People are dying in the back of ambulances and up to 160,000 more a year are coming to harm because they are stuck outside hospitals unable to be offloaded to A&E, a bombshell report has revealed.
Denis Campbell www.theguardian.com
Patients are also dying soon after finally getting admitted to hospital after spending long periods in the back of an ambulance, while others still in their own homes are not being saved because paramedics are trapped at A&E and unable to answer 999 calls, said the report by NHS ambulance service bosses in England.
In addition, about 12,000 of the 160,000 are suffering “severe harm” such as a permanent setback to their health. These include people with life-threatening health emergencies such as chest pains, sepsis, heart problems, epilepsy and Covid-19 because growing numbers of paramedics are having to wait increasingly long times to hand over a patient to A&E staff.
Ambulance logjams outside hospitals have become a major problem in the NHS in recent years as A&E staff have struggled to find beds for patients they have decided to admit because the hospital has run out of beds as a result of Covid-19, their inability to discharge patients who are medically fit to leave and the record demand for care.
That has left A&E personnel having to limit the number of patients who can be in their unit at one time, which leads to sometimes long queues of ambulances outside. The problem has become much more serious in recent months as all NHS services have seen unprecedented demand for care.
Labour and the Liberal Democrats said the “staggering” extent of damage to patients’ health underlined the risks posed by the deepening crisis facing NHS ambulance services.
The report, seen by the Guardian, has been drawn up by the Association of Ambulance Chief Executives (AACE) and is based on official NHS figures, which until now were secret. AACE represents the chief executives of England’s 10 regional ambulance services, all of which have had to declare an alert in recent months after being faced with unprecedented demands for help.
It concludes that: “When very sick patients arrive at hospital and then have to wait an excessive time for handover to emergency department clinicians to receive assessment and definitive care, it is entirely predictable and almost inevitable that some level of harm will arise.
“This may take the form of a deteriorating medical or physical condition, or distress and anxiety, potentially affecting the outcome for patients and definitely creating a poor patient experience.”
It does not say how many patients a year die because so many ambulances are stuck at hospitals. But it adds: “We know that some patients have sadly died whilst waiting outside ED [emergency departments], or shortly after eventual admission to ED following a wait. Others have died while waiting for an ambulance response in the community.
“Regardless of whether a death may have been an inevitable outcome, this is not the level of care or experience we would wish for anyone in their last moments. Any form or level of harm is not acceptable.”
AACE studied all handover delays lasting more than an hour that occurred across the 10 ambulance trusts on 4 January, and the harm resulting. It used the data to estimate how many patients a year suffer a deterioration in their health, or need much more invasive treatment such as surgery, as a direct result of waiting a long time to be treated by doctors and nurses.
It concluded that: “If these results from 4 January 2021, which was not an atypical day, are extrapolated across all handover delays that occur every day, the cases of potential harm could be as high as 160,000 patients affected a year.
“Of those, approximately 12,000 patients could potentially experience severe harm as a result of delayed handovers.”
Daisy Cooper, the Liberal Democrats’ health spokesperson, said: “These staggering figures will shock people to their core. These are absolutely devastating findings, which reveal that there is a huge toll of harm and severe harm, including tragically patient deaths, as a direct result of the colossal number of ambulance handover delays we’re now seeing.”
Ambulances are meant to hand patients over to A&E staff within 15 minutes, with none waiting more than half an hour. However, queues of as many as 15 ambulances at a time have been building up outside hospitals in recent years because hard-pressed staff have been too busy to accept them.
Last month the West Midlands ambulance service admitted publicly that handover delays were causing “catastrophic” harm to patients. Mark Docherty, its nursing director, said that despite its best efforts “we know patients are coming to harm” and that some patients “are dying before we get to them”.
Pressure on its ambulances forced the service to raise the risk assessment of harm to patients from level 20 to level 25 – the highest ever. “The definition of 25 is that harm is almost certain – and it’s going to be catastrophic. I think we’re now at that place,” Docherty added.
Jonathan Ashworth, the shadow health secretary, said: “This is a devastating report. The scale of harm and severe harm being done to patients is a scandal.
“Ministers should be ashamed that colossal numbers of patients – thanks to years of Tory NHS neglect – are languishing in ambulances waiting for vital life-saving care at risk of, and indeed suffering, serious harm, permanent disability or loss of life.”
Hospitals are under such pressure that about 190,000 handovers a month – around half the total – now take longer than they should, AACE’s report said. Paramedics have been warning that patients whose health has collapsed in their home or another setting have also been put at risk because being trapped outside A&Es means they are not available to respond quickly to 999 calls.
A series of recent incidents illustrate the crisis confronting ambulance services:
- A patient died after spending about an hour in an ambulance outside Addenbrooke’s hospital in Cambridge on 24 October. The patient had suffered a cardiac arrest. The hospital said the patient had “remained in the ambulance due to significant pressures on A&E”.
- John Swinney, Scotland’s deputy first minister, last week apologised for the “agony” endured by the family of Richard Brown, who died on the stairs outside his flat in Glasgow after waiting five hours for an ambulance
- A patient died of a cardiac arrest in Worcestershire royal hospital in Worcester on 4 October after waiting five hours in an ambulance outside. Paramedics warned A&E staff the patient was having trouble breathing but the patient died despite being rushed into the resuscitation room.
- A woman died in eastern England last month after waiting an hour for an ambulance crew to reach her on what should have been a seven-minute response. No crews were available in the 50 miles between Cromer and Waveney in Norfolk, so an ambulance from Ipswich in Suffolk had to answer the 999 call.
A Department of Health and Social Care spokesperson said: “We are committed to supporting ambulance crews who work tirelessly responding to emergencies every day. NHS England and Improvement has given ambulance trusts an extra £55m to boost staff numbers for winter, helping them to bolster capacity in control rooms and on the frontline.
“We are supporting the NHS to meet the unprecedented pressures it is facing, with record investment this year including an extra £5.4bn over the next six months to support its response to Covid-19 and £36bn for health and care over the next three years.”