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Ambulance services on fringe of collapse

Ambulance services are under intense pressure, with record numbers of callouts and the most urgent, category-one, calls last month.

BBC Two's Newsnight programme spent from 08:00 to 20:00 on Monday at six hospitals with the longest delays handing patients over from paramedics to accident and emergency staff.

This should take 15 minutes or less - but crews often wait many hours and sometimes whole 12-hour shifts, with ambulances queuing outside unable to respond to other emergency calls.

At Royal Cornwall, 25 ambulances were queuing by the afternoon, three for at least 10-and-a-half hours, at Derriford, in Plymouth, 20 were queuing up to 11 hours in an overflow car park and the longest wait at Heartlands was more than five hours.

"We're right on the fringe of collapse right now," a paramedic who has worked in emergency care for more than a decade said.

"People are phoning and being told that they're not going to get an ambulance for six or nine hours. And that's happening routinely - that is happening pretty much every shift."

"It would be wrong to say that there are times when I haven't shed a tear... for the people we haven't been able to help because it's been too late," the paramedic said. 

"They may have died anyway but there are definitely cases that I've been to where we should have been to them sooner and less harm would have come to them."

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Source: BBC News, 15 July 2022

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Ambulance services hit key recovery target

Ambulance services hit a crucial “interim” target for responding to the bulk of emergency calls last month, and showed marked improvements for the most serious category of incidents.

Offering a glimmer of hope after another winter of long ambulance waits, average category 2 performance in March was 28:34 (minutes, seconds) – more than five minutes better than March last year. It is only the third time it has dipped below 30 minutes, which has been set by government as an “interim” recovery target, since December 2022. 

Waits have soared since the covid-19 pandemic, fuelled by long hospital handover delays, and a string of inquests have highlighted the calamitous impact on patients.

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Source: HSJ, 13 April 2025

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Ambulance services hit crucial target

Ambulances reached some of the most seriously ill people within an average of 30 minutes last month – meeting a key NHS England target for the first time in more than a year.

Category 2 response times fell to 27m 25s in August, a fall of 6m from the previous month and the first time the 30m target imposed by NHS England’s urgent care recovery plan had been met since April 2023. These calls include suspected strokes and heart attacks.

The most serious patients – those in category 1, which includes cardiac and respiratory arrests – were reached in 8m 3s, the best performance since June 2021.

Both category 1 and category 2 responses were still outside the constitutional targets of 7m and 18m. However, the 30m interim target for category 2 calls has been a bellwether for how the NHS is delivering – last year ambulance trusts missed it with an average performance of more than 36m.

The position was helped by relatively low incident numbers in August, compared with recent months but also by a remarkable turnaround in performance by West Midlands Ambulance Services University Foundation Trust, which came close to hitting the 18m target at 18m 36s. In 2023-24 it averaged over 36m.

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Source: HSJ, 12 September 2024

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Ambulance service will collapse by August, predicts its nursing director

A struggling ambulance trust could face a ‘Titanic moment’ and collapse entirely this summer if the region’s worsening problems with hospital handover delays are not taken more seriously, its nursing director has told HSJ.

Mark Docherty, of West Midlands Ambulance Service (WMAS), said patients were “dying every day” from avoidable causes created by ambulance delays and that he could not understand why NHS England and the Care Quality Commission were “not all over” the issue.

He revealed that handover delays at the region’s hospitals were the worst ever recorded, that rising numbers of people were waiting in the back of ambulances for 24 hours, and that serious incidents have quadrupled in the past year, largely due to severe delays.

More than 100 serious incidents recorded at WMAS relate to patient deaths where the service has been unable to respond because its ambulances are held outside hospitals, according to the minutes of the trust’s March quality and safety committee.

"Around 17 August is the day I think it will all fail,” he said. “I’ve been asked how I can be so specific, but that date is when a third of our resource [will be] lost to delays, and that will mean we just can’t respond. Mathematically it will be a bit like a Titanic moment.

”It will be a mathematical certain that this thing is sinking, and it will be pretty much beyond the tipping point by then.”

