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News Article
Nine trusts account for third of ambulance ‘hours lost’
Patient Safety Learning posted a news article in News
Nine acute trusts accounted for a third of all ‘hours lost’ to ambulance handover delays last week, according to new data. The first NHS England winter sitrep data showed wide variation between providers on ambulance handover performance, with a small number of providers accounting for a huge proportion of delays. There were nine trusts where, for each ambulance arrival in the week to 20 November, an average (mean) of more than an hour was lost to handover delays. The providers accounted for around 7,000 hours lost, 33% the national total, despite only accounting for 7% of ambulance arrivals. At University Hospitals Plymouth an average of 2.3 hours were lost. The other trusts were; Norfolk and Norwich University Hospitals; East and North Hertfordshire; The Queen Elizabeth Hospital King’s Lynn; Great Western Hospitals; University Hospitals of Leicester; Torbay and South Devon; University Hospitals of North Midlands; and Worcestershire Acute Hospitals. Many of the worst performing hospitals were in the South West and East of England regions, which have previously been identified as areas which struggle on handover delays. Read full story Source: HSJ, 24 November 2022 -
News ArticleAmbulance 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.” Read full story Source: The Guardian, 23 November 2022
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News Article
"If we are queuing, we can't get to patients"
Patient Safety Learning posted a news article in News
Paramedics describe a health service in crisis with a lack of investment and increasing demand, of lengthy waits to transfer patients to hospitals and of a social care system facing collapse. So what does a typical ambulance shift look like? The area covered by the East of England Ambulance Service's nearly 400 front-line ambulances is vast. In 2020-21, the service received nearly 1.2 million 999 calls. Ed Wisken has been a paramedic for 13 years. An advanced paramedic specialising in urgent care, Mr Wisken says: "It is really sad to see patients who have had to wait such a long time for an ambulance - but this is just the culmination of years of underfunding and of reduced resources peaking now where demand outstrips supply." "It is upsetting to see it," he says. "It is not nice to see people who have been waiting hours and hours for an ambulance - but we have really hit crisis point now." He says the morale of fellow paramedics and other healthcare workers is currently very low. "The key is you just have to do just one job at a time and just take the patients that you see and do the best for them," he says. "If you worry about the bigger picture too much you will get frustrated and angry - but that's not going to be beneficial for yourself or your patients." Read full story Source: BBC News, 21 November 2022 -
News Article
Ambulance waits quadruple in handover hotspots
Patient Safety Learning posted a news article in News
Ambulance waiting times for stroke and suspected heart attacks have quadrupled in four parts of England since before Covid-19 – whereas others have only grown by half – underlining the severe impact of long accident and emergency handovers. Response times have leapt across England over the past two years, particularly for category 2 and 3 incidents, but the data makes clear that the steepest increases are in areas where hospitals have the biggest handover delay problems. Of the 10 patches with the largest increases in average category 2 performance between 2018-19 and 2021-22, four are served by major hospitals which make up NHS England’s “cohort one” of trusts selected for the worst handover problems; and four more are on government’s list of 15 which accounted for the most long handover delays last winter. The increase in handover delays – in turn linked to delayed discharge, staffing, lack of community services and social care’s collapse – are the stand-out reason for areas with a steep rise in response times. Read full story (paywalled) Source: HSJ, 18 November 2022 -
News Article
A&E staff ordered to receive ambulances ‘in all instances’
Patient Safety Learning posted a news article in News
Directors of a major hospital have ordered their accident and emergency staff to continue receiving ambulance patients into their department “in all instances”, following angry exchanges with paramedics. Hospital staff and ambulance crews have clashed at the new Royal Liverpool Hospital since its opening last month, after ambulance crews were prevented from bringing patients inside accident and emergency department when it was deemed to be full to capacity. The problems were escalated to hospital directors and North West Ambulance Service Trust earlier this month, resulting in new instructions being issued to the emergency department. In a letter to managers in A&E and the other divisions, seen by HSJ, the three most senior directors at the Royal Liverpool, wrote: “As you are aware we are currently experiencing long delays in accepting handover of patients from ambulance crews. “This phenomenon is not unique to us at the Royal Liverpool, nor is it particularly new, but our recent challenges have undoubtedly been exacerbated due to teams still familiarising themselves with working in a new environment and the patient flow challenges we have been experiencing on site. “However, what has changed has been the extent to which we have managed these pressures by continuing to hold patients in the back of ambulances, which we collectively agree is an unacceptable situation. Whilst providing corridor care is not what any of us would aspire to, we have to recognise and respond to the risk of patients awaiting response in the community. “We have therefore today met with NWAS colleagues and agreed that, with immediate effect, we will, in all instances, continue to receive crews from NWAS into the hospital building.” Read full story (paywalled) Source: HSJ, 16 November 2022 -
Content ArticleHow ambulance staff feel about their work has long been a concern, but the results of the latest staff survey show that their job satisfaction has deteriorated further. This blog from the Nuffield Trust takes a closer look at the findings and describes the importance of improving the situation.
