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 because 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 both in 2022/23 and particularly in 2023/24, the numbers continued to escalate. 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.

The winter of 2024/25 saw the highest number of half-hour handover delays, particularly during the end of the year. Overall, there was a 3% increase (7,592 more delays) compared with the previous winter. Comparing the six 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
• 249,626 ambulance handover delays in 2024/25, 30% of all ambulance arrivals

The 2024/25 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 at least 30 minutes in 2024/25. 

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%. In 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 were at an all-time high of 41% in Week 50 and then decreased to 23% in Week 1. The following year of 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%. During the winter of 2024/25, 31% of ambulances were delayed for more than half an hour on average, which is a slight increase since the previous winter. This is well above the operational standard which states that no more than 5% of handovers should be delayed by over 30 minutes.

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 every year are expected to wait for the handover from the ambulance to be completed.