Chart of the week: How do ambulance handover delays vary across England?

Each week we present analysis of data in chart form to illustrate some key issues and invite discussion. Ambulance handover delays are when an ambulance has arrived at a hospital with a patient, but the transfer of their care to hospital staff is delayed. Handover delays of over 30 minutes have been more common across England this winter than in previous years, but how does the situation vary in different parts of the country? Liz Fisher takes a closer look.

Data story

Published: 14/02/2022

An ambulance handover delay is when an ambulance has arrived at a hospital with a patient, but the transfer of their care to hospital staff is delayed, which negatively impacts on patient experience and compromises patient safety. The delay could reflect a large number of ambulances arriving at the same time, combined with insufficient capacity in the A&E department caused by a lack of space or staff, or difficulty admitting patients into a hospital bed.

This winter, the number of ambulances arriving at an English hospital where their handover has been delayed by more than 30 minutes has frequently exceeded the levels seen in previous winters. Much of that is driven by a larger number being delayed for more than 60 minutes than in previous years, but do different regions in England experience handover delays equally?

Overall, the South East has performed best this winter so far, with 88% of ambulances arriving at hospital with either no handover delay or experiencing a delay of less than 30 minutes. But this figure is only 70% in the South West, and 18% of ambulances arriving at that region’s hospitals have been experiencing a handover delay of more than 60 minutes, which is more than double the English average.

The differences between regions don’t appear to be a result of Covid patients needing to be admitted. Over the same time, London has had the highest weekly average Covid case rate and the second highest average rate of hospitalisations, but has performed better on ambulance handover delays than many other regions.

Staffing absence problems caused by the pandemic can’t explain the difference either. The North East and Yorkshire have had, on average per day, one of the highest hospital staff absences rates, but have been among the better performers on ambulance handover delays. Whereas the South West sickness absence rates are below the national average.

The ability of the South West to discharge patients and their adult general and acute bed occupancy rates do appear to be an issue, however, as well as a larger proportion of long “trolley waits” in emergency departments there over December and January. These may go some way to explain why the South West has longer handover delays. However, similar issues with discharge and bed occupancy in other regions haven’t yielded the same scale of ambulance handover delays.

As the Omicron-driven latest wave of Covid infections subsides, ambulance handover delays continue to increase nationally. Understanding what is causing these delays is vital to tackling the problem.

Proportion of ambulances arriving by length of time delayed 11/02/2022



Nuffield Trust analysis of NHS England and Improvement's urgent and emergency care daily situation reports.

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Data notes

When we refer to this winter, we are defining this as the analysis of NHS England and Improvement's urgent and emergency care daily situation reports between 29 November 2021 and 6 February 2022.

The proportion of ambulances arriving that are delayed by length of time delayed is the total number of ambulances arriving at a hospital within the region that are delayed by the given time within the time period divided by the total of ambulances arriving within the region over the time period.

Regions in this context relate to English NHS regions.

All analysis of hospital activity represents type 1 acute trusts only, apart from long trolley waits (defined as the proportion of patients admitted in an emergency who waited more than 12 hours before being admitted after a decision to admit), which looks at all emergency admissions via A&E.

Staff absences rates were calculated using the daily average number of absences from NHS acute trusts from NHS England and Improvement’s Urgent and Emergency Care Daily Situation Reports and the number of staff at those trusts in October 2021 from NHS Digital’s NHS Workforce Statistics.