How Does the NHS Plan to Tackle Ambulance Delays?

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Kate Sweeney

Head of Clinical Negligence

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As part of its Long Term Plan that was announced in 2019, the NHS set out ambitions to eliminate existing ambulance handover delays. This refers to amount of time it takes for a patient to be transferred from ambulance paramedics to hospital staff.

We know that in a medical emergency, every second counts, and the existing handover delays are putting patients at significant risk of further injury or even death as they wait to be treated by hospital employees.  

As well as affecting patients who have arrived at hospital in an ambulance, these delays are also impacting wider communities who are facing excessive waiting times for an ambulance after calling 999.

Demonstrating the severity of this situation, NHS Improvement referred to the case of Matthew, who sadly died from an overdose. At the time of Matthew’s death, 21 ambulances were stuck at his nearest hospital, New Cross in Wolverhampton, and there were no paramedics available to attend to him – and he sadly died.

Despite this ongoing Long Term Plan, almost 1 in 4 ambulance handovers have experienced a delay of 30 minutes or more in 2022-2023. The Standard Contract for the NHS states that all handovers should be done with no more than 15 minutes waiting time, so this is double the expected time. In December 2023, UK Coroners issued a warning over deaths that were linked to ambulance delays. One prevention of future deaths report covered three deaths that were linked to ambulance delays affecting the South West Ambulance Service. One death had an 8 hour wait and another 13 hours.

In order to try and reduce the amount of time patients are waiting for an ambulance, or waiting to be admitted to hospital, the NHS Emergency Care and Improvement Support Team (ECIST) have developed key lines of enquiry (KLOEs) for ambulance services, covering six domains. We’ve explored each of these further in this article.

Read on to find out more or get in touch with our expert Medical Negligence Solicitors for advice that is tailored to your individual circumstances.

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What are the key Lines of Enquiry?

Ambulance Handover Standards

As part of the KLOEs for ambulance services, the ECIST has set out key standards which are intended to invite “critical review” and provide opportunities for improvement where it is needed. These include:

  • an ambulance handover should be completed within 15 minutes of arriving, meaning delays are rare and only occur when there is an extraordinary peak in demand;
  • where the time to handover exceeds or is likely to exceed 30 minutes, the handover escalation process is put in place;
  • if a handover has been delayed by an hour or more, it will be escalated to a regional level in a timely manner by the ambulance trust;
  • where ambulance handovers have taken over an hour, a breach analysis will be carried out;
  • patients should be registered with the Emergency Department within 15 minutes of arriving.

The standards also outline the facilities that should be available to paramedics at the hospital such as toilets, hand-washing areas and clean drinking water.

In addition, the ECIST have emphasised the importance of a shared understanding amongst hospital and ambulance staff of what each part of the handover process entails. There should also be a recognition that clinical responsibility lies with the hospital at the point the ambulance arrives.

These standards should be upheld in every area of the hospital, regardless of the patient’s condition, and patients should never be held in ambulances outside of hospital buildings.


As part of efforts to make the handover process as efficient as possible, the ECIST have recommended that a patient’s ability to be mobile should be monitored at every stage of the journey.

If a patient is able to walk or use a wheelchair, ambulance crews should refrain from using trolleys to transport them. But to effectively prevent excessive trolley use, there must be alternative equipment available to paramedics at all times.

In situations where the patient does not need to go to hospital, ambulance crews should provide an assessment of the patient to “out of hospital care pathways”, including urgent care centres. Ambulance clinicians should have access to a care co-ordination service so that care can be transferred as efficiently as possible.

Healthcare professional referred ambulance arrivals who are expected

In order to reduce the number of patients being registered in Emergency Departments, the KLOEs set out that patients who need to be seen by a specialist should be accepted directly by the relevant assessment unit.

It is important to note that the decision to bypass the Emergency Department must be made by an ambulance crew member who has sufficient knowledge and skills to identify patients requiring this type of care.

Senior review

The KLOEs state that ambulance trusts should have an established process in place that allows for clinical review by an ambulance clinician with the appropriate skills. They should be able to investigate a patient’s condition and transfer them to hospital staff accordingly within 30 minutes of arrival.

Site escalation

Escalation plans should focus on giving patients the ability to decide to move along the acute pathway, with the objective of creating space and capacity within the Emergency Department. These patients must be assessed by clinical triage and should have care provided to them at all times by hospital staff.

There should also be a recognition that having patients on ambulance trolleys in non-designated areas amounts to “corridor care” and having escalation plans in place should prevent this from happening.

System Risk

All clinicians and system leaders must be aware of the risk to patients whilst on their way to hospital and in the Emergency Department.

Senior leaders should be assigned to overseeing the development and implementation of clinical handover processes, enforcing the focus on patient safety. This will involve reporting delays and the number of patients waiting for ambulances at site-wide bed meetings so that a systemic response can be put in place.

Can I Make a Claim if I’m Affected by Ambulance Delays?

The consequences of ambulance handover delays can be devastating for patients and their loved ones. When vital medical care and treatment is not received in a timely manner, there is an enhanced risk that patients’ existing conditions will worsen, and in the worst cases, this can be fatal.

If you or a loved one has suffered a delay in receiving treatment or being diagnosed as a result of ambulance handover delays, we could help you claim for Medical Negligence compensation.

How Simpson Millar Can Help

Ambulance delays are largely caused by queues at A&E departments, meaning that the number of ambulances available is significantly reduced. The consequences of this can be devastating and we know of multiple cases where patients have died whilst waiting for an ambulance to arrive.

We know how hard it is to deal with the death of a loved one, or help you get back on your feet – so our compassionate and friendly team are here to help you. Get in touch with us today by calling us on 0808 239 6043 to find out if we can help you on a No Win, No Fee basis.


YouTube. (n.d.). Ambulance Handover Delays.

Nuffield Trust. (n.d.). Ambulance handover delays. Retrieved from

NHS England. (2021-2022). NHS Standard Contract. Retrieved from

The Guardian. (2023, December 2). UK coroners issue warning over deaths linked to ambulance delays and say it could get worse over winter. Retrieved from

NHS England. (2020). Reducing ambulance handover delays - key lines of enquiry. Retrieved from

NHS England. (n.d.). Reducing ambulance handover delays - Key Lines of Enquiry (KLOEs). Retrieved from

NHS England. (2013). Prior Acute Hospital Care. Retrieved from

Kate Sweeney

Head of Clinical Negligence

Areas of Expertise:
Medical Negligence

Kate has extensive experience both in leadership and in the field of Personal Injury. She has 10 years of experience in Clinical Negligence where she handled a wide range of client files as well as managing and growing the team. For the last 16 years, Kate has worked in the area of Personal Injury, leading the team alongside managing a small caseload.

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