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No one doubts that an overstretched NHS is carrying enormous risks at the moment. From patients waiting to be seen in accident and emergency to those on waiting lists who may be deteriorating, the potential for patient harm is everywhere.

But probably some of the biggest risks lie with ambulance services at the moment. As HSJ previously reported, the Association of Ambulance Chief Executives has carried out a structured clinical review of handover delays over an hour which found 160,000 patients a year could potentially suffer harm – and severe harm in 12,000 cases.

That is, however, only part of the picture. It’s harder to measure the harm caused because those ambulances sitting outside A&Es are not responding to other patients who have called 999 and are waiting at home or elsewhere for one to turn up. These patients may be deteriorating and, in the case of category 1 patients, may be dying.

Repeat calls to ambulance services – often prompted by delays to ambulances turning up – are also presenting challenges to call handlers. HSJ noted last week how much longer it was taking ambulance services to answer calls as call volumes increased. No one knows if these unanswered calls are for someone in cardiac arrest or with traumatic bleeding: they are untriaged and may represent the highest risk of all.

There’s no quick or easy solution to this and AACE has been careful not to blame other parts of the NHS for the problems. While some actions may improve matters, the issue of handover delays seems likely to dog the NHS through the coming winter and possibly beyond.

Patient harm now ‘a continuing theme’

A report to the North East Ambulance Service highights a number of incidents in which patients suffered significant harm due to delayed ambulance response times.

The problem “is a continuing theme due to the unprecedented demand the service is currently experiencing”, it says.

Incidents including a cardiac arrest where an ambulance took more than an hour to arrive and the patient died have prompted trust chiefs to suggest they cannot prevent patient harm under their current funding levels.

NEAS has upheld several recent complaints made by families or patients about the harm being caused by delayed response times, but suggested the levels of demand on the service meant there was nothing it could have done differently.

In one example, a woman in her 50s died from a cardiac arrest shortly after arrival to hospital after NEAS took 62 minutes to respond to a 999 call. NEAS had designated the woman, who had a history of heart attacks, a category two response – which should aim to arrive within 18 minutes on average. Read our full story here.