Ambulances in England “lost” 35,000 hours queuing outside busy emergency departments, leaders have warned.
Services across England are operating under their highest ever operational level – indicating they are under “extreme pressure” – as patients are sometimes being forced to wait for treatment due to backlogs in emergency departments.
NHS leaders have ordered hospital bosses to “eliminate” ambulance delays and to stop using ambulance as extra emergency department “cubicles”.
Ambulances are supposed to be able to hand patients over to hospital staff within 15 minutes of arriving at the emergency department.
But the proportion waiting for more than an hour increased from 4,700 in April 2021 to over 35,000 in September 2021, according to the Association of Ambulance Chief Executives.
Here are some of the regional responses to current pressures:
– West Midlands Ambulance Service raised its risk rating for handover delays to its highest possible level for the first time in its history.
The risk rating shows that the trust believes that patient harm is “almost certain” due to the handover delays.
Board papers for the organisation state: “Unfortunately, there have been several cases where severe patient harm has occurred due to the hospital delay resulting in several serious incidents.”
The trust is conducting an investigation with Worcestershire Royal Hospital after reports suggested that a patient died following a five-hour wait in an ambulance at the doors of the emergency department.
The organisations said in a joint statement with the hospital trust: “We are aware of an incident where a patient died shortly after being taken into the Emergency Department of Worcestershire Royal Hospital on October 5.
“We have launched a joint investigation into the circumstances. While that investigation is ongoing it would be inappropriate to say anything further at this stage, other than to express our condolences to the patient’s family, who are being kept fully informed.”
– Another patient is said to have died in the back of an East of England Ambulance Service vehicle which was waiting outside Addenbrooke’s hospital in Cambridge.
An East of England Ambulance Service spokesperson said: “Sadly, a patient who had been transported by ambulance to Addenbrooke’s died before they could be transferred into the A&E department after their condition deteriorated.
“Our thoughts are with the family at this very difficult time, and the hospital has launched an investigation into the incident.
“In order to minimise any unnecessary pressures on A&E and our ambulance services, we urge the public to contact NHS 111 first if they feel unwell and are uncertain where best to seek treatment.”
A Cambridge University Hospitals NHS Trust spokesperson said: “During an extremely busy night in our Emergency Department, a patient was brought to Addenbrooke’s by ambulance with chest pains.
“They were assessed by a registered nurse on arrival and remained in the ambulance, due to significant pressures on A&E, where they were monitored by paramedics.
“Our Emergency Department staff supported the paramedics when the patient’s condition deteriorated, but sadly they died following a cardiac arrest.
“An investigation has now been launched by CUH and our thoughts are with the family at this very difficult time.”
– North East Ambulance Service said its longest handover time in September was four hours and 42 minutes.
Paul Liversidge, deputy chief executive at North East Ambulance Service, said: “Demands on our service have increased due to a rise in calls to 999 and 111, employee absence and the wider pressures being felt across the NHS in our region.
“We are currently experiencing some of the highest handover times we’ve ever seen.
“The timely handover of patients at our local hospitals is key to us being able to free up our crews.
“If our ambulance crews are stuck at hospital, they are not available to respond to 999 calls, leading to potential ambulance delays in the community
“However, we appreciate the difficult job our hospital colleagues face and we continue to work closely with them to try and relieve demand in a bid to ensure patients are seen as quickly as possible.
“Members of the public can help us by considering which service suits their needs best, keeping emergency services free for those whose life is at risk, taking the necessary precautions to stay safe and well during the pandemic and treating all NHS colleagues with dignity and respect so that they can remain well to keep our services running.”
– A spokesperson for South Central Ambulance Service said: “We remain very busy and would urge people to make use of alternatives to 999 if they are not facing a serious or life-threatening emergency, including visiting NHS 111 online at 111.nhs.uk.
“We continue to work closely with all our hospitals to manage demand and are working hard to respond to all patients who need an ambulance response as quickly as possible while prioritising our most seriously ill and injured patients.”
– East Midlands Ambulance Service board papers state that handover delays are the “main issue” facing the trust.
“Since the beginning of the summer we have started to see the hospital handover position deteriorating significantly. This relates to the delays we are experiencing in being able to hand over our patients on arrival at hospital,” according to the papers.
– London Ambulance Service issued a statement last week urging the public to help combat “unprecedented demand”.
It said in a statement: “We have faced unprecedented pressure since the start of the Covid-19 pandemic. But, 2021 has been different to previous years as the levels of demand in spring and summer months – and now into autumn – have remained high.
“Usually, the summer months and weeks into early autumn will see us experience periods of relative respite ahead of winter, where demand traditionally increases.
“What is different this year is that the number of calls to our 999 control rooms rose to 6,000 a day in the spring. The daily call rate figure has stayed around or above 6,000 ever since and has, on occasions, even gone above 7,000 calls in a 24 hour period.”