that the communities most in need of timely emergency response are often those experiencing the longest waits, compounding existing disparities in outcomes. Very often these communities are also lacking in terms of voluntary services and access to Automatic External Defibrillators (AEDs).

3.4              The breadth of ambulance data on presentation types, geography, age and time of need positions ambulance services as a key resource for Neighbourhood Health and system-level demand planning, however, ICBs very often neglect to include ambulance data in their population health analyses. This is an aspect AACE, and its members, are proactively endeavouring to encourage.

4. Impact of the urgent and emergency care plan

4.1              The NHSE UEC Recovery Plan has produced measurable progress in some areas:

• SDEC has been rolled out to every hospital in England with NHSE data showing over 200,000 more patients discharged same-day in 2023/24 than the previous year.
• UCR teams are still embedding and are at different stages of maturity, with a lack of a consistent model, across the country. Where referral pathways have been properly integrated, referrals from ambulance to UCR, and subsequent reductions in ambulance dispatch, are steadily improving.
• Category 2 mean response times have improved substantially from a low point of over 90 minutes in December 2022. The 2025/26 year‑to‑date average of 30 minutes 27 seconds is now broadly in line with the 30‑minute recovery standard.
• The 18-minute constitutional standard has, however, never been met outside of the pandemic period, and with Cat 2 demand at its highest recorded level for any February to date, the trajectory of demand growth continues to outpace the plan's improvement interventions.
• Handover performance is monitored more rigorously now, with publication of handover delay data creating accountability pressure. AACE would advocate that it would be helpful to have this metric within the National Oversight Framework (NOF) for acute providers to increase the focus on this to achieve handovers to the 15-minute standard.
• There have been gradual improvements in handover times in the last year or two, supported to some extent by the policy instigated by NHSE that no handovers should take longer than 45 minutes; the national average is currently 48 minutes, and we are still a long way off the national target of 15 minutes. Where hospital and ambulance leaders have worked proactively and collaboratively in introducing ‘withdraw at 45 minutes’ or ‘rapid release’ procedures, this has helped improve handover performance and, importantly, working relationships between ambulance and ED staff. The latter policies do not result in patients simply being left after 45 minutes, but have agreed escalation procedures and risk assessment processes built in.
• AACE has looked at a number of individual hospitals where handovers are consistently lower than the national average, or have improved significantly, and worked with those hospitals to identify initiatives and interventions that have helped the most – publishing a series of good practice case studies. Many of the measures taken are similar across trusts, but the most significant drivers of improvement are proactive leadership and a whole‑hospital approach to reducing ED crowding and managing handovers.

4.2              Ultimately, UEC planning needs to be undertaken system-wide, rather than by individual trusts (as required by the UEC Recovery Plan), and should involve all UEC partners, including ambulance, designing provision collaboratively, against an informed picture, forecast and gap analysis of demand and capacity. This would represent true integration and a collective endeavour to provide the best UEC for local populations.

5. How response time targets affect resource allocation

5.1              National targets - particularly those for Category 1 and Category 2 patients - drive significant resource allocation decisions. Trusts prioritise vehicle positioning, dynamic deployment and escalation processes around Category 1 and 2 compliance. This can deprioritise lower-acuity responses (Cat 3 and 4) leading to deterioration and subsequent increase in acuity – for example for someone who has fallen and is unable to get up (long-lie).

5.2              Handover delays distort target compliance in ways that resourcing decisions cannot easily compensate for. For example a trust meeting its resource plan and agreed trajectory for Cat 2 compliance may still fail targets if significant vehicle-hours are lost to hospital queuing each day.

5.3              Ultimately, time targets are not always helpful. While time can be evidentially described as an imperative for certain life-threatening conditions, for the majority of our demand, time targets may well inhibit our ability to do the right thing for our patients. The ambulance workforce comprises a wide range of clinical expertise, including degree-based, registered paramedics, as well as increasing numbers of specialist paramedics and advanced paramedic practitioners (masters-based), including independent prescribers. These skill-sets enable far greater discernment of what type of care a person requires and the urgency of that. More patients are being safely managed by experienced clinicians through virtual care (H&T) and more are being treated and discharged in the home (S&T) or referred into a community-based service or primary care (See, Treat & Refer, (ST&R)).

