Staff frustration and delays: Ambulance waits causing 'risk of harm'

A "dramatic deterioration" in ambulance handover performance is placing an increasing number of patients at potential risk of harm or even significant harm, a report has said.

Northern Ireland's comptroller and auditor general said about 3,800 patients were potentially subjected to severe harm last year because of ambulance handover delays.

Claire Smales, whose father Robert waited 23 hours for an ambulance in January, said the situation was "frustrating" for ambulance staff.

The Department of Health said it welcomed the report and would carefully consider its recommendations.

The report, by Dorinnia Carville, also identified that potentially more than 36,000 patients may have experienced some harm and that delayed handovers cost about £50m over the past five years.

It considered the performance of the process of moving a patient from an ambulance into an emergency department (ED) to be seen by medical and nursing staff.

Once Ms Smales' father got to the Ulster Hospital, he then had to wait a further nine hours in the ambulance, followed by another eight hours inside the ED before he was admitted.

Ms Smales told BBC News NI's Good Morning Ulster that the experience was "an ordeal" for her father, who is 88 and has dementia.

"I don't know quite what caused [the delay] but it was a significant wait and it was quite frustrating for the ambulance staff as well," she said.

"Their entire shift was spent talking to an old man who had been waiting for a long time at the hospital and then sitting outside the hospital with him.

"That's not what they want to do. They want to go out and help people. That was clear from talking to the ambulance staff."

In December 2024, the longest ambulance handover for a patient was 23 hours, although targets stipulate all handovers should be complete within 15 minutes.

This target has been comprehensively missed since 2019, the report said, and the overall performance throughout Northern Ireland is much worse than England and Wales.

In the past two years, only 7% of Northern Ireland Ambulance Service (NIAS) handovers met this target.

Despite a commitment from trust chief executives in February 2023 that no ambulance would take longer than two hours to hand over a patient to an ED, the NIAS recorded multiple handovers every day that are longer than 10 hours in recent months.

Last year, 11,000 ambulance handovers took more than three hours, up from about 400 five years ago.

Ambulance handover performance deteriorated considerably between 2019 and 2024 at all nine local hospitals with major EDs.

However, the Ulster Hospital, in the South Eastern Trust, has consistently recorded the longest handover times.

NIAS's performance when responding to 999 calls has deteriorated because of ambulances being increasingly tied up waiting outside EDs, which has raised concerns around performance in relation to emergencies and potentially serious incidents.

The NIAS said the current challenges were a result of the pressures faced across the entire health and social care system and which are manifested most in the pressures at EDs and patient flow through hospitals.

NIAS medical director Dr Nigel Ruddell told BBC Radio Foyle's North West Today that he was hopeful the report would act as a catalyst for change.

"There is risk of it deteriorating further, but we are hoping this very powerful report will give a wider understanding of what we have been describing for quite some time and give the impetus for significant change to happen," he said.

The number of Serious Adverse Incidents (SAIs) which NIAS has attributed to delays in responding to patients has also risen considerably, from eight in 2020-21 to 35 in 2023-24.

SAIs are declared for events or circumstances that could have led to harm or damage, including loss of life.

Last year 31 people passed away waiting for an ambulance, which is almost eight times more than the number of deaths four years ago.

The report also found that Northern Ireland is increasingly reliant on private ambulances, but they remain unregulated.

This reliance has increased 5,000% over the past five years.

Last year private ambulances were used on more than 1,000 occasions for emergency purposes at a cost of £3.6m.

The report highlighted how timely ambulance handovers rely significantly on other aspects of the emergency care system functioning effectively and the importance of NIAS and health trusts working together.

The audit office report said the current situation was "both unacceptable for patient wellbeing and a waste of public resources".

Ms Carville has made recommendations and highlighted key areas for improvement including:

• each health trust implementing decisive measures to improve ambulance handovers urgently
• improving oversight and regulation of the private ambulance sector
• sustained work by NIAS to reduce it sickness absence rate
• an increase in the proportion of patients NIAS refers to alternative care pathways

The Department of Health (DoH) said the report underlines the seriousness and scale of the pressures facing health and social care services.

"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 added.

The DoH said there is "no quick fix" and additional funding will be required.

The South Eastern Trust said the report "once again highlights the pressures on our staff who, liaising closely with NIAS, work extremely hard, under enormous pressure, to care for patients when they need it most".

It said the average ambulance turnaround time at the Ulster Hospital improved by 34% in February 2025 compared to 2024.