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Source: HSJ, 25 May 2022

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Ambulance service placed in ‘special measures’ to make drastic improvements

Following a damning report by the Care Quality Commission (CQC), the East of England Ambulance Service NHS Trust (EEAST) has been placed into special measures.

It comes after inspectors uncovered a culture of bullying and sexual harassment at the trust. As a result of the decision, EEAST will receive enhanced support to improve its services.

A statement from NHS England and NHS Improvement outlined that the Trust would be supported with the appointment of an improvement director, the facilitation of a tailored ‘Freedom to Speak Up’ support package, the arrangement of an external ‘buddying’ with fellow ambulance services and Board development sessions.

This follows a CQC recommendation to place the trust in special measures due to challenges around patient and staff safety concerns, workforce processes, complaints and learning, private ambulance service (PAS) oversight and monitoring, and the need for improvement in the trust’s overarching culture to tackle inappropriate behaviours and encourage people to speak up.

Ann Radmore, East of England Regional Director said, “While the East of England Ambulance Service NHS Trust has been working through its many challenges, there are long-standing concerns around culture, leadership and governance, and it is important that the trust supports its staff to deliver the high-quality care that patients deserve."

“We know that the trust welcomes this decision and shares our commitment to reshape its culture and address quality concerns for the benefit of staff, patients and the wider community.”

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Source: Bedford Independent, 19 October 2020

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Ambulance service in England ‘in meltdown’ as one in four 999 calls missed in October

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.

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.”

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Source: The Guardian, 23 November 2022

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Ambulance service facing 'terrifying' levels of risk, says trust chief

The chief executive of a small acute trust has described the “terrifying situation” faced by ambulance crews and hospital staff in trying to provide adequate emergency care as coronavirus threatens to overwhelm the local NHS services.

Susan Gilby, of Countess of Chester Hospital Foundation Trust, told HSJ staff are seeing “tragic and potentially avoidable” instances where patients with COVID-19 have reached the emergency department too late.

She suggested this is due to a combination of patients waiting too long to call 999, and then having to wait long periods for an ambulance to arrive.

Cheshire has been among the hardest hit areas in England during this third wave of coronavirus, with all four of its acute hospitals having very high covid occupancy rates.

Dr Gilby, a former critical care consultant, said her trust has been at around 60 per cent covid occupancy for the last fortnight, which has made her increasingly fearful of the difficulties in admitting patients through the emergency department due to a lack of beds. This can then cause knock-on delays for patients arriving in ambulances, and ties those ambulance crews up for long periods, preventing them from responding to further 999 calls.

She said ambulance turnaround times had been relatively good at the Countess of Chester, but she had spoken to paramedics handing over patients who were “really struggling” to get to people quickly enough.

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Source: HSJ, 22 January 2021

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Ambulance service faced 'extreme pressure' on night wife called six times for dying husband

A 999 call handler incorrectly categorised a call made by the wife of a man who died from a heart attack, an inquest has heard. The Welsh Ambulance Service Trust (WAST) handler should have escalated the call for Robert Weekley, 75, who died in his flat in Barry, to the most urgent level of 'red', which requires an ambulance to be sent within eight minutes.

Instead they wrongly categorised it as the second-highest level, 'amber one', which has no set response time, an inquest into Mr Weekley's death at Pontypridd Coroners' Court was told. 

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Source: Wales Online, 3 May 2024

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Ambulance service apologises to families

An ambulance service has apologised to families following a review into claims it covered up errors by paramedics and withheld evidence from coroners.

The families of a teenager and a 62-year-old man were not told paramedics' responses were being investigated by North East Ambulance Service (NEAS).

The deaths, in 2018 and 2019, were raised by a whistleblower last year.

Among the findings of the independent review carried out by Dame Marianne Griffiths, were inaccuracies in information provided to the coroner, employees who were "fearful of speaking up" and "poor behaviour by senior staff".

The study, commissioned by the former health secretary Sajid Javid in August, examined four of the five cases that were highlighted by the whistleblower, initially in The Sunday Times.

