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News Article
‘Blame shunting’ by providers leads to poor emergency care, says NHSE
Patient Safety Learning posted a news article in News
The ‘inability or unwillingness’ of some NHS and social care providers to work together has contributed to an ‘unimaginable’ deterioration in emergency care performance, according to NHS England The claim is made in the urgent care recovery plan for 2025-26, released by NHS England and the Department of Health and Social Care. The plan includes a new target to reduce 12-hour accident and emergency waits and pledges to invest £370m of capital funding in improving urgent care and mental health facilities. The plan said, “Each part of the system has responsibility for improving urgent and emergency care performance. However, blame shunting has become a feature in some poorly performing systems and can no longer be tolerated." National urgent care director Sarah-Jane Marsh told HSJ that “the duty to collaborate and work together and do the best for patients is on all trust boards, and it shouldn’t rely on some overseer to make sure that happens. It’s a fundamental part of being a leader”. Trusts will be told to ensure the proportion of patients waiting over 12 hours for admission, transfer or discharge from A&E remains less than 10%. The 45-minute “maximum” ambulance handover time will become mandatory across all trusts ahead of winter, according to the plan. Chief executive of the College of Paramedics, Tracy Nicholls, said, “The plan sets out progressive structural proposals that have the potential to enhance public safety and strengthen paramedic autonomy. However, it may underestimate key challenges, including workforce readiness, the capacity of the mental health system, and practical implications of the Right Care, Right Person model. Without urgent alignment of funding, training, and alternative care pathways, there is a real risk that paramedics could be left navigating a reform process that shifts responsibility without equipping them with the necessary tools and support. Read full story (paywalled) Source: HSJ, 5 June 2025 Related reading on the hub: How corridor care in the NHS is affecting safety culture: A blog by Claire Cox My experience of the 'Wait 45' policy - Florence in the Machine A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift- Posted
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News Article
Nearly £450m is being invested in the NHS in England to cut hospital waiting times and tackle persistently failing trusts, the health secretary has announced. Wes Streeting says his NHS reforms aim to deliver around 40 new centres to fast-track treatment for patients, up to 15 mental health crisis assessment units and almost 500 new ambulances. It is part of an attempt to shift patients away from A&E and avoid unnecessary hospital admissions. "No patient should ever be left waiting for hours in hospital corridors or for an ambulance which ought to arrive in minutes," said Mr Streeting. "The package of investment and reforms we are announcing today will help the NHS treat more patients in the community, so they don't end up stuck on trolleys in A&E," he added. In an example of the challenge facing the health secretary, Sky News on Wednesday revealed the scale of England's mental health crisis, exacerbated by a shortage of specialist beds and an overwhelmed social care network. The new Urgent and Emergency Care Plan for England says more needs to be done to drive down long waits, cut delayed discharges and improve care for patients. Read full story Source: Sky News, 6 June 2025 Related reading on the hub: How corridor care in the NHS is affecting safety culture: A blog by Claire Cox My experience of the 'Wait 45' policy - Florence in the Machine A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift- Posted
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Content Article
NHS England: Urgent and emergency care plan 2025/26
Patient Safety Learning posted an article in NHS England
This report sets out how the NHS will resuscitate urgent and emergency care, with a focus on getting patients out of corridors, keeping more ambulances on the road, and enable those ready to leave hospital to do so as soon as possible. Summary of actions and impact for patients and carers Focus as a whole system on achieving improvements that will have the biggest impact on urgent and emergency care services this winter By the year-end, with improvement over winter, we expect to: Reduce ambulance wait times for Category 2 patients – such as those with a stroke, heart attack, sepsis or major trauma – by over 14% (from 35 to 30 minutes). Eradicate last winter’s lengthy ambulance handover delays by meeting the maximum 45-minute ambulance handover time standard, helping get 550,000 more ambulances back on the road for patients. Ensure a minimum of 78% of patients who attend A&E (up from the current 75%) are admitted, transferred or discharged within 4 hours, meaning over 800,000 people a year will receive more timely care. Reduce the number of patients waiting over 12 hours for admission or discharge from an emergency department compared to 2024/25, so this occurs less than 10% of the time. This will improve patient safety for the 1.7 million attendances a year that currently exceed this timeframe. Tackle the delays in patients waiting to be discharged – starting with the nearly 30,000 patients a year staying 21 days over their discharge-ready-date, saving up to half a million bed days annually. Increase the number of children seen within 4 hours, resulting in thousands of children every month receiving more timely care than in 2024/25. Develop and test winter plans, making sure they achieve a significant increase in urgent care services provided outside hospital compared to last winter Improve vaccination rates for frontline staff