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News ArticleAmbulances called to serious emergencies in the East of England, which encompasses Essex, have the longest waiting times of anywhere in the UK, according to new data. The East of England Ambulance Service, which serves the county of Essex, has the longest wait times for life-threatening injuries of anywhere in the country. Ambulances took an average of 11 minutes and 12 seconds to respond to category one calls - those for life threatening injuries - in the Essex region in October. That’s up from 10 minutes 49 seconds in September, and far longer than the 7 minute target set by the NHS. This means it’s also the longest category one response time of any ambulance service in England, as compared to the average wait time for ambulances across England as a whole, category one calls were responded to in an average of 9 minutes and 56 seconds. A spokesperson for the East of England Ambulance Service said: "Our service is under extreme pressure with many ambulances delayed outside hospitals and high call volumes. "To help us respond effectively we have increased our escalation state across the Trust. We urge the public to please support us by using our services wisely and only calling for life-threatening illnesses and injuries." Read full story Source: Essex Live, 10 November 2022
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News Article
Female CEOs say ambulance service culture ‘deeply wrong’
Patient Safety Learning posted a news article in News
The only two female ambulance chief executives in the country have said there is something ‘deeply wrong’ with the culture in ambulance services. Helen Ray, the chief executive of the North East Ambulance Service Foundation Trust, said women working in the ambulance service “accept [inappropriate] banter, they accept sexualised behaviour from their male colleagues, and from patients, and they think it is okay”. She stressed “it is absolutely not [okay]” and said women must be given “safe spaces for talking and speaking up about that”. “There is something deeply wrong with the culture in the ambulance service”, she told the NHS Confederation’s Health and Care Women Leaders Network event on Tuesday. Siobhan Melia, interim chief executive of South East Coast Ambulance Service, said when she joined the trust four months ago on secondment from Sussex Community FT, it felt like she had “landed on a different planet”. Ms Melia said it was a culture “not like any other part of the NHS”. “The gender pay gap in my organisation is significant, so we see men in senior roles are taking it upon themselves to abuse their power, [with] both female students and female lower graded staff.” Read full story (paywalled) Source: HSJ, 10 November 2022 -
News Article
Half of ambulance arrivals ‘inappropriate’, says acute trust
Patient Safety Learning posted a news article in News
An audit conducted by an acute trust has found more than half the patients taken to one of its hospitals by ambulance were deemed “inappropriate for conveyance”. The assessment at Scarborough Hospital in Yorkshire, obtained by HSJ through a freedom of information request, examined a random sample of 100 patients, of which around 50 arrived by ambulance. Of those arriving by ambulance, half were deemed not to have required an ambulance conveyance. The Missed Opportunities Audit, which the trust said was “routine” and looked at a range of areas where the emergency department could streamline operations, said: “Fifty-two per cent of conveyance[s] by ambulances were deemed as inappropriate". “The reviewer did not have access to the policies of Yorkshire Ambulance Service, which may account for the low number of appropriate conveyances. However, based on clinical judgment for cases presenting by ambulance the arrivals should have presented either to a community service (33%) or via their own transportation methods (38%), as their documented clinical condition and social circumstances allowed for this.” Read full story (paywalled) Source: HSJ, 9 November 2022 -
Content ArticleAmbulance services in England are under immense pressure. In July 2022, all ambulance services in England declared REAP (Resource Escalation Action Plan) level four, reflecting potential service failure. Volumes of calls to 999 are increasing, patients in distress and pain are waiting longer for help to reach them, and ambulance teams feel unable to do their job well. The new Secretary of State for Health and Social Care has previously named cutting ambulance waits as his number one priority. As he takes up the role for the second time, he will again need to include ambulances in his list of priorities for the health and care system. Steps taken to date to help address the underlying issues have not yet had an impact on the pressures facing ambulance services. This analysis from The Health Foundation looks at ambulance service performance and explores the contributing factors and priorities for improvement.