It found two bereaved families were left in the dark about investigations into the response of paramedics called to help their loved ones.

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Source: BBC News, 12 July 2023

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Ambulance serious incidents triple

Serious incidents causing patient harm have increased steeply compared to previous years at an ambulance service whose nursing director still expects will “fail” next month under mounting service pressures.

There were 98 patient harm incidents at West Midlands Ambulance Service in June, official data obtained by HSJ suggests, up from 49 in the same month last year.

The figures show that from April-June this year, 262 harm incidents have been logged – a 240% on 77 in the same period in 2019 and a 71% on 153 last year.

Nursing director Mark Docherty, who previously warned the service was facing a “Titanic moment” and would “all fail” around a specific date of 17 August, said much of the increase can be attributed to worsening hospital handover delays. 

More than 700 people at one time waited for ambulances “that were not going to turn up” on Monday, according to Mr Docherty, who described the situation as a “really dangerous place to be”.

Mr Docherty explained how the harm incidents, including deaths, resulted from growing delays: ”You can’t underplay the risk. If you’ve got 750 patients like we did on Monday waiting, none of those patients have been assessed.

“Sadly, amongst them there will have been patients with stroke who won’t be treated because they’ve waited too long."

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Source: HSJ, 15 July 2022

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Ambulance sector vows to improve sexual safety

The ambulance sector has signed up to a consensus statement in a bid to tackle misogyny and improve sexual safety for its staff and patients.

The statement – which chief allied health professions officer for England Suzanne Rastrick launched at this week’s Ambulance Leadership Forum – commits the service to a “cultural transformation”.

Several ambulance trusts have been criticised for a culture which includes “highly sexualised banter” in recent years, with reports highlighting sexual harassment, often of younger female staff.

The statement’s guiding principles include: a focus on protecting staff from misogyny and inappropriate sexual behaviour; removing barriers to speaking up and supporting those affected; and working towards an inclusive culture where staff understand misogyny and come to work feeling “sexually safe”.

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Source: HSJ, 5 October 2023

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Ambulance response warning after woman's death

Long waiting times at hospitals in the north-west of England are putting patient's lives at risk by holding up ambulance crews, a coroner has warned.

It comes after the death of Bobilya Mulonge, who called 999 with breathing problems on 24 November 2022.

She waited 72 minutes for an ambulance - four times longer than North West Ambulance Service's (NWAS) 18-minute target for her category of emergency call - which "probably contributed to her death", coroner Lauren Costello said.

A NWAS spokesman said the service was "very sorry" an ambulance was unable to attend sooner and the service had made "significant" improvements since.

A report by Ms Costello has been sent to the health secretary and NWAS and urges the region's health authorities to take action to prevent further deaths.

She said evidence about ambulance delays revealed during the inquest had given rise to her concerns.

"In my opinion there is a risk that future deaths could occur unless action is taken," she wrote.

Dale Ollier, north-west regional organiser for Unison, which represents some ambulance staff, said backlogs in moving patients out of hospitals was having a "knock-on effect" at A&E, leading to a "bottleneck crisis".

“We have patients that could be safely discharged but there isn’t anywhere to discharge them to because of the lack of capacity in social care."

Ambulances were working "flat out", he added, but delays had lead to an "unbearable demand" on crews who were sometimes "tied up for several hours" waiting at hospitals.

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Source: BBC News, 20 June 2024

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Ambulance handover standard published

The Professional Record Standards Body (PRSB) has published a standard for ambulance handover to ensure that information can be transferred digitally to emergency departments from any ambulance and improve patient care and safety.

Emergency care needs fast, effective sharing of information. Once implemented, the standard for handover will improve continuity of care, as emergency care professionals will have the information they need available to them on a timely basis. It means that emergency care professionals will know what medications have been administered, diagnostic tests performed and whether the patient has any allergies as well as other important information.

The standard is published as a draft while PRSB seeks endorsement from relevant members and other organisations.

