Audit to Impact - Ambulance Handovers in NI

As we continue our Audit to Impact series, we are looking back at our report Ambulance Handovers in Northern Ireland, which examined delays in transferring patients from ambulances into Emergency Departments and the impact this was having on patients, services and resources. 

The full report is available here

1. Background to this report

   This 2025 report considered performance in moving patients from ambulances into Emergency Departments. 

   Delays in ambulance handovers are regarded as both unacceptable for both patient wellbeing and the efficient use of resources. 

2. What did the report find?

   Recognising the issue as highly challenging and interconnected with other health service challenges, the report highlighted a sustained deterioration in performance. 

   It estimated that delays had cost around £50 million over five years and contributed to an increasing reliance by the Northern Ireland Ambulance Service (NIAS) on private ambulance providers. 

    

3. What did we recommend?

   Our report made a number of recommendations, including:

   1. decisive measures should be taken to improve ambulance handover performance as a matter of urgency.
   2. The NI Ambulance Service should assess whether the significant ongoing reliance and expenditure on the private sector ambulance sector represents best value for money, or whether building additional in-house capacity would represent a more sustainable use of resources.
   3. Improvements to oversight and regulation, taking account of best practice in England where some Trusts have significantly improved performance.

4. What happened next?

   A number of actions have been taken to implement the recommendations in the report, including:

   1. Progressing a value for money assessment of private ambulance usage and committing to expand in-house capacity through additional recruitment and the development of new roles.
   2. Exploratory work on the necessary legislative and regulatory changes in the use of the private ambulance sector
   3. An April 2026 “Release to Rescue” from NIAS with the aim of ensuring no patient waits longer than two hours in an ambulance outside an Emergency Department.
   4. A visit by Department of Health officials and clinicians to a London hospital and shared lessons through a regional workshop in August 2025 to inform emerging guidance.

5. What was the impact?

   In taking these actions, the ambulance service has, in recent months, seen a dramatic improvement in handover times and response times to emergency calls. If sustained, these trends will result in a more effective ambulance service and a more efficient use of resources in the long-term, with better value for money being achieved.