Ambulance handover delays

Background

The national guidance states that patients arriving at an emergency department by ambulance must be handed over to the care of A&E staff within 15 minutes. A handover delay does not necessarily mean that the patient waited in the ambulance – they may have been moved into the A&E department, but staff were not available to complete the handover.

This is regarded as one of the most important indicators of a system under pressure, as it occurs as a result of a mismatch between A&E/hospital capacity and the number of elective or emergency patients arriving. Before an A&E department becomes so full that significant queueing begins, the hospital should implement an escalation plan and alert the local clinical commissioning group. If significant delays still occur, this demonstrates a failure of the hospital trust (and wider health system) to meet the needs of patients requiring emergency care, since allowing ambulance queues to build up is not an appropriate way of managing an increase in demand.

NHS England consulted on a proposed new set of standards for urgent and emergency care, as part of the NHS access standards review. The response to the consultation outlined plans to implement the new standards, including a measure of the percentage of ambulance handovers that take place within 15 minutes. Data is currently only published on handover delays over 30 minutes, and only in winter as part of NHS England’s Urgent and Emergency Care Daily Situation Reports. 

Data on ambulance handover delays of over 30 minutes is published as part of NHS England’s Urgent and Emergency Care Daily Situation Reports (SitReps) and collected from acute trusts each day during winter.

In general, there are fluctuations from week to week in the number of ambulance handovers that are delayed by over 30 minutes, and a notable increase in the number of ambulances delayed during Week 1 of any given calendar year (using the ISO week date system - see ‘About this data’).

Between 2018-19 and 2019-20, there was a slight upward trend in the number of ambulance handover delays during winter. There were fewer ambulance handover delays in 2020-21, the first winter of the Covid-19 pandemic. The winter of 2021-22 saw a greater number of handover delays than any of the previous years, and both in 2022-23 and particularly in 2023-24, the numbers continued to escalate. The winter of 2023-24 has seen the highest number of half-hour handover delays – a staggering 27% increase (73,978 more delays) compared with the previous winter. Comparing the five most recent winters, between Week 1 and Week 9 there were:

• 117,468 ambulance handover delays in 2019-20, 14% of all ambulance arrivals
• 81,988 ambulance handover delays in 2020-21, 10% of all ambulance arrivals
• 156,665 ambulance handover delays in 2021-22, 21% of all ambulance arrivals
• 165,924 ambulance handover delays in 2022-23, 24% of all ambulance arrivals
• 242,034 ambulance handover delays in 2023-24, 28% of all ambulance arrivals

The 2023-24 NHS Standard Contract sets the targets that “all handovers between ambulance and A&E must take place within 60 minutes, 95% within 30 minutes and 65% within 15 minutes”. Despite this national ambition, more than 1 in 4 ambulance handovers experienced a delay of least 30 minutes in 2023-24. Between Week 49 and Week 9 of the winter in 2023-24, there were 141,604 ambulance handover delays of over an hour, 11% of the total ambulance arrivals in the period (data not shown). A clinical review carried out by the Association of Ambulance Chief Executives found that in January 2023, of patients who experienced a handover delay of over an hour, 30,000 potentially experienced additional harm and 3,000 potentially experienced severe harm because of the delay. Whilst the number of ambulance delays over 30 minutes has on average been highest in 2023-24, NHS England reported that ambulance handovers decreased the hours lost during transfers throughout February 2024, from 23,494 hours to 18,799 hours. This means that in February 2024 it is more likely that a patient would experience an ambulance handover delay beyond half an hour but the duration of delay itself may be shorter than in previous weeks. 

Between the winters of 2018-19 and 2020-21, the proportion of ambulance transfers that were delayed for more than 30 minutes stayed between 6% and 17%. During the last weeks of 2021 (Week 49 to Week 1), the proportion of delayed ambulance arrivals was around 20% and slightly increased to 22.1% in Week 8 of 2022. During the winter of 2022-23, the proportion of delayed ambulance arrivals was at an all-time high of 41% in Week 50 and then decreased to 23% in Week 1. The following year, 2023-24, saw the opposite trend. Between Week 1 and Week 7 of 2023-24, the proportion of delayed ambulance arrivals hit record levels of around 30%. Since 2018-19, the overall proportion of ambulance transfers that were delayed over half an hour between Week 49 and Week 8 increased every year, meaning that more patients are expected to wait for the handover from the ambulance to be completed.