The past two months have provided ample evidence – if any more was really needed – that ambulance services across the UK are struggling to cope with the impact of rising demand awhile A&E departments were operating at full capacity, causing crews to be held up for hours waiting to do handovers.
– One patient died in the back of an ambulance, while waiting outside Addenbrooke’s Hospital in Cambridge to be handed over to A&E staff, while a pensioner died after a 40-hour wait for an ambulance to turn up in Glasgow.
– Another pensioner, in Oxfordshire, was left on floor of his house for more than five hours waiting for an ambulance. A second call to 999, after an hour, had to be diverted to a call centre in Yorkshire because the local service was too busy.
– South Central Ambulance Service, which covers Berkshire, Buckinghamshire, Hampshire and Oxfordshire, Sussex and Surrey, citing “extreme pressures”, declared a ‘critical incident’ (ie where the level of disruption results in an organisation being unable to deliver critical services) across the region and urged people to only call the emergency services about life-threatening illnesses and injuries.
– West Midlands Ambulance Service (WMAS) nursing director Mark Docherty told the Trust’s board that handover delays were causing the service to raise its risk category to the highest level for the first time as “we know patients are coming to harm” because of those delays, and that some patients were “dying before we get to them”.
– One WMAS crew waited 13 hours to hand over a patient at the Royal Shrewsbury Hospital in October, and the service lost almost 17,000 hours due to handover delays in September, nearly three times as many as a year earlier.
– At the same time the BMA released data showing the number of patients waiting over 12 hours in corridor trolley beds for admission increased to a record high.
– And north of the border, the Scottish Ambulance Service called for military assistance from the Ministry of Defence to support paramedics to help it cope with “unprecedented” pressure on the NHS.
Just hours after WMAS raised its risk category, NHS England’s (NHSE) medical director wrote to ambulance trusts and hospitals across the country urging them to “immediately stop all ambulance handover delays”, saying that ‘corridor care’ was unacceptable and that ambulances should not be used as A&E cubicles.
Among the initiatives NHSE has suggested might address the handover delay problem – 35,000 patients are said to have waited more than an hour in ambulances in September – was the creation of separate units at hospitals specifically for patients being assessed for admission from A&E. This was an idea first mooted in Scotland in September, although questions were raised at the time over patient safety considerations.
Nevertheless, last week the Evening Standard (ES) ran a piece on just such an initiative – an airport-style ‘arrival lounge’ being trialled at Queen’s Hospital in Romford, managed by existing A&E staff alongside London Ambulance Service (LAS) paramedics working in an unused part of the site, thus allowing patients to be monitored while waiting to be seen.
However, a few days later the Daily Mail quoted one A&E consultant describing the arrival lounge idea as “beyond stupidity and verging on insanity”, and claiming that without funding for extra staff to run such facilities would lead to patients dying.
Other short-term responses to the crisis have surfaced – the ES paper also suggested LAS was reintroducing the deployment of paramedics in cars or on bicycles and motorbikes to enable them to attend more incidents – but the crisis calls for much longer-term structural and funding solutions.
NHSE’s announcement back in July of an extra £55m award to ambulance trusts to boost staff numbers ahead of winter, and to “improve performance”, may go some way to easing the handover delays, but the cash may not stretch far enough, and does nothing to address issues like bed-blocking or pandemic-related staff burnout.
The Royal College of Emergency Medicine has said 1,000 extra hospital beds are needed in Scotland alone to relieve the bottlenecks experienced at A&E. And In March this year charity Mind Cymru published a survey which found that mental health had worsened across all the 999 services, but that ambulance staff were the worst affected.
Only one in three ambulance staff reported their current mental health as being very good, and last month Welsh Ambulance Services NHS Trust revealed that around 50 people a day – out of a frontline workforce of 3,000 – were absent because of stress and anxiety, largely caused by the difficulties experienced waiting outside hospitals.
Recent figures show that in the past two years the number of ‘category one’ (ie life threatening) incidents have risen by more than a quarter, and overall ambulance activity was up by 10 per cent – July this year was the busiest ever for ambulance services, with more than a million 999 calls – but nationally there’s an annual funding gap for these services of more than £200m.
The crisis in ambulances services has been brewing for years. As long ago as April 2018, the Observer conducted a survey of the ten NHS regions and found that ambulance services across England were already short of nearly 1,000 frontline staff, with LAS recording the highest tally of unfilled posts. Unsurprisingly, in early 2020, the Care Quality Commission downgraded LAS’ safety rating, citing concerns that the service had too few staff to answer 999 calls consistently.
The situation has inevitably become a huge cause for concern in unions representing paramedics and support staff. Earlier this year Unison wrote to the Association of Ambulance Chief Executives highlighting unsustainable demand, and suggested that “the only long-term solution to the crisis for the ambulance services is continual investment in the workforce to deal with the demand”.
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