Delayed patient handovers by ambulances in Wales ‘remain a challenge’, inspectors have found.

Healthcare Inspectorate Wales (HIW) assessed the progress made by Welsh Ambulance Services University NHS Trust (WAST) since reviews published in 2020 and 2021 in a new report which looked at progress across five key areas: patient flow and handovers, managing operational pressures, patient communication, leadership and governance, and data quality.

Overall, HIW found that WAST has made “significant progress” since the previous reviews and is “in a materially stronger position than at the time of those reviews.”

Many improvements appear to be embedded within routine governance and operational practice, including improvements in leadership, workforce support, clinical decision-making and digital governance, the report said.

The assessment found clear progress in the management of patient flow and delayed ambulance handovers ans said that 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.”

HIW 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.

“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,” HIW said.

“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.”

HIW has made recommendations to support the next phase of improvement focussing on areas including patient safety, patient experience, staff development, organisational learning and data quality.

HIW will continue to monitor progress through its ongoing work with WAST.

Alun Jones, Chief Executive of Healthcare Inspectorate Wales, 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.”