Ambulance chiefs in the West Midlands have taken the ‘regrettable’ decision to move to the highest ever risk rating amid fears that more people face ‘catastrophic harm’ – including death – because 999 help can’t get to them quickly enough.
At least eight patients waiting for emergency help have already died in the last three months as a result.
Paramedics are being stranded for hours at a time outside A&E departments, unable to offload their patients and get back on the road because of a lack of space, beds and resources in hospitals.
The ‘completely unacceptable’ situation will continue, and likely get worse through winter, without radical action, the West Midlands Ambulance Service board heard.
Prof Ian Cummings, chair of the service, said of the risks: “This takes us into a place we have never been before.
“Despite everything we are doing by way of mitigation, we know that patients are coming to harm as a result of delays in getting to them….some are dying before we get to them.
“This is a completely unacceptable situation,” he said.
“We know people are working exceptionally hard to try and solve this…but it is only going to get worse and will continue to cause harm.”
Eight patients needing emergency ambulances in August and September this year died while waiting, according to a Freedom of Information inquiry to the service.
Pressure is now mounting on hospitals trusts and health leaders across the region to come up with more solutions – especially in light of a new directive issued by NHS England telling them to “immediately” stop the delays.
Hospitals have also been told they cannot put patients into corridors – a last resort used in previous winters to cope with demand and release ambulances.
While recent media reports have focussed on patients who have died while waiting on the backs of ambulances, or shortly after making it into hospitals – like this incident in Worcester – Mr Cummings said the biggest risk was to those who didn’t get an ambulance to them in time.
“The patients in our care, in the back of one of our ambulances outside hospitals, are not ideally cared for but they are generally safe, with a highly skilled competent two person crew with them and subject to regular triage.
“But the risk is to those we cannot get to, who are waiting for us. They are the unknowns.”
Mark Docherty, the service’s director of nursing and clinical commissioning, said it was clear the situation would worsen without urgent action.
“If you look at the trajectory of the delays into winter, it is only going to get worse and we will lose so many hours in December, January and February it is not possible to see how we will respond to some patients in a timeframe that is acceptable.”
Earlier this month around one in ten of high risk patients – deemed category 2 – were not reached within two hours, he said – putting them at risk.
These would typically include suspected stroke and heart disease patients, he said.
As a result their chances of recovery and other potential harm could be adversely affected.
“We know for a fact we are causing harm,” he warned.
Craig Cooke, emergency services director for the service, added: “We have never seen this before.”
Peter Green, a paramedic, told the board that staff are under ‘real stress and anxiety’ over the delays, adding: “It doesn’t help when the Government says there is nothing wrong with the NHS and everything is fine.”
Dr Alison Walker, medical director for the service, added: “We are in a really difficult place – we hope the measures we are taking regionally, supported nationally, will make this a time limited increase to 25.”
The magnitude of the delays is set out in board documents that show that thousands of hours are being sacrificed every month to look after patients in parking bays outside Emergency Departments, while hospital staff inside battle to cope and free up beds and space.
Across the West Midlands, ambulances were held up for more than half an hour on thousands of occasions in the last month.
What should be a 15 minute handover is now routinely taking more than two hours. In the first 11 days of October, hold ups of more than 30 minutes added up to a total delay of 14,533 hours.
Worst locations for delayed handovers this month were Heartlands Hospital (801 hours of delays that lasted more than half an hour), Royal Stoke (653 hours) Worcestershire hospitals (512 hours), Royal Shrewsbury (450), Good Hope (441) and the Queen Elizabeth Hospital Birmingham (430).
Some handovers are taking more than 10 hours – a shocking situation for patients, that is also demoralising for crews, the Board was told.
Work under way to alleviate the problems and ease the burden on hospitals include:
* more 999 calls treated by ‘hear and treat’ clinicians, who provide health advice and support over the phone, and direct the caller to alternative help, if safe to do so – this now accounts for around 14% of all calls, when previously it has accounted for just 4%
* more 999 calls treated by paramedics when they are seen, or directed to other help, accounting for around 35% of patients.
* close working with hospitals to safely look after patients outside Emergency Departments, either in ambulances or, preferably, in specially created cohort areas.
* working locally and regionally to ensure mutual aid so those under pressure are supported by other settings, including via diversions and other steps.
* liaising with other parts of the health and social care system to provide alternative options, especially for older people.
NHS England wrote to all chief executives and health system leaders last week to demand that it makes it a ‘priority’ to free up ambulances ‘immediately.’
It told them that they should discuss the issue of ambulance handovers at every board meeting they hold, warned that “corridor care” is “unacceptable as a solution”, and said ambulances should not be used as “additional ED cubicles”.
However, hospitals across the region say they are working desperately hard to manage the issue, working closely with social care and other partners to safely discharge patients, encourage alternatives to hospital emergencies and find other solutions, against a backdrop of continuing high Covid case rates that limit capacity.
We have asked NHS England and the Department of Health and Social Care to provide a comment and also approached some of the hospital trusts named in the ambulance service reports.