More than 1,000 patients a day in England are suffering “potential harm” because of ambulance handover delays, the Guardian can reveal.
In the last year, 414,137 patients are believed to have experienced some level of harm because they spent so long in the back of ambulances waiting to get into hospital. Of those, 44,409 – more than 850 a week – suffered “severe potential harm”, with delays causing permanent or long-term harm or death.
In total, ambulances spent more than 1.5m hours – equivalent to 187 years – stuck outside A&Es waiting to offload patients in the year to November 2024, the Guardian investigation found.
Experts said the figures were “staggering” and showed how the NHS was in a more “fragile” state than ever before, amid a “perfect storm” of record demand for A&E, soaring numbers of 999 calls, and an increasingly sicker and ageing population.
The analysis of NHS data by the Guardian and the Association of Ambulance Chief Executives (AACE) highlights the huge scale of the challenge facing Keir Starmer as he prepares to set out how he plans to rescue the NHS.
Anna Parry, the managing director of AACE, which represents the bosses of England’s 10 regional NHS ambulance services, said the data “speaks for itself”.
She added: “These figures underline what the ambulance sector has been saying for a long time – that thousands of patients are potentially being harmed every month as a direct result of hospital handover delays.”
Ambulance handover delays occur when ambulances arrive at A&E but are unable to hand patients over to staff due to units being busy. It also means paramedics are unable to get back on the road to attend to other patients.
The delays mean patients are either forced to wait in the back of ambulances outside or are moved into A&E but hospital staff are not available to complete the handover from paramedics.
National guidance says patients arriving at an emergency department by ambulance must be handed over to the care of A&E staff within 15 minutes.
However, the target is persistently missed, the Guardian investigation found. Crews often wait many hours and sometimes whole 12-hour shifts outside hospitals, with queueing ambulances unable to respond to other emergency calls.
Last week almost a third of patients arriving by ambulance at hospitals in England – 32.1% – waited at least 30 minutes to be handed over to A&E teams.
The Guardian analysis is the first time a media organisation has examined a whole year’s worth of data on ambulance handover delays and the potential harm caused.
Ambulance crews lost 1,641,522 hours waiting to hand over patients to A&E staff due to delays exceeding 15 minutes in the 12 months to November 2024. That figure is up 18.5% on the same period the year before, the investigation found.
AACE estimates that 414,137 patients may have come to harm as a result of delays exceeding one hour in the last year – more people than the population of Coventry, England’s ninth largest city. That figure is up 18.7% on the year before.
Of those patients who suffered potential harm, 44,409 were estimated to have come to severe harm. That number is also an 18.7% increase on the year before.
Dr Adrian Boyle, the president of the Royal College of Emergency Medicine, said the findings of the Guardian investigation were “staggering” and reflected the “lack of capacity” in NHS urgent and emergency services.
“People are waiting for ambulances, waiting in ambulances and waiting on ambulance trolleys in hospital corridors because emergency departments are too full – causing potential harm.
“There needs to be an urgent focus on the ‘exit block’ – an increase in bed numbers to be able to move people from A&E to wards, and appropriate social care options to ensure people deemed medically well enough to go home, can do so.
“Only then will we see meaningful change at the front door of our hospitals.”
On Friday, NHS Cornwall and Isles of Scilly declared a critical incident because of long ambulance queues outside the Royal Cornwall hospital in Truro and high A&E patient numbers, with many people medically fit for discharge but awaiting the right care.
Rory Deighton, the acute network director at the NHS Confederation, said the Guardian’s revelations exposed a crisis in emergency care.
“As these figures show, patients are unfortunately often having to wait too long for an ambulance, and when they do reach hospital, as we’ve seen in recent days, handovers can also be delayed with many emergency departments forced to use temporary solutions like corridor care in a bid to meet demand.”
Deighton said tackling “shortfalls in social care provision” would be crucial to cutting ambulance handover delays by speeding up discharge of hospital patients and helping more older people avoid admissions in the first place.
“But the reality is that years of underinvestment in the NHS and social care, alongside rising levels of ill health in the country, mean our local health and care services are more fragile than ever.”
Adam Brimelow, the director of communications at NHS Providers, said the figures were “very worrying”. A “perfect storm” of very high numbers of the most urgent category of 999 calls on top of record A&E attendances had led to “real capacity challenges”, he said.
“Recent months have seen some of the busiest ever for ambulance callouts and stretched teams face an uphill battle when demand goes through the roof and outstrips available resources.”
Parry said a “high-priority focus” on cutting handover delays was essential to ensure ambulances were available for those most in need. The crisis was “not intractable”, she added.
The Department of Health and Social Care said long ambulance handover delays were “completely unacceptable” and its plans to “rebuild” the NHS would improve emergency care.
A spokesperson added: “This includes the investment and reform we have announced in social care and the 1,000 extra GPs we are recruiting, which will reach patients earlier, help keep them well, and ease pressures on ambulance services.”
An NHS England spokesperson said that while handover delays had improved before this winter, there was “clearly much more still to do” to reduce “unacceptably long waits for patients” in some parts of the country.
The NHS was “prioritising the sickest patients” and doing all it could to prevent avoidable admissions, including treating patients at home where possible and only admitting patients to hospital when necessary.
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