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 queuing 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 in 2022-23, the numbers continued to escalate, particularly during the last few weeks of 2022. There were 44,734 more ambulance delays in the winter of 2022/23 than in 2021/22. Comparing the four 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

The NHS Standard Contract sets the target that “all handovers between ambulance and A&E must take place within 15 minutes with none waiting more than 30 minutes”. Despite this national ambition, almost 1 in 4 ambulance handovers experienced a delay of at least 30 minutes in 2022-23. Between Week 49 and Week 9 of the winter in 2022-23, there were 128,413 ambulance handover delays of over an hour, 13% 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. In December 2022, 1,814 handovers took over 10 hours to complete.