Quarter of ambulance patients waiting more than an hour for A&E handover

One in four ambulance patients in England waited more than an hour to be handed to A&E teams at hospitals last week, as a combination of bed shortages and increased demand helped send delays to a new high.

Some four in 10 patients had to wait at least 30 minutes to be transferred to A&E.

Nursing leaders warned the NHS is “dangerously close to overheating completely” and said the figures suggested there was “absolutely no slack in the system”.

A total of 16,379 handover delays of more than an hour were recorded across hospital trusts last week, NHS England data shows.

This was 24% of all arrivals by ambulance, up from 17% the previous week.

The figure stood at 7% in the equivalent week in December 2021, and just 5% in December 2020.

Delays were high across the week, with no clear evidence that industrial action taken by nurses on Wednesday, December 15, had a specific impact.

NHS trusts in England have a target of 95% of all ambulance handovers to be completed within 30 minutes, with 100% to be completed within 60 minutes.

Overall, 28,105 patients, 41% of the total, had to wait at least 30 minutes last week to be handed over.

This is up from 34% the previous week, and compares with 20% at this point in 2021 and 15% in 2020.

A handover delay does not always mean a patient has waited in the ambulance.

They may have been moved into an A&E department until staff were available to complete the handover.

But the level of delays reflects the ongoing struggle faced by hospitals to find space for new arrivals.

An average of 22,771 people per day across England were ready to leave hospital last week, of which only 40% were discharged, down from 41% the previous week.

The average number of hospital beds occupied by people fit to leave stood at 13,697, up week-on-week from 13,245, and over a quarter higher than the equivalent week in December 2021.

Patricia Marquis, Royal College of Nursing director for England, said: “Health and care is under huge strain in the run-up to Christmas. These figures suggest there is absolutely no slack in the system, which is dangerously close to overheating completely.

“A key part of the problem is that the vast majority of hospital beds are full – around 95% – including with thousands of patients fit to be discharged. The lack of community and social care means they’ll be spending this Christmas in hospital.

“The real cause of this is record nursing vacancies in the NHS and tens of thousands more across health and social care. Ministers can only begin to fix this by addressing the record nursing vacancies and valuing the profession properly by paying nurses fairly to retain and recruit the staff patients need.”

Analysis of the latest data by the PA news agency shows that, among those trusts reporting at least 500 ambulance arrivals last week, the highest proportion of patients waiting more than an hour to be handed over was 58% at both University Hospitals Bristol & Weston (381 out of 655 patients) and Gloucestershire Hospitals (345 of 595).

This was followed by Northern Lincolnshire & Goole at 53% (311 of 590 patients), University Hospitals of Leicester at 52% (446 of 865), University Hospitals of North Midlands at 51% (333 of 651), Shrewsbury & Telford Hospital at 50% (271 of 540) and University Hospitals Dorset also at 50% (409 of 817).

Royal Cornwall Hospitals had 470 arrivals last week, of which 337 – 72% – waited over an hour to be handed to A&E teams.

A “wide-ranging set of pressures” is being faced by the NHS ahead of Christmas, health chiefs said, with rising flu cases and staff sickness adding to the struggle to clear ambulance handovers and delayed discharges.

An average of 1,939 people with flu were in hospital in England each day last week, up 67% on 1,162 the previous week.

There has been a surge in the number of flu patients in critical care beds, with the daily average standing at 149 last week, up 72% from 87.

Staff sickness is running at an average of 60,583 absences per day, up nearly a fifth on last month, while the number of staff off work because of Covid-19 has risen by a third since mid-November, to 7,218 a day.

Some hospitals are managing to discharge fewer than 10% of medically fit patients.

Levels last week fell as low as 5% at Stockport Foundation Trust, and 7% at Liverpool University Hospitals, Warrington & Halton Teaching Hospitals and the Northern Care Alliance in Greater Manchester, according to PA news agency analysis.

Other trusts with very low rates of discharging fit patients included Ashford & St Peter’s Hospitals in Surrey, Southport & Ormskirk Hospital and Worcestershire Acute Hospitals (all 10%), as well as Doncaster & Bassetlaw Teaching Hospitals (13%).

At a regional level, nearly half of medically fit patients in eastern England and London were discharged week (48%), compared with just 29% in north-west England and 33% in south-west England.

In north-east England/Yorkshire the figure was 42%, the Midlands 42% and south-east England 40%.