While national figures suggest some stability in urgent and emergency care, the latest NHS England winter situation reports (sitreps) reveal a concerning trend: ambulance handover delays have significantly deteriorated at 21 acute trusts across England this winter compared to the same period last year. Ambulance handovers—the critical transfer of patient care from paramedics to accident and emergency (A&E) staff, are a key indicator of urgent care flow. The worsening performance at these specific trusts underscores the growing variation in system pressures across the NHS, with delays far exceeding the recommended 15-minute standard. The crisis is concentrated in acute hospitals, particularly in the South West, Midlands, and major urban centres, regions already struggling with high demand and bed occupancy challenges.
A number of trusts recorded alarmingly high delay rates, highlighting severe flow blockages. Royal Cornwall Hospitals NHS Trust, for instance, saw approximately 82% of ambulance arrivals delayed by over 30 minutes, with a staggering 67% exceeding 60 minutes. University Hospitals Plymouth NHS Trust reported similar figures, with around 80% of handovers over 30 minutes and 66% lasting longer than an hour. Torbay & South Devon NHS Foundation Trust also faced severe issues, with approximately 72% of handovers exceeding 30 minutes and 56% taking over an hour. These figures are much higher than the national average, where nearly 31% of all ambulance arrivals nationally were delayed for more than 30 minutes during the 2024/25 winter, a situation that has persisted into 2026.
Sustained pressure is evident across multiple regions, with high delay proportions significantly exceeding targets. Other trusts reporting major delays, with a high percentage of handovers exceeding 30 minutes, include Great Western Hospitals NHS Foundation Trust (64%), Portsmouth Hospitals University NHS Trust (63%), and Royal United Hospitals Bath NHS Foundation Trust (65%) in the South West/South Coast. In the Midlands and North, Nottingham University Hospitals NHS Trust and University Hospitals of North Midlands NHS Trust both saw around 62% of handovers delayed by over 30 minutes. University Hospitals Birmingham NHS Foundation Trust (approx. 53%), The Shrewsbury & Telford Hospital NHS Trust (60%), and George Eliot Hospital NHS Trust (59%) also reported significant delays. Several other trusts, including The Princess Alexandra Hospital NHS Trust, Northampton General Hospital NHS Trust, and James Paget University Hospitals NHS Foundation Trust, recorded around 50% of handovers exceeding the 30-minute mark.
The root cause of these delays is the limited capacity within A&E departments, driven by high bed occupancy and persistent delays in patient discharge, which prevents staff from quickly accommodating incoming patients. National guidance aims for 95% of handovers within 30 minutes and 65% within 15 minutes, targets that most trusts are currently failing to meet. These delays have severe consequences: ambulances tied up waiting to hand over patients are unavailable for new 999 calls, drastically compromising the ability to respond to urgent incidents. Furthermore, trade unions express concern that the prolonged care of patients in ambulances by paramedics compromises the quality of care and increases workforce strain.
The trusts with the worst metrics, particularly Royal Cornwall Hospitals, University Hospitals Plymouth, and Torbay & South Devon, clearly illustrate how localised operational issues, including workforce shortages, intense bed pressure, and discharge bottlenecks directly translate into poor urgent care performance. For policymakers and the public, the worsening performance at these 21 trusts highlights that significant variation across the NHS remains a key challenge in urgent care delivery, even as broader efforts are made to stabilise performance across England's healthcare system.
