Ambulance crews could not respond to almost one in four 999 calls last month – the most ever – because so many were tied up outside A&Es waiting to hand patients over, dramatic new NHS figures show.
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An estimated 5,000 patients in England – also the highest number on record – potentially suffered “severe harm” through waiting so long either to be admitted to A&E or just to get an ambulance to turn up to help them.
Ambulance officers warned that patients were dying every day directly because of the delays since the service could no longer perform its role as a “safety net” for people needing urgent medical help.
“The life-saving safety net that NHS ambulance services provide is being severely compromised by these unnecessary delays and patients are dying and coming to harm as a result on a daily basis,” said Martin Flaherty, managing director of the Association of Ambulance Chief Executives (AACE), which represents the heads of England’s 10 regional NHS ambulance services.
Flaherty added: “Our national data for hospital handover delays during October 2022 is extremely worrying and underlines the fact that in some parts of the country efforts to reduce or eradicate these devastating and unnecessary delays are simply not working.”
The association’s latest monthly handover delays report, published on Wednesday, reveals that the performance of ambulance services fell to its lowest ever level in October.
The report shows that 169,000 hours of ambulance crews’ time across the month was lost due to delays. It meant that paramedics could not answer 135,000 calls. That number represented 23% of ambulance services’ total “potential capacity” to respond to 999 calls.
All three totals are the worst in NHS history.
“The ambulance service is in meltdown. These figures show that it is on its knees and close to collapse as a result of vacancies, underfunding, morale being at a very low ebb and demand for ambulance care having doubled to 14m calls a year since 2010,” said Rachel Harrison, national secretary of the GMB union, which represents 15,000 staff in English ambulance services.
Ambulance services’ ability to respond rapidly to patients needing emergency and potentially life-saving care is being hampered increasingly by hospitals being unable to admit people to A&E fast enough. That is because they have almost 14,000 beds occupied by patients who are fit enough to leave but cannot be safely discharged, mainly because social care provision is inadequate to allow going home or entering a care home.
Steve Barclay, the health secretary, has identified handover delays as one of the greatest challenges facing the NHS. A&E doctors share AACE’s concern that patients are suffering sometimes serious harm, and even dying, as a result of long delays to their treatment.
The AACE report also discloses that:
- 18% of ambulance handovers took more than an hour last month, when the NHS target is 15 minutes – a nine-fold increase on the 2% seen in October 2019.
- The average handover time was 42 minutes, up 12 minutes from October 2021 and up 23 mins from Oct 2020.
- The number of one, two, three and 10-hour handovers was the highest ever recorded.
- Delays exposed an estimated 41,000 patients to potential harm, of whom about 5,000 were put at risk of, or experienced, “severe harm”, including death.
“These figures are a national disgrace but they only confirm what GMB members tell us every day,” added Harrison. “We’ve got ambulances waiting outside hospitals for more than a day, while terrified workers wait and hope their patients won’t die. In fact, a third of GMB ambulance workers think a delay they’ve been involved with has led to the death of a patient. It can’t carry on.”
The most recent NHS England data showed that ambulances were taking almost 10 minutes to reach patients facing a life-threatening emergency. The NHS target response is seven minutes.
Dr Sitso Amankwah, a GP in Kingston, London, tweeted on Tuesday about a patient who had taken an Uber ride to A&E rather than face a potentially long wait for an ambulance. “That’s good, so not unwell enough to need 999 then,” the GP told the patient. “No, I felt awful, but … Uber could get me there in less than four hours,” the patient replied. Amankwah added: “Ladies and gentlemen, I present you the NHS in 2022.”
A Department of Health and Social Care spokesperson said: “The government is clear that the NHS is a top priority and we are making up to £8bn available for health and social care in 2024/25.
“We are providing record-breaking funding which will help get us through the winter. This is on top of the action we’ve already taken including … delivering 50,000 more nurses, increasing the number of NHS call handlers, and creating the equivalent of at least 7,000 more beds, to improve patient flow through hospitals and get ambulances back on the roads quickly. We will publish a full recovery plan for urgent and emergency care next year.”