towards the pre-pandemic uptake level of 2018/19. This means that in 2025/26, we aim to improve uptake by at least 5 percentage points. Increase the number of patients receiving urgent care in primary, community and mental health settings, including the number of people seen by Urgent Community Response teams and cared for in virtual wards. Meet the maximum 45-minute ambulance handover time standard. Improve flow through hospitals, with a particular focus on reducing patients waiting over 12 hours, and making progress on eliminating corridor care. Set local performance targets by pathway to improve patient discharge times, and eliminate internal discharge delays of more than 48 hours in all settings. Reduce length of stay for patients who need an overnight emergency admission. This is currently nearly a day longer than in 2019 (0.9 days) and needs to be reduced by at least 0.4 days . Reduce the number of patients who remain in an emergency department for over 24 hours while awaiting a mental health admission. This will provide faster care for thousands of people in crisis every month. National improvement resource and additional capital investment is simplified and aligned to supporting systems where it can make the biggest difference Allocating over £370 million of capital investment to support: Around 40 new same day emergency care centres and urgent treatment centres. Mental health crisis assessment centres and additional mental health inpatient capacity to reduce the number of mental health patients having to seek treatment in emergency departments. Expansion of the Connected Care Records for ambulance services, giving paramedics access to the patient summary (including recent treatment history) from different NHS services, enabling better patient care and avoiding unnecessary admissions.- Posted
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Content Article
The purpose of this study was to identify which, and to what extent, demographic and operational factors are indicative of likelihood for a new call handler or paramedic to remain in role within the first two years of employment at an ambulance trust using data held in the trust’s bespoke data warehouse. Several factors showed a significant contribution to the likelihood of remaining in post within an ambulance NHS Trust. Among the findings, short-term sick leave in the first two years of employment was associated with increased retention for paramedics. In addition, female call handlers were found to have increased retention and paramedic retention increased with time outside of ‘job cycle time’ (JCT) activities (ie, activities other than responding to calls). This study presents a method for extracting new insights from routinely collected operational data, identifying common drivers and specific predictors for retention among the ambulance NHS workforce. It emphasises the importance of workforce-centred retention strategies, highlighting the need for non-JCT time, which in turn would allow paramedics to have time to reflect and recuperate to avoid burnout and attrition. The study also suggests that a lack of sick leave might indicate a lack of trust and self-care culture, potentially leading to paramedic staff attrition. Our approach to retention analytics provides a new mechanism for trusts to monitor and respond to their attrition risks in a timely, proactive fashion.- Posted
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My experience of the 'Wait 45' policy
Anonymous posted an article in Florence in the Machine
The images on the left highlight the increased delays in ambulance responses and the potentially catastrophic consequences. Equally, the panic-inducing headlines of measures brought in to resolve the crisis. I work on the healthcare frontline and I’d like to share my experience of the 'Wait 45' policy in my trust and the impact it is having. Implementation of a new policy In December 2024, all ambulance trusts in England were told to implement a new policy, ‘Release to Respond’, also known as the ‘Wait 45’ policy, which means ambulances will only wait at Emergency Departments (ED) for 45 minutes before patients are left and the crews make their way to the next call. This was initiated following increasing waits for crews to handover patients to the ED. These waits were not inconsiderable periods of time, with many reports of crews spending their entire shift parked outside the ED with just one patient. This has resulted in some appalling headlines—for example, elderly people being left waiting for up to 15 hours for an ambulance to arrive and people having cardiac arrests where ambulances are not available to respond. Based on this, the adoption of the ’Release to Respond' policy makes sense. However, the introduction of this policy has been met with some scepticism and equally horrendous headlines about patients being dumped while crews run. The policy states that crews will not dump and run, and that handovers will be given, and patients will be placed on a chair, trolley or wheelchair in a dedicated space. But this policy is another example of not identifying the whole problem and bringing in a measure that only addresses the needs of one part of the healthcare system, while making it considerably worse for other parts! What is the point of an integrated care system (ICS) and board (ICB) if they do not look at an integrated intervention to address this situation? What is the reality of the ’Wait 45’ policy? The Wait 45 policy in my trust has completely changed the way the ED manages patients. Corridor care is a term used to describe the practice of providing medical attention to patients in hallways or other non-designated clinical areas due to overcrowding or resource shortages. It used to be that corridor care was for patients who had been seen, had a plan and who were either waiting to go home or for a bed on a ward. Now, in my