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News Article
'Distressing' 999 wait highlights South West Ambulance delays
Patient Safety Learning posted a news article in News
South West Ambulance has the longest waits in the country for people to get through to the operator. It takes almost a minute on average for ambulance control to answer 999 calls compared with just five seconds for the West Midlands service. Jean and Claire Iles called 999 six times to request an ambulance for Steven Iles' internal bleeding and two of their calls were unanswered for 10 minutes "He just looked at me and he just passed away before they could even get to him," 41-year-old Claire Iles said. "I rang about 4pm and said he has gone grey, and I said if you don't come now he is going to die, and it was still 20 minutes before the ambulance turned up." She was at home with her parents in Yate, near Bristol, when her father, Steve, 63, fell ill. It took 11 hours for a South West Ambulance crew to arrive, but Jean said by that time it was too late. Mr Iles died at 17:10 GMT on 19 March from a strangulated hernia that cut off the blood supply to his heart. The trust has apologised for the distress and anxiety caused but said it remained under "enormous pressure". Read full story Source: 4 November 2022 -
News Article
Trusts should seek extra funding to be ready for major incidents, says inquiry
Patient Safety Learning posted a news article in News
Ambulance trusts should review their ability to respond to mass casualty incidents and press commissioners for any additional resources they need, the report into the Manchester Arena bombing has said. Only 7 of the 319 North West Ambulance Service Trust vehicles available on the night of the attack, in 2017, were able to deploy immediately, the report said. It said experts believed that “such a situation would almost inevitably be replicated if a similar incident were to occur again anywhere in the country”, given current resources and demand. Ambulance trusts are now hugely more stretched than in 2017, with response times having significantly lengthened due to lack of resources. The second volume of the report from the inquiry, chaired by Sir John Saunders, published today, is critical of the emergency services’ response to the bombing which killed 22 people. NWAS “failed to send sufficient paramedics into the City Room [an area adjoining the Arena]” and did not use available stretchers to remove casualties in a safe way, it says. A key role for managing the incident – that of ambulance intervention team commander – was not allocated for half an hour. But it also raised issues of ambulance capacity and availability for major incidents involving mass casualties. “Around the UK, ambulance services are always ’playing catch up,’” it said, with no spare frontline capacity. With demand doubling over the last 10 years, the inability to respond to such incidents is only going to get worse – and lives will be lost if they do not attend the scene quickly and in sufficient numbers, the report said. Read full story (paywalled) Source: HSJ, 3 November 2022 -
Content ArticleThis investigation by the Healthcare Safety Investigation Branch (HSIB) explores issues around patient handover to emergency care. Patients who wait in ambulances at an emergency department are at potential risk of coming to harm due to deterioration or not being able to access timely and appropriate treatment. This is the second interim bulletin published as part of this investigation, and findings so far emphasise that an effective response should consider the interactions of the whole system: an end-to-end approach that does not just focus on one area of healthcare and prioritises patient safety. The reference event in this investigation involves a patient who was found unconscious at home and taken to hospital by ambulance. They were then held in the ambulance at the emergency department for 3 hours and 20 minutes and during this time their condition did not improve. The patient was taken directly to the intensive care unit where they remained for nine days before being transferred to a specialist centre for further treatment.
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News ArticleHarm to patients has become “normalised” as burned-out paramedics are working without breaks, the national care watchdog has warned. Concerns over the pressures on staff at South East Coast Ambulance Service have been raised by the Care Quality Commission (CQC). Senior staff told the CQC that patients were being adversely affected by ambulance delays but it was now being seen as “part of the culture”. The CQC found pressures on staff within the South East Coast Ambulance Service, such as long waits outside of the emergency department, had led to low morale and staff feeling they were not valued. It said: “Staff described feeling frustrated and burnout and that senior leaders did not understand or respond to the challenges or concerns they raised. Some local senior managers described that harm to patients, caused by delays in reaching them, had become normalised as a culture.” “At times there were many outstanding category 3 [urgent] patients awaiting an ambulance or assessment by a paramedic practitioner. At busy times, these patients waited for extended lengths of time for crews and callbacks. Therefore, this group of patients were at risk of deterioration whilst they were waiting for a response.” Read full story Source: The Independent, 26 October 2022
