There has been a “dramatic deterioration” in ambulance handover times in Northern Ireland, the Auditor General has found.
The number of handovers taking more than three hours rose from around 400 (less than 1%) in 2019/20 to just over 11,000 (9%) in 2023/24.
A new report by Northern Ireland’s Comptroller and Auditor General Dorinnia Carville found that these delays led to tens of thousands of instances of potential harm to patients.
It comes as hospital emergency departments (EDs) across the region continue to be under pressure with high volumes of patients.
The number of handovers taking more than three hours rose from around 400 in 2019/20 to just over 11,000 in 2023/24 (Liam McBurney/PA)
Earlier this year, Dr Nigel Ruddell, the medical director of the Northern Ireland Ambulance Service (NIAS), said that delays getting patients into emergency departments was leading to an increase in deaths.
Last December, the BBC reported that a patient waited 19 hours in the back of an ambulance outside an emergency department.
The Auditor General’s report, which pertains to the year 2023/24, found more than 36,000 instances in 2023/24 when patients may have potentially experienced some harm as a result of ambulance handover delays.
It also found around 3,800 occasions when patients were potentially subject to severe harm.
The report considers performance relating to the process of moving a patient from an ambulance into an emergency department to be seen by medical and nursing staff, and highlighted a “worsening performance” against the NIAS target of completing handovers within 15 minutes.
It found that in 2019/20, around 27% of handovers were completed in this time frame compared with 7% in 2023/24.
It also described the overall performance throughout Northern Ireland as much worse than in England and Wales.
The report outlined the impact of the longer times for ambulance handovers as including an estimated £50 million of lost operational capacity in NIAS between 2019/20 and 2023/24, with 25% of operational capacity lost in 2023/24 due to delays.
It also found a deterioration in NIAS performance when responding to 999 calls because of ambulances being increasingly tied up waiting outside emergency departments, and noted particular concerns around performance in relation to emergencies and potentially serious incidents.
Meanwhile, the report found an increased reliance on the unregulated private sector to address service provision gaps. In 2019/20, NIAS commissioned private sector ambulances to provide emergency department relief on more than 20 occasions. By 2023/24, this had risen to more than 1,000 occasions.
It noted that the delays in ambulance handovers were interconnected with other, well-publicised challenges and pressures on the health service, such as limited bed space within hospitals and delays in discharging patients fit to leave hospitals.
Auditor General Dorinnia Carville said the report included ‘recommendations, and good practice from other regions, highlighting key areas for improvement’ (Liam McBurney/PA)
The report also referenced other department-commissioned research which cited ambulance handover delays as the single biggest risk to patients in the emergency care system in the region.
Ms Carville described the length of time ambulances were waiting outside hospitals as “unacceptable”.
“Having ambulances waiting outside hospitals for lengthy periods of time is both unacceptable for patient well-being and a waste of public resources,” she said.
“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.”
In a statement the department of health said it will carefully consider the report’s recommendations.
“The department notes the recognition that the root cause of the delayed ambulance handovers is the wider severe health and social care system pressures and hospital discharge delays,” they said.
“Patients are waiting too long in ambulances outside our emergency departments as a direct consequence of poor flow in our hospitals and social care constraints.”
The department also said it recognises the risk of harm to patients and impact on the ability of NIAS to respond to their next emergency call.
They said reducing ambulance handover delays has been a “key priority for the department”, and it has undertaken a “significant programme of work”.
“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 said.
“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.
“The department is determined to find better ways to work as a system to tackle these complex issues.
“That is why the minister initiated a series of winter planning workshops to identifying solutions to the system flow issues that we collectively face.
“The department expects to see better outcomes in advance of next winter, including improvements to ambulance handover times.”
They added that the department is looking at initiative used elsewhere, and is engaging with the London Ambulance Service over a model it uses which has improved ambulance handover times.