5.4              AACE advocates a shift towards measuring ambulance service performance primarily through clinical effectiveness, safety, quality of care and—crucially—patient outcomes, with time‑based metrics retained only for those categories where time is genuinely critical. This would better align 999 responses with the principle of ensuring each patient receives the right care, in the right place, first time. Engagement with patients consistently shows that, while timely response matters, the quality of clinical decision‑making, communication, dignity and overall care experience are equally central to their expectations of ambulance services.

6. How ambulance services can be used more effectively

6.1              We believe that truly integrated 999 and 111 services at system or regional level, run by ambulance trusts, or through a single collaborative approach with a 111 provider, linked directly to multi-disciplinary clinical assessment services and care coordination hubs would impact positively on patient experience and outcomes – enabling faster emergency response, and navigation of lower acuity patients into the most appropriate service at neighbourhood level (see our graphic).

6.2              Ambulance services can be more effectively deployed through greater investment in clinical triage and alternative pathways:

• H&T: expanding ambulance control room clinical hubs, and multi-disciplinary care-coordination hubs (nurses, paramedics, GPs, Mental Health (MH) nurses, dentist, palliative care nurses) to resolve more incidents remotely without dispatch of an ambulance, particularly for lower-acuity and mental health calls, and support clinical decision making for ambulance clinicians on scene with patient.
• S&T or ST&R: enabling paramedics to manage more patients at scene and, when necessary, refer directly as ‘trusted assessors’ to community services, urgent treatment centres or GP practices, avoiding ED conveyance.
• Specialist clinical pathways: cardiac, stroke, sepsis, frailty and major trauma pathways that bypass ED and go directly to definitive treatment centres are well-evidenced and should be extended where possible.
• Ambulance service volunteer Community First Responder (CFR) schemes: increasing coverage in rural areas, particularly for cardiac arrest and increasingly in attending non-injury falls.

6.3              Effectiveness also depends on real-time access for ambulance clinicians to patient care records and care plans (including ReSPECT forms / end-of life plans), and data sharing between ambulance services, 111/ primary care and social care - enabling crews to know what community alternatives exist at point of need.

7. Ambulance services providing care directly in the community

7.1              There are several ways ambulance services are providing care closer to home and reducing avoidable conveyance to EDs. Collectively, these initiatives reflect a sector-wide shift from conveyance as default towards assessment, treatment and referral in community settings - though the maturity, consistency and commissioning basis of these models varies considerably across trusts and ICB areas.

7.2              Ambulance initiatives supporting care closer to home include:

• Multi-disciplinary team clinical hubs and unscheduled care co-ordination centres that bring together ambulance, community, mental health, GP and voluntary sector services to support clinical decision-making, hear & treat outcomes, and direct patients to appropriate care without hospital attendance.
• Call before convey and Single Point of Access arrangements give crews real-time access to senior clinical advice - including from GPs, advanced clinical practitioners and emergency medicine consultants - enabling more patients to be managed on scene or referred into community pathways.
• Specialist and Advanced Paramedic Practitioner response models provide enhanced on-scene clinical capability and paramedicine models, with independent prescribing, that result in more patients being treated and left safely at home (S&T or ST&R) – including successful rotational models working within primary care in some parts of the country.
• Diagnostics brought to the patient - including mobile X-ray (paramedic and radiographer response), point-of-care troponin testing and ultrasound - extend the range of conditions that can be assessed and managed in the community by ambulance clinicians.
• Mental health co-response vehicles, typically staffed by a paramedic alongside a mental health professional, are widely deployed to reduce inappropriate ED conveyance for patients in crisis. In addition, we know that having MH nurses in our clinical coordination hubs significantly reduces conveyance to ED for these patients, however, these resources are not always available from MH teams or to employ directly, despite NHSE guidance in December 2022 to place MH professionals in 999 call centres on a 24/7 basis.
• Virtual ward integration allows paramedics in some areas to onboard patients directly to remote monitoring programmes rather than conveying to hospital.
• Video technology, including stroke telemedicine and GoodSAM remote consultation, supports clinical triage and decision-making at scene or within emergency operations centres.
• Ambulance CFR volunteer schemes extend community reach, particularly for non-injury falls.

