There has been a dramatic deterioration in ambulance handover times in Northern Ireland, with the number of handovers taking longer than three hours rising from around 400 (less than one per cent) in 2019-20, to just over 11,000 (nine per cent) in 2023-24. This is among the findings in a report published today (Tuesday 11 March) by Northern Ireland’s Comptroller and Auditor General.
Dorinnia Carville’s report considers performance relating to the process of moving a patient from an ambulance into an emergency department (ED) to be seen by medical and nursing staff. It highlights a worsening performance against the Northern Ireland Ambulance Service’s (NIAS) target of completing handovers within 15 minutes. In 2019-20, around 27 per cent of handovers were completed in this timeframe – this compares with just seven per cent in 2023-24. Overall performance throughout Northern Ireland is much worse than in England and Wales.
The report describes the impact that this deterioration in ambulance handovers is having, in terms of both operational efficiency and patient outcomes. This includes:
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Potentially over 36,000 instances in 2023-24 when patients may have experienced some harm as a result of ambulance handover delays, and around 3,800 occasions when patients were potentially subject to severe harm.
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An estimated £50 million of lost operational capacity in the NIAS between 2019-20 and 2023-24, with 25 per cent of operational capacity lost in 2023-34 due to delays.
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A deterioration in NIAS performance when responding to 999 calls because of ambulances being increasingly tied up waiting outside EDs. The report notes particular concerns around performance in relation to emergencies and potentially serious incidents.
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An increased reliance on the unregulated private sector to address service provision gaps. In 2019-20, NIAS commissioned private sector ambulances to provide ED relief on just over 20 occasions. However, by 2023-24 this had risen to over 1,000 occasions.
The report does note that delays in completing ambulance handovers are interconnected with other, well-publicised challenges and pressures on the health service, such as limited bedspace within hospitals and delays in discharging patients fit to leave hospitals. It references other Department commissioned research which cited ambulance handover delays as the single biggest risk to patients in the emergency care system here.
Northern Ireland’s Comptroller and Auditor General, Dorinnia Carville, commented:
“Having ambulances waiting outside hospitals for lengthy periods of time is both unacceptable for patient wellbeing and a waste of public resources. Addressing this issue will no doubt be challenging. However, this report includes recommendations, and good practice from other regions, highlighting key areas for improvement.”
“In particular, we have stressed the need for strong leadership to help break down siloed working and instil a culture that sees patients as the responsibility of hospitals and trusts when an ambulance arrives at a hospital, and not just once the handover process is complete.”