trust, the corridor is for undifferentiated patients (patients who present with symptoms that have not yet been diagnosed or categorised) that come in directly from the ambulances. This has increased the risk to patients and staff. The corridor is used as soon as the department is full and then, only when the corridor is full to capacity, does the Wait 45 policy get initiated. At this point it is almost guaranteed that the corridor will need additional staffing from somewhere, while the first crew need to wait their 45 minutes—the hospital now has 45 minutes to find these additional staff otherwise the nurse: patient ratio increases in the corridor. The ratios of nurse to patients differs depending on the area of the hospital: in major treatment areas it is 1:4 but in the corridor it is 1:6; however, there is no upper limit of patients in the corridor and staff are often moved from other in-patient areas to work in the ED where they are invariably working in the corridor. These nurses will not have a ED background and will find it challenging and may miss the subtle signs that an experienced ED nurse may spot. There is often a lack of support for nurses in the corridor, leaving additional staff having to rely on their previous experience and judgement to guide them on what needs to be done. Handover criteria not being met Ambulance trust and the acute trust staff should at handover discuss the criteria for placing patients in a corridor—i.e., patients are supposed to be independent, able to move themselves to the toilet, be clinically stable and not have an infectious presentation However, in my experience this criteria is often not followed, as highlighted in the following examples I have seen and heard: Suspected neutropenic patients placed in the corridor. These patients have a low neutrophil count (a type of white blood cell) and are more vulnerable to infections. The concern for those on immunosuppressants seems to be non-existent now; there was a significant concern during the Covid-19 pandemic, but now being immunosuppressed is met with a tut, roll of the eyes and a shrug of the shoulders. It rarely features in handovers. Ambulance crews handing over patients that needed a hoist transfer at their nursing home; it is clearly not appropriate to care for these patients in a corridor where they should be mobile to use bedpans or commodes. Elderly patients who have fallen—either with significant trauma or with no apparent injuries—placed in the corridor. One patient had pain in their neck and received a trauma CT scan in the corridor—surely this patient should not have been in a corridor in the first place! Patients with diarrhoea and vomiting placed in the corridor, sometimes next to the neutropenic patients. Those with significant respiratory symptoms suggestive of influenza or Covid-19 placed in the corridor, despite the known risks to those that are in the corridor with them. I have even had a patient with a Glasgow Coma Scale of 10 (this is a tool that healthcare providers use to measure decreases in consciousness) handed over to the corridor… Wouldn’t resuscitation be a better location for them? Unintended consequences It is easy to understand why ‘Release to Respond’ policies are needed. With no external pressure, it appeared that many trusts lacked the willingness to investigate changes to reduce the overcrowding in the ED. However, while I recognise that the ambulance trusts need to have their staff available and not tied up at hospitals, this is making the ED unsafe. Another unintended consequence of these policies is that the working relationships between the ED nurses and the ambulance crews has deteriorated. I have noticed an increasing lack of willingness to help each other and incivility is growing. Asking simple questions results in dirty looks and aggressive questioning about ’who are you‘. The natural feeling is now one of defence, protecting each other against comments, pulling back into areas of comfort and knowledge. The standard replies are now ‘no’ and a feeling that this is not my problem or my fault. Unilateral measures that do not address the whole problem I cannot help but think implementing a unilateral solution like the ‘Release to Respond’ policy is based entirely on ‘work as imagined’ and benefits only one part of a highly complex area. It places additional burdens on already overstretched resources. The worst of which is that EDs are still seen as being made of elastic, with the ability to continually expand even when the evidence shows every hospital is beyond capacity every day of the year! When I first heard about ICSs and ICBs, I really hoped we would start to see a time of collaboration, working together to solve some of the issues within healthcare. Sadly, there does not yet seem to have been a change. In fact, it feels very much that we renamed but stayed the same. Probably, because all that has happened since the ICSs were introduced is restructuring after restructuring. They are not being allowed to work. Please, don’t get me wrong. I can see why these policies are in place. If I called an ambulance, I would like it to be available to respond and unfortunately currently they are not and have not been for a while. But I cannot help but think that until the ICS and regional NHS organisations take ownership of these problems, and all the stakeholders are represented at the table to analyse, design, implement and, most important of all, EVALUATE an intervention, we are condemned to keep implementing unilateral measures that do not address the whole problem. Further reading on the hub The crisis of corridor care in the NHS: patient safety concerns and incident reporting A silent safety scandal: A nurse’s first-hand account of a corridor nursing shift A nurse's response to the NHSE guidance on their principles for providing safe and good quality care in temporary escalation spaces How corridor care in the NHS is affecting safety culture: A blog by Claire Cox Share your insights Do you have experience of corridor care either as a patient or a healthcare professional? What impact have you seen on patient safety? You can comment below (sign up here for free first) or email the editorial team at [email protected]- Posted