7.3              Barriers include: workforce capacity constraints; inconsistent commissioning - community paramedicine and rotational models are often locally funded, time-limited, and subject to cuts; lack of ready access for ambulance to patient care records; and the absence of a consistent national contractual mechanism to fund ambulance trusts for non-emergency community and prevention work.

7.4              Enablers include: pan ICB-level strategic commissioning of ambulance services including activity in community paramedicine and prevention; digital interoperability investment and the Single Care Record; and paramedics having trusted assessor status to allow direct referrals into other services.

8. How NHS structures influence effectiveness

8.1              All ambulance services in England are commissioned by ICBs through a lead commissioner model, whereby a single host ICB holds the commissioning relationship on behalf of the other ICBs across the ambulance trust's footprint. All but one English ambulance service operates across multiple ICBs - in some cases five or more historically, although the numbers are changing - and the lead commissioner model in practice provides coordination rather than genuine authority, with insufficient delegated power to drive strategic change across ICS boundaries. In some cases, ambulance services become drawn into a single host system's financial recovery, with consequences for the entire region they serve.

8.2              Current block contract arrangements and annual funding settlements limit ambulance trusts' ability to plan strategically, invest in workforce development, innovate or develop new care models that require multi-year horizons. The block contract structure also lacks the segmentation needed to incentivise appropriate non-conveyance, pathway innovation or alternatives to ED - meaning the financial framework actively works against the shift to more integrated models of care.

8.3              AACE is working with NHSE and ambulance commissioners, to design a new payment model that  will drive improvements in productivity and incentivise activity aligned to national objectives and system priorities. It should also lead to greater consistency in data quality, improving the way we capture and utilise activity and cost data for clinical work with patients and outcomes. It will also help with delivering better integrated and neighbourhood care – encouraging and incentivising system working, for example incentivising acute trusts to take handover from ambulance clinicians within 15 minutes or incentivising local systems to standardise local urgent care pathways. We also need it to encourage innovation more broadly and investment in new services and technologies.

8.4              AACE's 2025 commissioning position paper calls for a multi-tiered framework: national core service specifications and outcome frameworks; regional strategic commissioning with genuine delegated authority, isolated from individual ICB financial pressures; and local collaborative pathway commissioning responsive to population needs. The Strategic Commissioning Group model operating in the south-east - across Kent, Sussex, Surrey Heartlands and Frimley ICBs with South East Coast Ambulance Service - demonstrates that when this kind of structured multi-ICB governance exists at regional level, it can accelerate service development significantly. AACE's position is that this model should be adopted nationally, and we welcome the move to multi-year settlements.

9. Capturing and sharing learning across the sector

9.1              AACE facilitates formal sharing and learning mechanisms through its national professional and director-led groups, for example, National Ambulance Services Medical Directors (NASMeD), Chief Paramedics Group (CPG), National Strategy and Transformation Directors (NASAT), National Directors of Operations (NDOG) and Chief People Officers group (CPOs). These groups meet regularly, share operational practice and agree sector positions on clinical and governance matters and report into the Ambulance Chief Executives Group (ACEG).

9.2              AACE also works closely with partners such as NHS Alliance and their membership networks, the King’s Fund, and universities in conducting independent evaluations and research.

9.3              Through our internal networks and working with partners, we are able to take a strategic, sector-wide approach to key priorities – such as working with NHSE to design a new payment mechanism for ambulance services, or reviewing common patient and staff safety issues, or exploiting the economies of scale in collaborative procurement of digital solutions.

AACE welcomes the opportunity to provide oral evidence and is willing to share further data or case studies in support of this inquiry.

16 April 2026