Your first category (Be there now) is of course impossible to achieve unless you have an ambulance parked outside every house, office, shop etc. in the UK. The 8 minute target was designed to allow for this fact, in that it is the maximum allowable time that we should be aiming for in life & death emergencies. Imagine you have brittle asthma, have been in a serious car accident, or are performing CPR on your wife. You want (and need) an ambulance straight away, and 8 minutes is probably the very most you're willing (or indeed able) to wait. Ideally you want it in 3-4 minutes. Of course, 3-4 minutes is completely unachievable in all but the most unusual of circumstances, and if this had been set as the target you'd be complaining about how "stupid targets" make you rush around in a dangerous frenzy. Hence 8 minutes as a compromise. If you aren't able to get to a life-threatening emergency within 8 minutes (particularly in a built up area such as London) you damn well should be ashamed of your service, whether the target is there or not. What we absolutely must do better is classify "life-threatening" more appropriately. Currently a lot of calls classified as such are really not. This is in part due to the inevitable problems of telephone triage and the somewhat necessary over-caution that is required because of these. Better use of clinical judgement by call-takers is perhaps one mechanism by which this can be achieved, although that does throw up problems as, by and large, these people are not clinically-qualified. Another attack route is better education of the public - this is already being done with advertising campaigns, but also more widespread first aid training (perhaps by tieing it to the national curriculum a bit more tightly than it currently is, or offering free courses to community members).