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Content Article
In December 2022 Dylan Cope, a 9 year old boy, died of sepsis after being discharged from hospital. A coroner in Newport found the boy's death “would have been avoided if he had not been erroneously discharged”, and said what happened "amounts to a gross failure of basic care”. In this video from Welsh Ambulance Services University NHS Trust, Dylan's parents explain what happened when he became unwell and deteriorated, and the how delays and failures in his care had a devastating impact. They highlight the need for compassionate responses when someone has died or suffered following failures or mistakes in care, and describe how they were engaged with following Dylan's death. -
News Article
CEO tells staff ‘silence is complicity’ after record sexual misconduct reports
Patient Safety Learning posted a news article in News
An ambulance trust has dismissed “multiple staff” for sexual misconduct offences this year following its “highest year ever for reported sexual safety incidents” in 2024, HSJ has learned. East of England Ambulance Service Trust’s chief executive Neill Moloney wrote to staff to warn them they all have a “moral obligation” to “step up when [they] see inappropriate behaviour”. In the letter, seen by HSJ, Mr Moloney said: “Silence is not neutrality. It is complicity. We all have a moral obligation to support those that experience this behaviour… If you witness or experience inappropriate sexualised behaviour, I am encouraging you to report it.” He added: “Last year alone, 44 sexual safety incidents were reported — our highest year ever for reported sexual misconduct — figures driven in part by higher reporting of incidents. “Already in 2025, we have dismissed multiple staff for sexual misconduct. This includes sexualised conversation and language in ambulances and crew rooms. This is considered sexual misconduct and we need your support to continue to eradicate this.” The trust told HSJ that four people were dismissed for sexual misconduct in 2024, and to date in 2025, a further four people have been dismissed. The concerns follow the results of the NHS Staff Survey published last month, which highlighted the depth of the sexual misconduct problems across the whole ambulance sector, with the Association of Ambulance Chief Executives calling for a “cultural reset”. Read full story (paywalled) Source: HSJ, 28 April 2025- Posted
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News Article
Violence and abuse against ambulance staff in UK at highest level on record
Patient Safety Learning posted a news article in News
The number of violent assaults, acts of aggression and incidents of abuse against ambulance staff in the UK has risen to the highest on record, according to data health leaders described as “horrendous” and “truly shocking”. There were 22,536 incidents of violence, aggression and abuse directed at paramedics and other ambulance workers in 2024-25, up 15% on the 19,633 in 2023-24, figures from the Association of Ambulance Chief Executives (AACE) show. It means that each week on average those responding to 999 calls are the victims of 433 attacks, include kicking, punching, slapping, head-butting, spitting, sexual assault and verbal abuse. Senior ambulance officials said they believed the true toll was even higher, with many incidents not reported or recorded. Female paramedics and ambulance workers are the most likely to be targeted by the public. Jason Killens, the AACE chair, said: “These figures are truly shocking and reflect a pattern of increased violence, aggression and abuse directed at hard-working ambulance people who are there to help people in their times of greatest need. “Frontline staff as well as call handlers are affected by this horrendous abuse, and this unacceptable behaviour has a major long-term impact on the health and wellbeing of ambulance people who are simply trying to do their jobs and help save lives.” Read full story Source: The Guardian, 24 April 2025- Posted
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News Article
Crucial emergency care system to be scrapped by NHS England within months
Mark Hughes posted a news article in News
An IT system that prevents 999 call-handling services from being overwhelmed is set to be withdrawn by NHS England in an effort to save money. NHS England has confirmed it will not renew the contract for the Intelligent Routing Platform (IRP), and that the service will cease to be available within three months. NHS England now proposes that individual ambulance trusts will be responsible for tackling delays in answering calls, as was the case before the pandemic. HSJ understands that ambulance leaders are very concerned by the decision and the speed with which it is to be implemented. Read full story Source: Health Service Journal (Paywalled), 14 April 2025- Posted
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News Article
Ambulance services hit key recovery target
Patient Safety Learning posted a news article in News
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. Read full story (paywalled) Source: HSJ, 13 April 2025- Posted
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News Article
