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PurposeReview of major policy paper in relation to the ambulance service [in England] efficiency and productivity with reference to observed “unacceptable variation”.Design/methodology/approachCritical review of ambulance service/EMS policy approach in England.FindingsLord Carter’s review describes failings in performance of UK ambulance service/EMS. However, the identified failings are essentially a repetition of many almost identical similar findings. There is a tendency of policy in respect of the ambulance service in England, as exemplified by Lord Carter’s report to consider analysis of the problem a more significant task that actually addressing the shortcoming defined.Research limitations/implicationsThis viewpoint comment piece is produced as a viewpoint with all the attendant limitations implied in this approach. However, it has been produced from an informed position.Practical implicationsChallenge to current UK ambulance policy. Previous repetitious finding need to be addressed definitively.Social implicationsThe efficiency of UK ambulance services/EMS is seriously impaired, and indeed these findings have been acknowledge previously. However, little by way of active remediation has been attempted. The current approach as exemplified in Lord Carter's recent review appears to ensure that analysis of the long- standing problems that exist is sufficient and possible preferable to active remediation and improvement.Originality/valueNo previous critical review of this type has been attempted (as it would be career-limiting).