Read the Ambulance handover to emergency care standard

Source: PRSB, 1 November 2019

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Ambulance handover delays still harming tens of thousands each month

Tens of thousands of patients are still suffering harm from delays in ambulance handovers to emergency departments despite a concerted effort to tackle the problem, figures seen by HSJ indicate.

The data shows more hours have been lost to handover delays lasting more than 15 minutes in most of the first five months of 2024 compared to the same period in 2023. In May, more hours were lost than in May 2022 and May 2023. 

The Association of Ambulance Chief Executives told HSJ the problem remained severe and the government needed to act to improve it.

AACE managing director Anna Parry said it had consistently warned about the ongoing risk of handover delays.

She said: “This is why one of our key requests of the new government has been that they proactively support the ambulance sector’s aim to ensure patients universally receive high-quality, timely care and no longer experience unacceptable delays in response or handover of care, for example, at hospital emergency departments.

“This problem is not intractable. We have demonstrated that in areas where there is a strong leadership focus and true system-wide support, handovers can be managed effectively, despite the significant pressures and constraints our health and social care system is under. However, it remains vital that we see more demonstrations of excellent leadership to get to that point across the country.”

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Source: HSJ, 10 July 2024

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Ambulance handover delays soar as winter bites

Ambulance handover delays rose last week with close to 13,000 crews waiting more than an hour to offload patients — marginally more than the comparable week last year.

Week of 27 November 2023 figures were missing data for several days from some trusts, NHSE said.

The number of hour-plus waits for ambulancs to pass patients to emergency departments was 12,797, according to new NHS England data. 

That appeared to be steeply up from about 8,000 in the past two weeks, although NHSE said last week’s was not directly comparable due to missing data.

It was just ahead of the 12,534 recorded for the week ending 11 December last year.

Last year the numbers rose to over 16,000 in the third week in December then peaked at 18,720 in the week running up to New Year, in what many said was the worst winter crisis for decades, amid a sharp, early wave of flu.

This year the numbers of long waits have risen earlier than last, and several ambulance trusts have reported coming under severe pressure in the last few days. NHS England has warned junior doctors strikes next week and in the new year may compound hospital flow problems.

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Source: HSJ, 15 December 2023

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Ambulance handover delays in England may harm 1,000 patients a day

More than 1,000 patients a day in England are suffering “potential harm” because of ambulance handover delays, the Guardian can reveal.

In the last year, 414,137 patients are believed to have experienced some level of harm because they spent so long in the back of ambulances waiting to get into hospital. Of those, 44,409 – more than 850 a week – suffered “severe potential harm”, with delays causing permanent or long-term harm or death.

In total, ambulances spent more than 1.5m hours – equivalent to 187 years – stuck outside A&Es waiting to offload patients in the year to November 2024, the Guardian investigation found.

Experts said the figures were “staggering” and showed how the NHS was in a more “fragile” state than ever before, amid a “perfect storm” of record demand for A&E, soaring numbers of 999 calls, and an increasingly sicker and ageing population.

The analysis of NHS data by the Guardian and the Association of Ambulance Chief Executives (AACE) highlights the huge scale of the challenge facing Keir Starmer as he prepares to set out how he plans to rescue the NHS.

Anna Parry, the managing director of AACE, which represents the bosses of England’s 10 regional NHS ambulance services, said the data “speaks for itself”.

She added: “These figures underline what the ambulance sector has been saying for a long time – that thousands of patients are potentially being harmed every month as a direct result of hospital handover delays.”

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Source: The Guardian, 5 January 2025

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Ambulance handover delays hit record high

Long ambulance handover delays hit record levels in the past week as the winter crisis in the NHS reached its height. There were an average of 2,834 hour-long handover delays every day in the week to 4 January, according to the latest NHS winter sitrep data released today. That was the highest since records began.

The previous record was at the start of January 2023—a time of intense and high-profile pressures on services, due to a very high flu peak and ongoing Covid-19, when many patients were harmed.

At that time a daily average of 2,682 hour-long delays were reported. Since then, cutting handover delays has been a high priority of government and NHSE.

On Monday, HSJ reported long ambulance handover delays were surging in the Midlands and northern regions, which have recorded more of them than in the 2022-23 winter.

