Target times for ambulances to reach some seriously ill patients could be lengthened, the BBC has learned.
A leaked NHS document includes plans to change the response time for some Red 2 patients - those with "serious but not the most life-threatening" conditions - from eight to 19 minutes in England.
It said the plans had been approved by Health Secretary Jeremy Hunt, subject to approval by ambulance trust bosses.
The Department of Health said no decisions had been made.
"The secretary of state would only agree to proposed changes that improve response times for urgent cases," it added in a statement.
Shadow health secretary Andy Burnham told the BBC Mr Hunt had urgent questions to answer, adding: "We need to hear from the health secretary today."
'Urgent request'The memo said NHS England had "explicitly stressed" the plans were confidential, adding details of the proposals "should not be disseminated beyond the group" involved in the discussions.
But the document, written by the Association of Ambulance Chief Executives (AACE) and dated 16 December, has been leaked - and one ambulance service director told BBC home affairs correspondent Sally Chidzoy the plans were about "political expediency rather than patient safety".
The document said there were existing plans for changes "after the general election" in May.
But it said Prof Keith Willett, of NHS England, made an "urgent request" for discussions due to "unprecedented demand" on health services - and now the "target for implementing these changes is the first week of January 2015".
Call types:- Red 1: Respiratory or cardiac arrest - response in eight minutes
- Red 2: All other life-threatening emergencies, such as stroke and fits - response in eight minutes
- Other response times are agreed locally
There are no plans in the document to change the response targets for Red 1 patients - those with life-threatening conditions where response time "may be critical", such as heart attacks and serious bleeding.
The national target is for ambulance trusts to reach 75% of Red 1 patients within eight minutes, and 95% within 19 minutes. The time starts as soon as an emergency call is connected.
Red 2 targets are currently the same, except that the "clock start" can be up to 60 seconds after a call is connected.
The changes proposed in the AACE document for current Red 2 situations are:
- A "small number" to be moved to Red 1 - those where a short extra wait "could have a potentially serious detrimental impact"
- Just under half will keep the 75% within eight minutes target, but trusts will have up to three minutes from receiving a call before the clock starts
- About 40% to have a 19-minute response target, as well as three minutes before the clock must start
The Red 2 category includes conditions such as strokes and fits, but the document does not say which conditions would be put in each of the new categories.
Lower grades of call-out - known as "Category C" and "Hear and treat" - are dealt with by locally agreed targets.
The document said the proposed changes could bring "substantial improvements".
One line in it said ambulance trusts would be able to cut the number of fast-response cars being used in favour of deploying more double-crewed ambulances.
One ambulance service director, who asked not to be named, told the BBC: "This is being done for political expediency rather than patient safety and it's being done with the full blessing of Jeremy Hunt.
"This is being pushed through with limited consultation with the chief executives and the health service as a whole.
"There has been no consultation with the wider health system, which is required when you are making such a major change which could impact on patient safety."
'Life-threatening'The AACE document acknowledges that details of the new response arrangements have not had the "breadth of exposure that would normally be expected".
Mr Burnham told BBC Breakfast: "These are all potentially life-threatening situations.
"We are talking about stroke patients here and while I said I would accept the debate, I'm not saying that these changes are right. Because these changes would lead to people in very serious situations waiting longer for an ambulance to arrive and I think we need to have the clinical evidence about why it is OK to let people wait longer.
"I've not accepted that argument at all yet."
The current response times apply in England and Wales, but the document does not mention what impact its proposals might have in Wales.
What is your experience of the ambulance service? You can email haveyoursay@bbc.co.uk. If you are willing to speak to a BBC journalist, please leave a contact number.
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