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News ArticleHospitals “desperate” to free up beds could be putting patients in danger, The Independent has been told. NHS trusts are being forced into “risky behaviours” in the push to free up hospital beds and A&E departments, experts have warned. It comes as new data reveals that waits for ambulance crews outside hospitals hit 26 hours in September, with more than 4,000 patients likely to have experienced severe harm due to delays. In documents leaked to The Independent, hospital leaders in Cornwall warned staff that current pressures in its emergency care system combined with ambulance delays have “tragically resulted in deaths”. Royal Cornwall Hospitals Trust and the Cornwall Partnership NHS Foundation Trust said in the document that ambulance delays and waits in A&E were causing a “risk to life”, and that as a result they were planning to begin discharging patients into the care of the voluntary sector. The document said: “It is likely that the risk of such support not meeting all the patients’ individual requirements is less than the risk to life currently experienced in the community when there are significant handover delays at the hospital front doors.” It comes as North West Ambulance Service launched an investigation after a patient died waiting in the back of an ambulance outside A&E, the Manchester Evening News reported. Read full story Source: The Independent, 24 October 2022
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News ArticleParamedics in England cannot respond to 117,000 urgent 999 calls every month because they are stuck outside hospitals looking after patients, figures show. The amount of time ambulance crews had to wait outside A&E units meant they were unavailable to attend almost one in six incidents. Long delays in handing patients over to A&E staff meant 38,000 people may have been harmed last month alone – one in seven of the 292,000 who had to wait at least 15 minutes. Of those left at risk of harm, 4,100 suffered potential “severe harm”, according to the bosses of England’s ambulance services. Read full story Source: The Guardian, 21 October 2022
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News Article
Paramedics in ‘Mexican standoff’ with A&E staff after ‘unprecedented’ rule change
Patient Safety Learning posted a news article in News
Angry exchanges between paramedics and A&E staff in Liverpool have broken out after new measures were deployed to hold and treat patients in the back of ambulances. Sources said there have been “Mexican standoff” situations at Aintree Hospital in recent days, after hospital staff insisted patients who had been brought inside should be returned to ambulance vehicles. Staff at North West Ambulance Service told HSJ they were informed of a new protocol last week, which said patients should be kept in the back of ambulances if the corridor of the emergency department is full with patients. There have been repeated orders from NHS England and the Care Quality Commission over the past year for hospitals to ensure patients can be offloaded by ambulance crews, even if they fear they do not have adequate staffing or beds to accept them. One senior source at NWAS said: “To see a new protocol like this is absolutely unprecedented. I very much doubt the execs had approved it. “We’ve had Mexican standoff situations over the weekend with crews who have brought patients into ED being told to take them back out to their vehicles, but they’ve refused to do this as it means they cannot cohort. “We completely accept that taking extra patients means the ED and hospital staff have to deal with additional and unacceptable risk, but holding ambulances is not the solution because the risks to patients out in the community are even greater. Despite repeated instructions from NHS England and the CQC this still doesn’t seem to be understood.” Read full story (paywalled) Source: HSJ, 17 October 2022 -
News Article
Outstanding air ambulance team 'go the extra mile'
Patient Safety Learning posted a news article in News
An air ambulance service has been praised by inspectors for providing an "outstanding level of care". The Care Quality Commission (CQC) carried out checks on the Essex & Herts Air Ambulance Trust (EHAAT) in August and September. The report said patients felt "truly respected and valued as individuals" and described teamwork as "exemplary". Ben Myer, EHAAT head of clinical delivery, said "everyone worked so hard to make the desired result a reality". The service provides emergency care and transport in Essex and Hertfordshire, and surrounding areas when needed. As well as being rated outstanding overall, the charity was also rated outstanding for being safe, effective, caring, responsive to people's needs - and being well-led. Jane Gurney, EHAAT chief executive, thanked the local community for supporting the service, and issued a personal thank you to "each team member across the charity, whatever their role, all of whom work so hard every day to uphold these high standards". Read full story Source: BBC News, 12 October 2022 -
Content ArticleThis Nuffield Trust Quality Watch blog from Sophie Flinders and Sarah Scobie takes a closer look at the rising number of patients facing delays in leaving hospital – and explores the reasons for why it’s happening.