Paramedics across England are watching patients die in the back of ambulances because of delays outside emergency departments, according to a survey by Unison. The gridlock of patients in some of the country’s hospitals has led to queues of up to 20 ambulances outside casualty departments in certain areas. In a number of cases, crews have been forced to wait more than 12 hours before handing over patients. The survey of nearly 600 ambulance workers reveals the toll of the waits on patients and the crews looking after them. Unison warns that “car park care” is increasingly becoming the norm, with hospital medical staff tending to patients in the back of ambulances. More than three-quarters (77%) of paramedics and emergency medical technicians said they have had to look after people in the back of ambulances in the past year while stuck outside emergency departments. Two-thirds (68%) have waited in hospital corridors, or in other locations, with one paramedic often caring for several patients to allow colleagues to respond to other calls. More than two-thirds also reported patients’ health deteriorating during long waits, and one in 20 (5%) said people have died in their care because of long delays in being admitted. Gavin Taylor, 58, a Unison representative and ambulance worker in the north-west of England, said it was now a regular occurrence to be waiting several hours to hand over a patient. He said: “It’s heartbreaking because we are here as a caring profession and the delays have an impact on the care and wellbeing of patients.” Read full story Source: The Guardian, 6 April 2025- Posted
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Ambulance services play a pivotal role in ensuring the safety of mothers and their newborns during urgent and emergency situations. These services act as the frontline responders, providing immediate care and facilitating timely transport to appropriate healthcare facilities. World Patient Safety Day, observed annually on 17 September, serves as a global platform to raise awareness about patient safety and encourage collaborative efforts to reduce harm in healthcare settings. The theme for 2025, 'Safe care for every newborn and every child', underscores the critical importance of safeguarding our youngest and most vulnerable patients from preventable harm. In the UK, ambulance services play a pivotal role in ensuring the safety of mothers and their newborns during urgent and emergency situations. These services act as the frontline responders, providing immediate care and facilitating timely transport to appropriate healthcare facilities. Their contributions are multifaceted, encompassing emergency childbirth assistance, neonatal transfers and the management of obstetric emergencies. In addition, many women and families will use the 999/111 service throughout the childbearing continuum, often using these services as a gateway to accessing maternity care. A recent review of Maternity and Newborn Safety Investigations (MNSI) highlighted that 6 in 10 independent investigations that met the criteria for MNSI involved the ambulance service. Out-of-hospital births, though relatively rare, present unique challenges for ambulance clinicians. Intrapartum care accounts for approximately 0.05% of emergency medical services' caseload, with only about 10% of these cases resulting in deliveries managed by ambulance staff. This limited exposure can lead to a decline in obstetric clinical skills, potentially impacting patient care. To address this, continuous training and simulation exercises are essential. For instance, the London Ambulance Service has developed a bespoke communication tool to support midwives in out-of-hospital settings, ensuring effective communication during the transfer of women or babies in emergencies and delivers bespoke mandated emergency training to its frontline clinicians. Such initiatives enhance the preparedness of ambulance clinicians to manage emergency deliveries safely; however, these are not standardised across services. Challenges and areas for improvement Despite their critical role, UK ambulance services face challenges that can impact maternal and neonatal safety. Incidents of delayed response times have been reported, leading to tragic outcomes. For example, a three-day-old baby named Wyllow-Raine Swinburn passed away after an eight-minute delay in answering a 999 call and a 31-minute wait for the ambulance to arrive. Although the delays were not deemed the direct cause of death, they highlighted inefficiencies in the emergency response system. In other cases, the lack of effective training for ambulance clinicians impacted upon the management of a time critical breech delivery, with tragic consequences. Such cases underscore the need for systemic improvements, including better resource allocation, enhanced training and the implementation of robust protocols to minimise delays in emergency response. Collaboration between ambulance services and midwifery teams is essential for improving outcomes in maternal and neonatal emergencies. The development of communication tools and training programmes exemplifies efforts to standardise information exchange during emergencies, thereby reducing the potential for errors and delays. Furthermore, ambulance services are increasingly recognising the importance of specialised roles focused on maternity care. For instance, paramedics with additional training in neonatal and maternity care can provide more comprehensive support during emergencies. Susie, a paramedic with the Northwest Ambulance Service, highlighted her passion for improving maternity care within the ambulance service, emphasising the importance of continuous professional development in this area. Conclusion As we observe World Patient Safety Day 2025, it is imperative to acknowledge and support the vital role of UK ambulance services in safeguarding mothers and their newborns during and following pregnancy. Continuous training, effective communication tools and collaborative practices are essential to enhance the safety and quality of care provided. By addressing existing challenges and building on successful initiatives, we can move closer to the goal of ensuring safe care for every newborn and every child from the very start. Further reading Exploring the pre-hospital setting for the emergency care and transfer of neonates: the role of UK ambulance and neonatal transport services Displaced risk. Keeping mothers and babies safe: a UK ambulance service lens An exploration of maternity and newborn exposure, training and education among staff working within NWAS Disparities In Access to the Northwest Ambulance Service during pregnancy, birth and postpartum period and its association with neonatal and maternal outcomes World Patient Safety Day 2025- Posted
