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 community) 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 has recently 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 are 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 are published as part of NHS England’s Urgent and Emergency Care Daily Situation Reports (SitReps) and are collected from acute trusts each day during winter. No data on ambulance handover delays were reported for the winters of 2015-16 and 2016-17.
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 2010-11 and 2019-20, there was an upward trend in the number of ambulance handover delays during winter. However, in the winter of 2020-21, during the coronavirus (Covid-19) pandemic, the number of ambulance handovers delayed by over 30 minutes was lower than in 2019-20. Comparing the two most recent winters, between Week 49 and Week 9 there were 164,275 ambulance handover delays in 2019-20, compared to 117,385 in 2020-21. This corresponds to a fall in the number of patients arriving by ambulance at emergency departments, with 1.26 million in the winter of 2019-20 compared to 1.14 million in 2020-21.
About this data
Data on ambulance handover delays of over 30 minutes is collected as part of winter daily SitReps. The 30 minutes includes the 15 minutes allowed under SitRep guidance if an ambulance is unable to unload a patient immediately on arrival at A&E because the A&E is full.
The start time of the handover is defined as the ambulance's time of arrival at the A&E department. The end time of the handover is defined as the time of handover of the patient to the care of A&E staff.
All accident, emergency and urgent patients destined for A&E (type 1, 2 or 3) are counted. This includes urgent GP patients brought by ambulance to A&E. Non-emergency patients are not counted. Patients being transported between locations/trusts/hospitals (e.g. for outpatient clinics, tertiary care) are not counted. Ambulance trusts do not count the time required for crews to complete record forms, clean vehicles, re-stock vehicles or have a break.
The ISO week date system was used – each week begins on a Monday and the first week of the year is the first week when the Thursday falls in the new year. For example, if January 1st fell on a Friday, Week 1 would start the following Monday. The average of Weeks 51 and 52 were calculated for analysis purposes, as there is much variation depending on when Christmas and New Year falls in that particular year. In 2020-21, the average of Weeks 51, 52 and 53 were calculated.
For more information, please see NHS England’s Urgent and Emergency Care Daily Situation Reports.