News NI health reporter
PA MediaA “dramatic deterioration” in ambulance handover performance is placing a significant and increasing number of patients at potential risk of harm or even significant harm, a report has said.
Northern Ireland’s comptroller and auditor general said about 3,800 patients were potentially subjected to severe harm last year because of ambulance handover delays.
It also identified that potentially more than 36,000 patients may have experienced some harm and that delayed handovers cost about £50m over the past five years.
The Department of Health said it welcomed the report and would carefully consider its recommendations.
The report by Dorinnia Carville considered the performance of the process of moving a patient from an ambulance into an emergency department (ED) to be seen by medical and nursing staff.
Where was the longest wait?
PacemakerIn December 2024, the longest ambulance handover for a patient was 23 hours, although targets stipulate all handovers should be complete within 15 minutes.
This target has been comprehensively missed since 2019, the report said, and the overall performance throughout Northern Ireland is much worse than England and Wales.
In the past two years, only 7% of Northern Ireland Ambulance Service (NIAS) handovers met this target.
Despite a commitment from trust chief executives in February 2023 that no ambulance would take longer than two hours to hand over a patient to an ED, the NIAS recorded multiple handovers every day that are longer than 10 hours in recent months.
Last year, 11,000 ambulance handovers took more than three hours, up from about 400 five years ago.
Ambulance handover performance deteriorated considerably between 2019 and 2024 at all nine local hospitals with major EDs.
However, the Ulster Hospital, in the South Eastern Trust, has consistently recorded the longest handover times.
NIAS’s performance when responding to 999 calls has deteriorated because of ambulances being increasingly tied up waiting outside EDs, which has raised concerns around performance in relation to emergencies and potentially serious incidents.
The NIAS said the current challenges were a result of the pressures faced across the entire health and social care system and which are manifested most in the pressures at EDs and patient flow through hospitals.
“These pressures have resulted in prolonged turnaround times for ambulances at EDs, which impacts upon our ability to respond to emergency calls within the community,” the service added.
The report also found that Northern Ireland is increasingly reliant on private ambulances, but they remain unregulated.
This reliance has increased 5,000% over the past five years.
Last year private ambulances were used on more than 1,000 occasions for emergency purposes at a cost of £3.6m.
The report highlighted how timely ambulance handovers rely significantly on other aspects of the emergency care system functioning effectively and the importance of NIAS and health trusts working together.
It noted that delays in completing ambulance handovers are interconnected with other, well-publicised challenges and pressures on the health service, such as limited bed space within hospitals and delays in discharging patients.
It referenced other Department of Health (DoH) commissioned research which cited ambulance handover delays as the single biggest risk to patients in the emergency care system in Northern Ireland.
The research, which involved a review of emergency medicine in Northern Ireland, highlighted that improvements were needed in the system.
The NI Audit Office report said while NIAS can take some steps to improve its performance it cannot resolve the problems alone, and the DoH and health trusts also have significant responsibility for reducing ambulance handover delays.
Delays are a symptom of poor patient flow across the emergency care system.
What is recommended?
The audit office report said the current situation was “both unacceptable for patient wellbeing and a waste of public resources”.
Ms Carville has made recommendations and highlighted key areas for improvement including:
- each health trust implementing decisive measures to improve ambulance handovers urgently
- improving oversight and regulation of the private ambulance sector
- sustained work by NIAS to reduce it sickness absence rate
- an increase in the proportion of patients NIAS refers to alternative care pathways
Report ‘underlines scale of pressures’
The Department of Health said the report underlines the seriousness and scale of the pressures facing health and social care services.
“The Department of Health recognises the risk of harm to patients who are delayed at handover on arrival at the emergency department and the impact this has on NIAS’s capacity to respond to the next emergency call in the community,” they said.
“Reducing ambulance handover delays has been a key priority for the department.”
It said to improve the situation it had put measures in place to provide alternative services.
“While pressures manifest at the emergency department, flow through the system and getting those people medically fit for discharge back into the community remain significant issues, meaning that a whole system approach is required,” they added.
“Although some progress has been made in delivering changes to services to meet the needs of patients and service users, there is no quick fix and addressing the current situation will require sustained long-term effort, additional recurrent funding and support across the political spectrum.”
What has the trust said?
The South Eastern Trust said the report “once again highlights the pressures on our staff who, liaising closely with NIAS, work extremely hard, under enormous pressure, to care for patients when they need it most”.
“This is not the service we want to provide, nor the service the public deserves, as we know how distressing long ambulance waits can be, not just for the patient, but also for their families,” the trust said.
“Regrettably demand for care in our hospitals continues to outstrip current capacity.”
It said the average ambulance turnaround time at the Ulster Hospital improved by 34% in February 2025 compared to 2024.
“An emergency department is not the most appropriate place for people to receive care, particularly for our older and more vulnerable population,” the trust added.
“That is why we are dedicated to providing more hospital level care in the community.”
