The Northern Ireland Ambulance Service (NIAS) is a cornerstone of the emergency healthcare system, responding to hundreds of thousands of calls each year. In moments of crisis, countless people across Northern Ireland depend on this critical service. However, in recent years, the system has faced unprecedented pressure, most notably reflected in significant delays in ambulance handovers at Emergency Departments.

Currently, only 12% of ambulance arrivals at hospitals meet the target handover time of 30 minutes, resulting in the loss of nearly 120,000 on-the-road hours in 2023/24 alone. In some hospitals, handover delays span multiple hours, with extreme cases exceeding 24 hours.

These are not just statistics; they represent real human lives. Seventy people have lost their lives in the last five years as a direct consequence of ambulance delays, and 97,000 people have had to have their calls escalated while waiting for an ambulance. Many more have seen their conditions worsen as they wait for help to arrive.

Ambulance delays affect everyone when they need urgent help, and rural communities have been disproportionately impacted. The dire impacts are also felt by overburdened healthcare professionals who continue to face immense and unsustainable pressure.

A decade of political mismanagement has driven us to this unacceptable state. Successive Executives have shirked their responsibilities, allowing our health service to fall into a state of decay. The system is now at breaking point, with hollow promises of transformation and political stability amounting to nothing more than empty rhetoric. This crisis isn’t the fault of a single minister or party; it’s the result of a collective failure of leadership.

This situation is intolerable. Urgent action is needed to address this crisis and its devastating human consequences. Yet, despite the urgency, little progress has been made in resolving the ambulance crisis. The argument against immediate intervention is often based on the notion that systemic transformation is required across staffing, capacity, patient flow, and discharge processes. While these issues are undoubtedly critical, waiting for comprehensive reform does nothing to address the immediate crisis.

We need to start somewhere. It is unacceptable for people to die waiting for an ambulance or to spend hours—even days—in an ambulance outside a hospital.

This paper proposes the introduction of a mandatory 45-minute limit for ambulance handovers, drawing on models that have been successfully implemented elsewhere. In doing so, this aims to get ambulances back into the communities where they are needed, rather than stalled outside emergency departments.

This work has been informed in part through site visits with Emergency Departments and Ambulance Services in Northern Ireland and England.

You can view the full 'Help Can't Wait' plan below: