Increasing handover delays contributing to growing ambulance waiting times

Increase in handover delays – the time an ambulance spends waiting outside a hospital before transferring a patient – is a major cause of the decline in ambulance response times, new analysis finds.

  • In July 2022, more than 1 in 10 ambulances waited over an hour with patients outside hospitals – up from 1 in 50 in July 2019.
  • Patients with the most critical calls are waiting 18% longer than in 2018/19. For non-urgent cases, waits have doubled to an average of 3 hours.
  • The Health Foundation calls for urgent ‘whole system’ focus ahead of a challenging winter for the NHS.

A sharp increase in handover delays between ambulance services and hospitals has resulted in patients waiting longer than ever for ambulances to arrive, new analysis warns.

Analysis by the Health Foundation on ambulance service performance in England has found that the percentage of handover times exceeding 60 minutes was seven times higher in July 2022 than in 2019.

The analysis also shows that patients are facing record-breaking ambulance waiting times, with patients in April to March 2021/22 waiting 18% longer than they would have waited in April to March 2018/19 for the most critical calls. For non-urgent cases that still require an ambulance response, waits have more than doubled to an average of over 3 hours. Because ambulance services are stretched, the increases in handover times are magnified, leading to far greater increases in average response times.

Long ambulance handover times signal system-wide challenges and have devastating consequences for patients and their families. Rising times suggest different parts of the system – from social care to hospitals – are under severe strain, putting patients’ lives at risk.

The increase in ambulance handover delays is largely being driven by the lack of hospital bed capacity and delays in discharging patients. To ease this pressure there needs to be greater investment in social care and community services.

To address increasing ambulance waiting times, the Health Foundation is calling for a whole system approach with greater investment in:

  • hospital capacity and flow through hospital with more beds and more staff
  • out of hospital care, including social care
  • community services, such as mental health services, which can prevent health conditions becoming crises.

Charles Tallack, Director of Data Analytics at the Health Foundation, said:

‘The sharp increase in handover delays is a major cause of the increase in ambulance waiting times. The cumulative effect of demand returning to pre-pandemic levels, the need to catch up with backlogs, and the ongoing impact of COVID-19 has resulted in the pressures we are now seeing right across the system – putting patients’ lives at risk.

‘Delays at the front door of the hospital are a consequence of wider challenges hospitals are facing in discharging patients. Getting a handle on this must be a priority for the new Secretary of State for Health and Social Care. Tackling ambulance performance will require further investment in NHS and social care capacity and a comprehensive, funded workforce plan to ensure services have the staff they need.’

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