Delayed patient handovers are still a problem facing the Welsh Ambulance Service Trust (WAST), a Health Inspectorate Wales (HIW) report has found. The latest assessment looked at progress across five key areas: patient flow and handovers, managing operational pressures, patient communication, leadership and governance, and data quality.
Progress and noteworthy practice
The assessment found clear progress in the management of patient flow and delayed ambulance handovers, stating WAST has strengthened clinical decision-making and worked within the healthcare system to develop alternative ways for patients to access appropriate care without attending an emergency department. It identified several examples of noteworthy practice, including initiatives that provide patients with earlier clinical assessment and help direct them to the most appropriate care.
HIW also noted improvements in ambulance handover performance, with handover lost hours in November 2025 falling to their lowest level in four years. Significant improvements were identified in how WAST manages periods of high demand and operational pressure. Leadership capacity, workforce support, speaking-up arrangements and training and development infrastructure have all strengthened since the previous reviews.
Ongoing challenges
However, handovers remain an area of concern for the inspectorate. The HIW report states: "Whilst improvements have been made, delayed ambulance handovers remain the most significant challenge and continue to present a risk across the urgent and emergency care system."
"Although many improvements have been implemented and appear to be embedded, further evidence is needed to demonstrate that these changes are delivering lasting benefits for patients, staff and services, particularly by improving patient safety and reducing the risks associated with delayed handovers and prolonged waits for care. HIW also recognises that delayed handovers are a whole-system issue which WAST cannot resolve alone."
WAST also provided evidence that sickness absence had reduced, although there is not yet enough evidence to demonstrate the sustained impact of its workforce and wellbeing initiatives. The trust has strengthened its digital governance and increased investment in improving the quality of information used to support patient care, service planning and performance monitoring, the report said, adding it has also taken steps to manage increasing pressures on its non-emergency patient transport service.
Recommendations and responses
Chief executive of Healthcare Inspectorate Wales, Alun Jones, 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."
"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. 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. However, 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. Our recommendations are intended to support the next phase of improvement and help ensure positive changes are sustained."
HIW has made recommendations focusing on patient safety, patient experience, staff development, organisational learning and data quality, and will continue to monitor progress through its ongoing work with WAST.
Chief clinical officer at the Welsh Ambulance Service, Andy Swinburn, said in response: "We welcome the review from Healthcare Inspectorate Wales (HIW) and we are pleased that HIW have recognised the improvements we have made in the last few years."
"Given the scale of work being undertaken by the service, it is no coincidence that in November 2025, we saw handover lost hours fall to their lowest level in four years. However, we constantly strive to deliver the best possible service to the people of Wales and we recognise that while this is an encouraging step in the right direction, there is still a lot more work to be done."
Swinburn added: "We will continue to work with health boards and partners across the wider NHS to improve our services wherever possible and we remain committed to the Handover 45 principles, which aim to see no ambulance handovers at emergency departments exceed 45 minutes."
