• NHS Improvement has told trusts to stop “unacceptable rules” which have delayed ambulances at emergency departments
  • Regulator says tackling delays is a “top priority” for patient safety, and reveals it is developing national support
  • NHS Improvement directors will scrutinise all long-wait ambulance turnarounds

NHS Improvement has warned acute trusts they could be risking patients’ safety by introducing “unacceptable rules” which can “delay” ambulances at emergency departments.

A letter from the regulator reveals concerns that hospitals are using rules or approaches which were causing additional delays to ambulance crews. NHS Improvement said it posed a risk to safety because it “takes ambulance crews off the road”.

In a letter to trusts, seen by HSJ, the regulator said: ”There is recognition that ambulance trusts’ response to 999 calls is impacted significantly by handover difficulties and protracted turnaround times at some hospital emergency departments.

”There are also incidents of unacceptable rules being applied by acute trusts to regulate or delay ambulance access and of ambulances queuing outside of EDs to transfer patients.”

It said ”no restrictions should be placed on ambulances in order to limit or regulate access to the emergency department” and that once patients were handed over they should be managed in the clinical setting most appropriate to their acuity.

NHS Improvement told the trusts that all ambulance handovers longer than an hour would be followed up by its regional leads every day. The regulator is also putting in place a programme to try to help trusts improve. A version of the letter was sent in December to all acute trusts across England.

A subsequent letter, also seen by HSJ and sent by NHS Improvement to acute trusts on 17 January, expanded on the safety risks of delayed ambulance handovers. It said: ”Time spent waiting to hand patients over takes ambulance crews off the road and reduces capacity of the ambulance service to respond to new calls.”

This letter added that “one of the most significant risks” the system faced was of patients waiting to be assessed by clinically trained paramedics after calling 999. It said Keith Willet, NHS England medical director for acute care, “has identified this issue as his top priority for improving patient safety and reducing clinical risks”.

“The key intervention required is to ensure that excessive delays, (i.e. over an hour) are escalated to executive director level in both organisations for action at the time.

“Execs and clinical teams may have to make difficult choices in order to free up the paramedic crews […] Please give this issue your immediate attention,” the letter said.

A spokesman for NHS Improvement told HSJ: “Improving the handover of patients from ambulances to hospitals is absolutely vital. We know that delays can have a real impact on patient safety by constraining the ability of the ambulance service to attend to the sickest patients promptly.

”Clinical teams make decisions every day, often under great operational pressure, in order to free up paramedics but there still isn’t a consistent approach in the sector.

“Time spent waiting to hand patients over takes ambulance crews off the road and reduces the number of the ambulances able to respond to new calls. NHS Improvement wants to see a significant reduction in hospital handover delays and an end to practices that get in the way of ambulance crews handing over their patients and getting back on the road.

“To enable us to work alongside the sector better we have started developing a new programme of enhanced support to help providers continue to improve the experience of those needing urgent medical attention.”

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