A “dramatic deterioration” in ambulance handover times at emergency departments (EDs) in the North is placing a “significantly increased” number of patients at risk of harm, according to a report by the Northern Ireland Audit Office.
The study, published on Tuesday, identified more than 36,000 potential instances in 2023-24 when patients may have experienced some harm due to delays in being handing over to hospital staff. It found a further 3,800 or so occasions when patients were potentially subjected to severe harm.
The risk arises largely due to patients having to wait in ambulances outside EDs, the report said, highlighting one incidence at Ulster Hospital last December where the handover took more than 23 hours.
There has also been a “deterioration” in the Northern Ireland Ambulance Service (NIAS) response to 999 calls because ambulances are increasingly tied up waiting outside EDs. The risks to patients are “compounded” by the “unacceptably long” responses to emergency calls, the report said.
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The report found the number of ambulance-to-ED handovers taking more than three hours has risen from around 400 (less than one per cent) in 2019-20 to more than 11,000 (nine per cent) in 2023-24.
The NIAS target of completing all handovers within 15 minutes has been “comprehensively missed”, the report said, with only 7 per cent completed within that time frame in 2022-23 and 2023-24, compared to about 27 per cent in 2019-20.
More than a third (34 per cent) of handovers took more than an hour to complete in 2023-24.
The report added that while the review focused on the five-year period from 2019-24, “the months prior to the publication of this report have seen some exceptionally poor performance”.
“NIAS is recording multiple handovers every day that are longer than 10 hours,” it said.
[ Nurses in North join call for emergency plan to tackle ED overcrowdingOpens in new window ]
The report noted that handover delays were connected to other “significant” challenges facing the health service in Northern Ireland.
The handover times were significantly worse than in England and Wales, while the data could not be compared to the situation in Scotland.
In her report, Northern Ireland’s Comptroller and Auditor General, Dorinnia Carville, said the “serious deterioration” in the time taken to complete ambulance-to-ED handovers is placing a “significantly increased” number of patients at risk of harm, or significant harm.
Her report put the cost of handover delays over the last five years at €59.5 million (£50 million). A quarter of the operational capacity of the NIAS was lost due to delays in 2023-24, it said.
As a result of the worsening delays, NIAS has become “increasingly reliant” on the unregulated private ambulance sector to address gaps in service provision, at increasing cost.
The Ms Carville said having ambulances waiting outside hospitals for lengthy periods is “unacceptable for patient wellbeing and a waste of public resources”.
She said addressing the issue will be “challenging”, but the report’s recommendations “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”.
The report made 11 recommendations and said hospital trusts and the NIAS “must work collaboratively to implement decisive measures to improve ambulance handover performance as a matter of urgency”.
