The essential stories and debate in the NHS

Handover delays reveal pressure points

Ambulances queuing outside hospital front doors are a stark visual metaphor for the extreme pressure on the NHS – but also a good indicator of where the system is most stretched and patients potentially most at risk.

Handover speed gives a good indication of flow through the system. Indeed, NHS England warned trust leaders in November that handover delays “must be recognised as a system wide responsibility”.

Wrightington, Wigan and Leigh hospital chief Andrew Foster wryly commented on Twitter earlier this week that it was “time to open up an ambulance trust with the lovely fleet of 14 parked outside the front door”.

The accompanying picture is an alarming sight, and not an isolated one. Performance has deteriorated over December. 

One in 10 ambulance handovers were delayed by 30 minutes or more in the week NHS England begun its winter SitRep reporting of the data (27 November to 3 December). By the week beginning on Christmas day, this had risen to one in six, according to NHS Providers’ winter tracker.

Our trust level analysis of the first five weeks of NHS England’s SitRep data reveals the depth of the problems facing the system and the areas struggling most – you can see where the hot spots are here.

A few things are apparent:

  • Three of the five most challenged trusts (United Lincolnshire, Princess Alexandra and East Lancashire) on delayed handovers were also on a list of consistent accident and emergency four hour underperformers published by HSJ in September.
  • Four of the five Essex hospital providers (Southend, Colchester, Princess Alexandra and Mid Essex) appear in the top 20 most challenged on handovers – underlining the issues in a long troubled health economy.
  • Providers from Kent and Lincolnshire – two other highly challenged health economies – are also on the list, underlining the relationship between handover delays and systemwide issues.

A quick health warning on the data itself: much of it is not validated and is provided, and published, at speed. It may include some inaccuracies. But statistical experts consulted by HSJ believe it gives a good overall picture of the system’s problems.

One senior provider source said the data showed how severely strained the system was. But the source stressed trusts were doing all they could to minimise delays and that without the planning put in place for winter these difficulties would probably have been worse.