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News Article
Emergency care in ‘dire’ situation as performance plummets over weekend
Patient Safety Learning posted a news article in News
Several ambulance trusts have moved to the highest level of alert in the wake of severe pressure on emergency services in recent days. Internal data seen by HSJ suggests ambulance response times have deteriorated dramatically, while the average time for call handlers to answer 999 calls has increased to almost two minutes in some areas. Staff across the country have been sounding the alarm over the pressures, with one senior source saying the situation was “really dire” again, after a period in which pressures had eased in August and September. The internal data showed ambulance trusts in the South West, East of England, London and the West Midlands had all declared the highest level of alert, known as REAP 4. More are expected to follow. The average response time for category 2 calls in the South West – including suspected heart attacks and strokes – was 1 hour 24 minutes, with 10% of these calls responded to in more than 3 hours 11 minutes. The target is 18 minutes. Emergency departments have also faced severe pressure. An emergency care consultant in Plymouth tweeted that patients were facing 70-hour waits to be admitted to wards, with some waiting 18 hours to be handed over by ambulance staff. Fionna Lowe added: “I have taken to asking families to feed their relatives. It has never been this bad.” Read full story (paywalled) Source: HSJ, 4 October 2022 -
Content Article
AvMA case study: Lyndsey's story
Patient-Safety-Learning posted an article in Risk management and legal issues
This article tells the story of Lyndsey, who was 36 years' old and expecting her third child when she died of shock and haemorrhage, and a perforated gastric ulcer. Sadly, her baby also died as a result of Lyndsey's condition. In her narrative report, the Coroner raised concerns that Lyndsey had been prescribed methadone with no face-to-face consultation, and that she had received a prescription with no planned medical review. She also raised concerns about the reliability of the ambulance pre-alert system due the absence of systems for auditing the effectiveness and reliability of the pre-alert system and the lack of knowledge and training of staff in control. -
News Article
Paramedics pilot plan to reduce huge ambulance queues at A&E
Patient Safety Learning posted a news article in News
Hannah Rusby reassures her patient he’s in good hands. He is in his eighties, skeletal, confused and struggling to answer basic questions. His breathing is rapid. After a few minutes of probing questions and basic tests, Rusby knows this is serious — after months of decline while living alone, the man is critically ill and needs to go to hospital urgently. With more than 500,000 people waiting for social care assessments across England, emergency calls such as this are increasingly common. “We are becoming a middleman for all the other services,” said Rusby, who qualified as a paramedic seven years ago and works for the London Ambulance Service (LAS). She said the job increasingly involves responding to people who fall through society’s cracks. Daniel Elkeles, 49, chief executive of the LAS, agrees: “There are lots of patients who, if something else were available, we wouldn’t need to take them to hospital. As the population has got older and frailer, it’s unsurprising that an increasing number of the calls are not traditional emergencies.” He believes paramedics can be the link between GPs, community nursing and social care. From next week, the LAS will pilot having three cars covering six boroughs in southwest London. Each will have a paramedic and a community nurse and will respond to 999 calls from elderly people who have fallen at home. They’re going to see every frail elderly person who has fallen [and] hasn’t broken a bone, and our aim is to keep all of those patients at home. The community nurse will assess the house to make sure it’s safe then refer the patient to their GP and an urgent community response team,” said Elkeles. The service hopes this will mean as many as 1,000 fewer people going to A&E a year. Read full story (paywalled) Source: Sunday Times, 2 September 2022 -
Content ArticleTherese Coffey, the new health and social care secretary, sets out the government’s plans for the NHS and social care to deliver for patients, this winter and next. The government's plan for patients sets out the priorities for health and care, delivering across four key areas: ambulances backlogs care doctors and dentists. Read her Ministerial foreword below.
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News Article
‘Gross’ care delays could become ‘new normal’, says CQC report
Patient Safety Learning posted a news article in News
The Care Quality Commission (CQC) has urged system leaders to move away from “quick fixes” to the “enormous gap in resources and capacity” in urgent and emergency care. A report by the CQC and a large group of emergency clinicians and other health and care leaders calls for a ”move away from reactive ‘quick fixes’ such as tents in the car park or corridor care to proactive long-term solutions and to address the enormous gap in resources and capacity”. The use of tents and treating more patients in corridors have been increasingly adopted by hospitals in recent months, sometimes encouraged by NHS England, particularly when they are under pressure to reduce handover delays from ambulances. The report, 'People First: a response from health and care leaders to the urgent and emergency care system crisis', suggests: expanding use of urgent community response teams to attend minor injuries 999/111 calls, giving acute and social care providers direct access to GP and community service booking systems, and providing “rapid access” to support packages to help people avoid hospital admission. Read full story (paywalled) Source: HSJ, 22 September 2022 -
Content ArticleThis letter from NHS Confederation to Thérèse Coffey MP, the new Secretary of State for Health and Social Care, sets out what needs to be done to support the delivery of an emergency winter plan for health and social care services. It outlines the views of NHS Confederation members on what will be needed to deliver the ‘ABCD’ highlighted as priorities by the Secretary of State: ambulances, backlogs, care and doctors and dentists.