Sir Stephen Powis, NHS England’s national medical director, said: “It is clear that hospitals are under exceptional pressure at the start of this new year, with mammoth demand stemming from this ongoing cold weather snap and respiratory viruses like flu—all on the back of 2024 being the busiest year on record for A&E and ambulance teams."

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Source: HSJ, 9 January 2025

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Ambulance handover delays equivalent of 70 days

An ambulance trust lost 1,700 hours of working time in one week in April due to vehicles waiting outside a hospital.

The BBC has discovered that the figure was reached twice during April as ambulance crews waited outside Gloucestershire Royal Hospital in Gloucester to handover patients.

That equates to about 70 days worth of waiting time each week.

The trust that runs the hospital said it was facing "significant challenges" as it dealt with "unrelenting demand".

Figures show that since the end of January, South Western Ambulance Service NHS Foundation Trust (SWASFT) has lost a minimum of 800 hours of working time each week due to ambulances having to wait outside Gloucestershire Royal Hospital, unable to get patients into A&E.

The national target for transferring patients from ambulances in to A&E is 15 minutes, but in some cases people had to wait up to 10 hours in ambulance queues in Gloucester.

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Source: BBC News, 12 July 2022

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Ambulance handover delays at A&E are putting patients at risk

Between April 2020 and March 2021 there were approximately 185,000 ambulance handovers to emergency departments throughout Wales. However, less than half of them (79,500) occurred within the target time of 15 minutes.

During that period there were also 32,699 incidents recorded where handover delays were in excess of 60 minutes, with almost half (16,405) involving patients over the age of 65 who are more likely to be vulnerable and at risk of unnecessary harm.

Data published by the Welsh Government highlighted that in December 2020 alone, a total of 11,542 hours were lost by the ambulance service due to handover delays. This figure has been rising sharply and has now reached pre-pandemic levels once again.

Inspectors said these delays have consistently led to multiple ambulances waiting outside A&E departments for excessive amounts of time, unable to respond to emergencies within their communities.

"These delays have serious implications on the ability of the service to provide timely responses to patients requiring urgent and life-threatening care," the report stated.

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Source: Wales Online, 7 October 2021

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Ambulance delays cause ‘severe harm’ to record 6,000 patients a month

A record number of patients suffered “severe harm” as a result of ambulance delays in December, soaring by nearly 50 per cent in just one month as the NHS crisis deepened.

Almost 6,000 suffered permanent or long-term harm due to long waits to hand over patients outside A&Es – up from just over 4,000 in November.

A further 14,000 patients were likely to have suffered “moderate harm”, an analysis by The Independent of NHS ambulance data and estimates of harm by the Association of Ambulance Chief Executives (AACE) found.

This includes incidents that resulted in patients needing further treatment or procedures, the cancelling of treatment, or being transferred to another area.

Miriam Deakin, director of policy and strategy at NHS Providers, said the figures are a “worrying reminder of the huge pressure the NHS is under”.

She said: “Trust leaders are doing everything they can to provide patients with safe, high-quality care but they know patients face lengthy handover delays far too often, contributing to avoidable harm.”

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Source: The Independent, 20 January 2023

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Ambulance delays a ‘factor’ in 104 deaths in one region during final quarter of 2022

According to the South West Ambulance Service Foundation Trust, 104 patient deaths reviewed under National Quality Board guidelines in quarter three of 2022-23 related to delays “which are thought to be a result of pressures within the wider health system”.

The trust has stressed the deaths were not necessarily directly caused by delays, but that delays were a “common factor” in the 104 cases.

Since July 2019, all ambulance trusts have been required to implement Learning from Deaths reviews following a report by the Care Quality Commission three years earlier, which found that opportunities were being missed to learn from patient deaths.

A total of 876 incidents were identified as being within the scope of a review at the end of last year by SWASFT, of which 210 were reviewed.

Deaths included in the review occurred while the patient is under the care of the ambulance service, from the initial 999 call being made to their care being transferred to another part of the system or to the point where a decision is made not to convey them to hospital.

