A&E handover delays ‘still getting worse at some hospitals’

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A&E handovers in ‘decay’ at some hospitals despite improvements elsewhere, say ambulance chiefs
Chiefs highlight ‘significant’ regional variation in handover delays
Improvements remain ‘fragile’ ahead of winter, says AACE

Ambulance chiefs say handover delays have got worse at some trusts in recent months, despite the picture improving nationally since last winter.

A report from the Association of Ambulance Chief Executives, published today, says there are continuing concerns about handover delays at emergency departments.

Jason Killens, the body’s lead chief executive for operations, told HSJ: “There’s been some improvement [at some sites] since February, but what we’ve also seen is a commensurate or bigger decay in other sites across that same period.”

Mr Killens said “it’s difficult to be precise” about why some trusts have struggled more than others but that challenged hospitals are often affected by “pathway issues” including delayed discharges.

“And then maybe there are challenges around stable leadership or the visibility of the leadership, the culture there about managing that risk dynamically, and so on,” he added.

Mr Killens said there was a “sharp rise” in the number of handover delays due to extra demand on emergency services during the hot weather last week, which “demonstrates the fragility” of the improvements made.

AACE’s report seeks to demonstrate that a small proportion of hospitals account for a large proportion of handover delays.

Analysis by HSJ shows there were eight acute trusts where more than 10,000 “hours lost” were reported from mid-November last year to the end of February, which accounted for 25 per cent of all hours lost nationally.

Name	Total hours lost last winter	% of national total
University Hospitals Plymouth Trust	20,829	5%
Royal Cornwall Hospitals Trust	15,719	4%
University Hospitals Bristol And Weston FT	13,066	3%
University Hospitals Dorset FT	12,710	3%
University Hospitals Birmingham FT	11,753	3%
Norfolk And Norwich University Hospitals FT	11,426	3%
Gloucestershire Hospitals FT	10,616	2%
University Hospitals Of North Midlands Trust	10,247	2%

Gloucestershire Hospitals said it had worked hard to make improvements since last winter, but said there were various ongoing difficulties. Royal Cornwall said the improvement had been made, but cited “continued fluctuations in activity” which causes challenges. Other trusts in the table were also approached for comment.

The AACE report also charted the major increase in the frequency and length of hospital handover delays nationally over the past decade. In 2011, around 20 per cent of handovers were exceeding the expected 15-minute target, with delays over an hour rare.

But by 2022-23, 68 per cent of all hospital handovers throughout the NHS were taking longer than 15 minutes and 14 per cent were taking longer than an hour, with many stretching for several hours.

The report also features examples of good practice from trusts which have managed ambulance handovers well, stressing the importance of visible leadership, culture within the hospitals, collaboration between system partners, and assessment of category three and four 999 calls to reduce ambulance call-outs, among other factors.

It thanked the following hospitals for their efforts on this; Chesterfield Royal; George Eliot; Homerton; John Radcliffe Hospital; Milton Keynes General; North Tees; Royal Berkshire; Salford Royal; Walsall Healthcare Trust; and West Middlesex.

NHS England said handover delays had fallen since the start of the year, following an “incredibly challenging” winter. It said “substantial improvements in ambulance response times and A&E performance” had been made since then, pointing to measures set out in the urgent and emergency care recovery plan.