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An ECG is a test that records the electrical activity of a patient’s heart. It needs to be correctly carried out and accurately interpreted to determine the patient’s condition and potential diagnosis. This Health Services Safety Investigation Body (HSSIB) investigation was prompted by the case of a 29-year-old woman with chest pain. Her ECG was misinterpreted and she later died of a heart attack. The investigation focused on paramedic education, training and competence in ECG practice and the task of carrying out and interpreting an ECG in the context of the patient’s clinical signs and symptoms. The investigation spoke to key stakeholders to understand the safety risks that may be present in this area. The way 12-lead ECGs are undertaken and interpreted was identified as a growing area of concern, with systemic safety risks that can have a significant impact on the outcome for patients. HSSIB identified safety learning for ambulance services to help train qualified paramedics. It has also made a safety recommendation to the Health and Care Professions Council and the College of Paramedics to improve undergraduate teaching for paramedic students, to reduce this safety risk for patients. HSSIB makes the following safety recommendation HSSIB recommends that the Health and Care Professions Council and the College of Paramedics work in collaboration with relevant stakeholders to improve the undergraduate teaching of 12-lead electrocardiograms by reviewing and updating any relevant standards, guidance, and curricula to provide clarification on: the level of education and expected level of competency and assessment required of student paramedics in relation to electrocardiograms any minimum expected standards for electrocardiogram education in higher education institutions, including the time spent on electrocardiogram learning, methods used, and subject matter expertise required of teaching staff how patient protected characteristics, health inequalities and other specific patient factors are taught in relation to electrocardiograms how effective feedback mechanisms can be developed between higher education institutions and ambulance services. This is to help improve consistency in the way paramedic students are educated about electrocardiograms. HSSIB makes the following safety observations Ambulance services can improve patient safety by including patient protected characteristics, health inequalities and other specific patient factors that can impact on the task of carrying out and interpreting a 12-lead ECG, when developing refresher training. Ambulance services and national organisations can improve patient safety by providing and supporting protected time and resources for paramedic training and continuous professional development, while understanding the potential impact on operational performance. Ambulance services can improve patient safety by providing additional support to paramedic students and paramedics through exposure to a range of clinical scenarios that help develop and maintain 12-lead ECG competency on a regular basis. Acute hospitals and ambulance services can improve patient safety by developing local mechanisms to share information about patient outcomes where paramedics have undertaken a 12-lead ECG. This can help to support learning for paramedics and provide feedback on where their practice may be improved. -
News Article
Staffing vital to high hear and treat rates, say trusts
Patient Safety Learning posted a news article in News
Some 30,000 emergency ambulance trips could be avoided every month if trusts provided more advice over the phone, according to NHS England figures. The proportion of emergency calls dealt with through hear and treat ranges from more than 20 per cent at the best-performing trusts to less than half that in other areas. Typically, this involves patients being given advice such as self-care, seeing a GP or pharmacist, or being directed to an alternative pathway for urgent care. Based on February’s figures, released by NHS England, an additional 30,000 patients could have been seen if every trust matched the performance of West Midlands Ambulance Service University Foundation Trust and London Ambulance Service Trust, both of which dealt with 20.6 per cent of patients in this way. London Ambulance Service Trust has managed more than one in five patients through hear and treat while seeing an additional 500 to 520 calls each day this winter. Michael Ward, deputy director of clinical safety and compliance at LAS, told HSJ the initiative had helped lessen demand on hospitals. He said the trust had boosted recruitment of both band 6 clinical advisers and band 7 clinical support managers, to support control room staff. Advice to control room staff on the most clinically appropriate pathway is readily available, including a 24/7 clinical safety officer. The trust has also worked to make these roles attractive for staff, with the provision of training and development plus timely feedback on decisions, he said, adding that the roles were attractive to paramedics who no longer want the physical strain of frontline work. “I think there is scope for more hear and treat,” Mr Ward said. “There is a natural ceiling but I don’t think we have reached it yet.” Read full story (paywalled) Source: HSJ, 19 March 2025- Posted
