Ambulance handover delays improve but still pose risk, watchdog says

Delays in handing patients over from ambulances to hospitals remain the most pressing challenge for Wales’s emergency care system, despite notable improvements within the ambulance service, a Health Inspectorate Wales review has found.

The review examined Welsh Ambulance Services University NHS Trust against five criteria – patient flow and handovers, operational pressure management, patient communication, leadership and governance, and data quality.

Inspectors concluded the trust is now in a materially stronger position than when earlier reviews in 2020 and 2021 highlighted serious concerns.

Key advances include reinforced leadership, enhanced workforce support, more robust clinical decision‑making and tighter digital governance.

In particular, the trust has introduced alternative routes to care, allowing some patients to be assessed and treated without a visit to an emergency department.

Data show ambulance handover performance improved, with the number of hours lost to handovers in November 2025 falling to the lowest level recorded in four years.

During periods of high demand, inspectors observed stronger capacity to manage pressures, citing better staffing arrangements and clearer escalation pathways.

Sickness absence among ambulance staff has also declined, although the inspectorate noted insufficient evidence yet to confirm the long‑term impact of wellbeing initiatives.

Alun Jones, Chief Executive of Healthcare Inspectorate Wales, said: “Our previous reviews of Welsh Ambulance Services University NHS Trust in 2020 and 2021 identified significant concerns relating to delayed handovers, patient experience and pressures across the urgent and emergency care system.”

He added: “It is encouraging to see that the Trust has responded positively to many of those findings and has made significant progress in a number of important areas.”

Jones highlighted the development of alternative care pathways, stating: “We found evidence of strengthened clinical decision‑making and alternative care pathways, helping some patients access appropriate care without needing to attend an emergency department.”

Nevertheless, he warned that delayed ambulance handovers continue to present challenges across the healthcare system.

“While progress has been made, we want to see stronger evidence that these changes are improving patient safety and delivering lasting benefits for patients,” Jones said.

The inspectorate’s latest recommendations focus on patient safety, patient experience, staff development, organisational learning and data quality.

It will continue to monitor the trust’s progress, stressing that handover delays are a whole‑system issue that cannot be solved by the ambulance service alone.

Health boards across Wales have been urged to collaborate more closely with the ambulance trust to streamline admission processes.

Hospitals are currently reviewing their emergency department capacity and triage procedures to reduce bottlenecks that contribute to prolonged handovers.

Welsh Ambulance Services has rolled out a digital handover platform intended to speed information exchange between crews and hospital staff.

Early feedback suggests the platform reduces paperwork and clarifies patient status, though full adoption across all trusts remains pending.

Training programmes for ambulance crews now include modules on rapid assessment and decision‑making to minimise unnecessary transfers.

Workforce support measures, such as flexible rostering and mental‑health resources, have been expanded in response to staff wellbeing concerns.

Despite the reductions in sickness absence, the inspectorate noted that staff turnover rates have not yet shown a comparable decline.

Patient advocacy groups have welcomed the progress but continue to call for transparent reporting on handover times and outcomes.

Data released by the trust indicate that the average handover time fell from 45 minutes in 2020 to 28 minutes in late 2025.

However, occasional spikes still occur during winter surges, when hospitals face heightened occupancy levels.

Health Minister Eluned Morgan has pledged further investment in emergency care infrastructure to support the trust’s ongoing reforms.

She affirmed that the Welsh Government will work with NHS Wales to address systemic pressures that impede timely patient transfers.

The inspectorate’s report underscores that sustained improvement will require coordinated action across ambulance services, hospitals and policy makers.

Stakeholders are expected to submit progress updates to HIW by mid‑2026, after which a follow‑up assessment will gauge the durability of recent gains.

For now, the trust’s leadership remains optimistic, citing the latest data as evidence that targeted interventions are beginning to bear fruit.

Continued vigilance will be essential to ensure that reduced handover times translate into tangible safety benefits for patients across Wales.