Picture this. You have a medical emergency that requires you to call 999. The ambulance crew arrives to your door on blue lights, finds out what is happening and provides you with the emergency treatment that you need straight away. They tell you that they need to take you to the Emergency Department (ED). When they arrive, you are stretchered into the department, to find yourself in the back of a queue of other ambulance patients on stretchers. You wait for over an hour for the crew to be able to handover your care to the ED. Frustrating? You’re not alone. In 2024, over 61,000 patients in the Northeast and Yorkshire alone waited over an hour to be handed over.
Each delayed handover locks a crew outside hospital, leaving fewer ambulances on the road for the next stroke or sepsis call and lengthening the time critically ill patients wait for definitive care.
A shifting policy landscape
The Urgent and Emergency Care Plan 2025/26 frames long handovers as both a symptom and a driver of poor flow. A new Release to Rescue standard (also known as “withdraw at 45” or “rapid release protocol”) requires trusts to clear every ambulance within 45 minutes once a 30-minute threshold is reached, a move expected to release more than half-a-million crew hours each year. Meanwhile the forthcoming 10 Year Health Plan for England pledges a fundamental shift from hospital-centred to community-centred care, signalling that reliable ambulance turnaround times will be a barometer of wider system reform.
Yet national targets alone cannot explain why handovers stall in one hospital bay but not in another, nor predict how a 45-minute ceiling will play out against winter pressures. That gap motivates our NIHR YH ARC study.
What we are doing
We have formed an extensive collaboration between NHS partners across Yorkshire to examine this problem in more detail. We are linking every adult conveyance by Yorkshire Ambulance Service (YAS) to a Type 1 ED between 1 February 2019 and 31 March 2023—over two million records once Computer-Aided Dispatch, ED attendance, admitted-patient care and Office for National Statistics mortality data are combined. We are using a national database held at the University of Sheffield called CUREd+ to undertake the analysis (https://sheffield.ac.uk/data-connect/data-assets/cured-research-database) to:
- Identify determinants of prolonged handover at patient, ambulance and hospital level, using penalised regression and machine-learning models to rank modifiable drivers.
- Quantify consequences for seven- and thirty-day mortality, length of stay, ambulance response and on-scene times.
- Model system effects such as the monthly proportion of handovers ≥ 60 minutes and its relationship to regional response performance.
Because the 45-minute rule is being implemented as we write, we are also building a prospective stream of live YAS and ED data to evaluate adherence and early impact. Protocol development is under way; first interim analyses are planned for spring 2026.
The qualitative lens
Numbers do not capture operational nuance. Our parallel qualitative study is therefore conducting in-depth semi-structured interviews with chief operating officers, strategic leads and frontline managers across six EDs in Acute NHS Trusts, as well as with staff from YAS. The study is guided by the Consolidated Framework for Implementation Research (CFIR) and aims to explore:
(1) How the “withdraw at 45” initiative is being implemented in each ED
(2) The key challenges, facilitators, and opportunities for improvement
(3) The perceived impact of the initiative on factors such as patient care, handover delay times, the ED, and YAS.
Data collection is currently underway, and the final report will be available in March 2026.
Why this matters
Ambulance handover may look like an ED logistics problem, but every extra minute outside hospital echoes down the urgent-care pathway, delaying treatment for the next patient in the queue and eroding public confidence. By pairing big-data analytics with frontline experience, our study will offer region-specific evidence to help leaders make the 45-minute ceiling stick—and perhaps move closer to the 15-minute gold standard that preceded today’s crisis.