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A 35-year-old man from Cardiff died after collapsing at home despite his mother and brother trying to give him CPR. Martyn Wright collapsed at home, and it has since been found that there were errors in the way his family's calls to the ambulance service were handled. Martyn's mum, Claire, claimed that calling 999 was a "lottery". In a statement to WalesOnline, she, said: "Through lived experience, we have learned our 999 emergency service cannot be relied upon even when there is clearly an immediate risk to life, it's now quite simply a lottery. An ambulance initially allocated to attend my son who collapsed at home suddenly in December, 2022, was stood down in error by a novice 999 call-handler, this caused a significant delay to him receiving vital treatment. "Despite our younger son performing CPR on his unconscious brother, when they did arrive 45 minutes later as a result of a follow up call made by myself, Martyn was tragically beyond help." Martyn's case was referred to the Public Services Ombudsman for Wales, who has found there were errors in the handling of his case. On the day of his collapse, Martyn was at home with his mum and brother. Two 999 calls were made. The first call was incorrectly downgraded from a red priority to "green 2". The second call was also not handled appropriately, with incorrect information given to Mrs Wright about resuscitation. As a result, the ambulance arrived 32 minutes late. Through it all, Mrs Wright and her son were, the report said, "attempting to deliver CPR without instruction or support". Mrs Wright complained about how the calls were handled, how the attending paramedics kept a record of events and whether the outcome for Martyn would have been different had the ambulance arrived earlier. The ombudsman found that the Welsh Ambulance Service trust did not properly manage the two 999 calls made after Martyn had collapsed. Read full story Source: Wales Online, 18 March 2025- Posted
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Ambulance services underprepared for ‘mass casualty incidents’
Patient Safety Learning posted a news article in News
Ambulance services would still struggle to respond effectively to a mass-casualty event like the Manchester Arena bombing, HSJ has learned, as nearly all have been denied the funding needed to bolster preparedness. The public inquiry report on the May 2017 attack, which killed 22, was sharply critical of the emergency services’ response, including North West Ambulance Service Trust. The inquiry’s November 2022 report made nearly 150 recommendations to prepare for future attacks. Crucially, ambulance trusts were told to review their capacity to respond to a mass-casualty incident – including whether they had enough trained specialist staff – then tell commissioners what extra funding they need to ”respond effectively”. Gaps identified included the availability of 24/7 “critical care cars”, specialist practitioners in hazardous area response teams, and tactical commanders in operations centres. But eight out of England’s 10 ambulance trusts have confirmed to HSJ – through Freedom of Information requests and follow-up enquiries – that they have not received funding from commissioners to cover what they found was needed. HSJ understands that, while some trusts have strengthened specialist teams using other income, they have not received funding for the majority of what the reviews said was needed, and there are therefore still significant gaps in readiness. Read full story (paywalled) Source: 14 February 2025- Posted
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NHS 111 firm admits fault for not sending ambulance to baby who later died
Patient Safety Learning posted a news article in News
A private call handling firm operating the NHS 111 non-emergency service has admitted it was at fault for failing to send an ambulance to a baby boy who died shortly after falling ill, an inquest has heard. Ben Condon, who was born premature, died aged two months at Bristol children’s hospital in April 2015 after developing a respiratory illness. A first inquest into his death ruled that Ben died as a result of acute respiratory distress syndrome, human metapneumovirus and prematurity but the conclusion was quashed by high court judges. On Monday, a fresh inquest opened into Ben’s death and heard that when the child went home to Weston-super-Mare, North Somerset, with his parents he developed a cold. His father, Allyn Condon, rang the non-emergency 111 service – run at the time by Care UK – at about 6pm on 10 April. The call handler referred Ben for an out-of-hours telephone call-back appointment with a GP within two hours rather than send an ambulance, a decision the coroner said was affected by “bias” as the handler was aware of “external pressures” facing ambulances. The court heard that by 7.45pm when Condon and his wife, Jenny, had not received the call from the GP, they took their son to the Weston general hospital. Reading from a written statement, the assistant coroner Robert Sowersby said Care UK had apologised to the Condon family and the adviser was taken off calls for nearly three weeks and received further training. “Care UK admitted it was at fault for having not sent an ambulance after the call,” Sowersby said. “It said that changes in the recordings of telephone calls needed to be made and apologised for their failings. “Care UK identified in the root cause analysis that the health adviser failed to actively listen and failed to accept the responses provided and there was a failure to select the appropriate pathway responses.” Read full story Source: The Guardian, 3 February 2025- Posted
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News Article
Ambulance crews stuck at A&E miss thousands of 999 calls a day in England