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Source: HSJ, 4 April 2023

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Ambulance crews urged to conserve oxygen

Ambulance staff are being urged to conserve oxygen supplies because of a national shortage of small cylinders used both on ambulances and in some A&E departments.

South East Coast Ambulance Service Foundation Trust has told staff the shortage is caused by the high number of patients with respiratory conditions and “the suppliers are reporting that this is higher than during the first wave of the covid pandemic”.

In a message to staff last week, East of England Ambulance Service Trust said: “Oxygen suppliers, including BOC, are currently unable to supply sufficient numbers [of small cylinders] to fulfil our orders.

“This has been escalated nationally and NHS Procurement are working to support ambulance trusts with supplies.” But it added that over the next few days it would need to “carefully manage” supplies.

The type of cylinder affected typically provides about 30 minutes of oxygen on full flow and is widely used on ambulances and also where patients are cohorted in accident and emergency departments or kept in corridors waiting to be passed to hospitals, without access to the normal piped supply. Many ambulances will carry several smaller cylinders, and sometimes they also carry one larger one. However, if a patient requiring oxygen can’t be handed over quickly at A&E, ambulance supplies may start to run low.

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Source: HSJ, 30 December 2022

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Ambulance crews told to leave patients on a trolley if A&E wait exceeds 45 minutes

Paramedics will only wait with patients for 45 minutes before leaving them on a trolley in A&E, one ambulance trust has said.

One in five ambulances are waiting at least an hour outside accident and emergency departments to hand over patients, the latest data show, despite NHS standards stating it should only be 15 minutes.

Now, London Ambulance Service (LAS) leaders have told hospitals their staff will only remain with patients for a maximum of 45 minutes for handover due to “the significant amount of time being lost” waiting in A&E departments.

A leaked letter, seen by ITV News, from the LAS said: "From January 3 we are asking that any patients waiting for 45 minutes for handover... are handed over immediately to ED (emergency department) staff allowing the ambulance clinicians to leave and respond to the next patient waiting in the community.

"If the patient is clinically stable the ambulance clinicians will ensure the patient is on a hospital trolley or wheelchair/chair and approach the nurse in charge of the emergency department to notify them that the patient is being left in the care of the hospital and handover the patient."

The email added that if the patient was not clinically stable, ambulance crews would stay with the patient until handover is achieved but added that the clinical responsibility for the patient lied with the hospital.

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Source: The Telegraph, 3 January 2023

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Ambulance crews stuck at A&E miss thousands of 999 calls a day in England

Paramedics in England are unable to respond to 100,000 urgent 999 calls every month because they are stuck outside hospitals waiting to hand over patients, endangering thousands of lives, the Guardian can reveal.

As the crisis engulfing the NHS intensified this weekend, figures showed ambulance crews are tied up at A&E for so long that on more than 3,500 occasions each day they are unable to respond to a 999 plea for help.

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Source: Guardian, 12 January 2025

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Ambulance crews in England to use iPads to assess accident and stroke victims

Ambulance crews will start using iPads to send photographs of accident and stroke victims to specialist hospital doctors so that they can make rapid diagnoses and save some patients a trip to A&E.

NHS England is giving 30,000 iPads to regional ambulance services to help paramedics decide what care to give and whether to take someone to hospital or treat them at the scene.

The tablet computers will be a vital link between ambulance crews and hospital consultants, whose digital interaction will make treatment faster and better, NHS England said.

For example, the devices will let paramedics show an A&E department how badly injured patients have been in a road traffic crash, so that they can prepare for their arrival. They will also allow crews access to patients’ medical records to help them build a better picture of their health.

“Ambulance crews have been at the forefront of the pandemic, routinely dealing with life-and-death situations and often first on scene to treat and diagnose critically ill patients,” said Sir Simon Stevens, NHS England’s chief executive. “These devices are another tool for our highly skilled paramedics and ambulance technicians as they continue to respond to the country’s most critically ill and injured patients.”

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Source: The Guardian, 18 May 2021

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