Nearly 350 ambulances were tied up at hospitals for over an hour every day last year, as the national service identified delays as a “very high” risk to patient safety in its corporate risk register.
Official analysis shows 126,867 out of 355,593 ambulance handovers in 2025 — around 35.7% — took longer than an hour to complete at hospital. Before the pandemic, the figure was fewer than 1%.
And the Scottish Ambulance Service has set out the impact of delays on its operations, in a briefing circulated to MPs which warned that handover delays are leaving “fewer available ambulances to respond to new calls” and causing “longer waits — particularly for lower-acuity patients”.
The Scottish Ambulance Service's latest risk register shows that hospital delays are considered one of the its biggest risks, with the issue rated “very high”.
It says that handover delays would result in "harm to patients who are unable to access emergency departments or other hospital care in a timescale required by the acuity of their condition".
In the register, the service warns that delays can lead to “harm occurring to patients in communities who have not yet received an ambulance response because all available resources are stacking at local hospitals.”
The register highlights the wider impact of delays, including patients being left waiting for long periods without access to basic facilities, and staff being unable to take breaks or complete shifts on time.
In evidence circulated to some MPs, the service also warned the situation is leading to “increased clinical risk”, as delays reduce the number of ambulances available and extend waiting times.
Official data also shows a median turnaround time of 49 minutes, meaning half of all ambulance journeys involved crews spending close to an hour at hospital before they could respond again.
Turnaround time is measured from when an ambulance arrives at hospital to the point it is able to leave, including the transfer of care to hospital staff and any associated clinical or operational duties before crews can be redeployed.
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The analysis also shows that 30,672 journeys — around 8.6% — took more than two hours, while 13,655 took more than three hours, 6,654 exceeded four hours and 3,197 lasted over five hours.
The detailed breakdown of how long crews are spending at hospitals after transporting patients shows longer handovers have become increasingly common over the past decade with 0.8% of journeys taking more than an hour in 2014. This has risen to 4.6% in 2019, before increasing sharply in recent years to 13.9% in 2021, 26.6% in 2022, 27.9% in 2023 and 31.9% in 2024.
The service’s briefing states delays are being driven by pressure inside hospitals rather than demand alone.
It said the “most significant constraint is not demand alone, but restricted operational capacity”, pointing to delays in getting patients into wards after they arrive at accident and emergency wards. It said hospitals are struggling to move patients through the system, with high bed occupancy and delays in discharging patients meaning there is often nowhere for new arrivals to go.
As a result, ambulances are left waiting outside or inside emergency departments until staff can take over care.
The service warned this creates a knock-on effect across the system, stating that delays mean “the system becomes less able to absorb surges in demand”, leaving crews under sustained pressure. In practical terms, when hospitals are full, ambulances cannot hand over patients quickly which keeps crews tied up at hospital instead of responding to new emergencies.
The ambulance service said: "Ambulances are frequently delayed at hospital due to handover delays, reducing available fleet capacity. Crews are managing more complex patients, often requiring longer on-scene assessment and care."
Last November, the Scottish health secretary Neil Gray said that almost 100 new ambulance staff were expected to help the NHS cope with increased winter pressures.
The new recruits were to be placed across departments in time to support the busiest months of the year.
The previous winter, the SAS was placed on the highest level of emergency due to the "significant pressure" placed on services.
At that point growing pressure on services has led to queues of ambulances waiting outside accident and emergency departments during peak periods.
And figures from Public Health Scotland showed waiting times in A&E had been increasing since 2016.
More than 800 deaths in Scotland the previous year were believed to have been linked to long A&E waits, according to the Royal College of Emergency Medicine (RCEM).
The ambulance service briefing identified flow constraints within hospitals as a key driver of delays, including high levels of hospital occupancy and delayed discharge of patients due to limited community and social care capacity.
These factors, the service said affect how quickly patients can be moved through hospitals and how quickly ambulances can complete handovers and return to service.
It said: "Current pressures are best understood not as isolated issues within ambulance services or emergency departments (EDs), but as the consequence of system-wide constraints in capacity, flow, and access to alternatives to hospital care. While demand remains high, the dominant issue is a reduction in effective capacity across the system, which directly impacts response times, patient experience, and clinical outcomes.
"Sustainable improvement will depend on coordinated action across the system, with particular focus on improving patient flow, especially reducing hospital handover delays and delayed discharge, strengthening community and intermediate care capacity to reduce avoidable demand, expanding consistent, accessible alternatives to hospital care, aligning accountability across ambulance, hospital, primary and social care services [and] enabling ambulance services to operate as clinical integrators, not solely response and transport providers."
Emma Harper, SNP candidate for Galloway and Dumfries West said: "Waiting times are down for ten months in a row, operation numbers are up, we have more GPs and GP walk-in centres are opening all over the country – the SNP’s plan for the NHS is working.
“Under the SNP, we have seen a 62% increase in the number of paramedics working in the Scottish Ambulance Service over the past decade - with an increase of 450 since 2020 alone.
“There is of course still much work to be done, but under John Swinney’s reliable and trusted leadership, we are determined to see through our plan and a re-elected SNP government will work tirelessly to carry on improving Scotland’s NHS.”
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