Patient_Safety_Learning posted a news article in News
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. Read full story Source: Guardian, 12 January 2025 -
News Article
Paramedics in England cannot respond to 3,500 urgent 999 calls every day because they are stuck outside hospitals waiting to hand over patients, putting other lives at risk, a Guardian investigation has found. Here two ambulance service workers describe their experiences on the frontline that they say “feels like a war zone at times” amid the worst NHS winter crisis in years. Read full story Source: Guardian, 12 January 2025 -
News Article
Ambulance handover delays hit record high
Patient-Safety-Learning posted a news article in News
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." Read full story (paywalled) Source: HSJ, 9 January 2025 -
News Article
Mum told to give seriously ill son painkillers amid ambulance delay
Patient_Safety_Learning posted a news article in News
The mother of a Belfast man, who collapsed outside a hospital, said she was shocked when a 999 call handler told her he should take painkillers as they would have to wait hours for an ambulance. Brian Rooney, 35, suffered a heart attack outside the Royal Victoria Hospital's emergency department after his bowel had perforated at home. He is now in an induced coma following emergency surgery, which resulted in the removal of his intestine. The Northern Ireland Ambulance Service (NIAS) apologised to Mr Rooney and his family "for not meeting their expectations in terms of the care provided to him". Read full story Source: BBC online, 8 January 2025 -
News Article
Ambulance handover delays in England may harm 1,000 patients a day
Patient Safety Learning posted a news article in News
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.” Read full story Source: The Guardian, 5 January 2025 -
News Article
Man, 84, left lying on driveway after breaking hip
Patient Safety Learning posted a news article in News
An 84-year-old man with heart conditions endured an agonising three-hour wait for an ambulance while lying on his damp driveway after breaking his hip. Graham Woolston was driven to his home in Lowestoft, Suffolk, by his son Daniel Woolston last Friday before falling and injuring himself at about 22:20 GMT. Despite his age and pre-existing medical conditions, coupled with the cold weather, paramedics did not arrive at the scene until about 01:20 GMT. Neill Moloney, chief executive of East of England Ambulance Service (EEAST), said: "We would like to apologise sincerely to Mr Woolston and his family." Mr Woolston had just spent eight hours in James Paget University Hospital, Gorleston, Norfolk, after experiencing dizziness over Christmas. But after arriving home, he stumbled out of his son's car and hit the floor, shattering his hip and leaving him in excruciating pain. After calling for an ambulance Daniel, 47, and his sister, with the help of neighbours, covered him in a duvet and blankets and used an umbrella to keep him dry. Within an hour and a half of the fall, Mr Woolston started to look "a bit pale", so Daniel called the ambulance service again, but to no avail. He was, however, told to get a defibrillator kit in the event his dad went into cardiac arrest, which he interpreted as being asked to "play paramedic". Read full story Source: BBC News, 3 January 2025- Posted
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Welsh Ambulance Service declares critical incident
Patient_Safety_Learning posted a news article in News
The Welsh Ambulance Service has declared a critical incident because of increased demand across the 999 service and extensive hospital handover delays. It said more than 340 calls were waiting to be answered across Wales at the time the critical incident was declared on Monday evening. In addition, more than half of the trust's ambulance vehicles were waiting to handover patients outside hospitals. The service is urging the public to call 999 only for serious emergencies as some patients continue to wait many hours for an ambulance. Read full story Source: BBC, 30 December 2024 -
News Article
A national probe has been launched into the deaths and harm of thousands of NHS patients waiting for cardiac surgery, as doctors and experts warn of a “crisis in heart care”, an investigation by The Independent has revealed. The audit was ordered by NHS England after concerns were raised about the impact on patients left waiting too long for specialist surgery, according to a leaked memo. Waiting times for all types of cardiac surgery are also under review. Senior doctors have described how the NHS is struggling to provide life-saving care to those suffering heart attacks and strokes, with worsening ambulance delays meaning patients are being deprioritised. The latest figures show waiting lists for cardiology services have doubled since the onset of the pandemic in March 2020 with 412,164 patients waiting for routine care in October 2024 – up from 397,956 the year before. The Independent can also reveal: Ambulances are transferring just 31% of patients between hospitals for life-saving heart attack surgery in the target time. Nearly 1,000 patients in London face a 10- to 12-week wait for heart surgery who should have had it within four weeks. Multiple coroners have issued warnings in the last year after patients died waiting for routine and emergency cardiology surgery. British Heart Foundation figures suggest 39,000 people died prematurely from cardiovascular disease in 2022. Dr Sonya Babu-Narayan, clinical director at the British Heart Foundation (BHF), and consultant cardiologist, said: “Unacceptably long waits for time-critical heart care puts people at significant risk of life-long heart failure or even premature death." Read full story Source: The Independent, 9 December 2024- Posted
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