‘40,000 put at risk last month’ while waiting in ambulance

The number of hour-plus delays to handing over patients from ambulances to emergency departments in March was the highest ever recorded, following steep increases since last summer.

Figures collected by the Association of Ambulance Chief Executives, and shared with HSJ, reveal that one trust recorded a delay of 23 hours during March. 

The average of the longest delays recorded across all England’s 10 ambulance trusts was 11 hours.

There were 21,639 delays of more than two hours – nearly 18 times the number in March 2021 – with 44,000 hours of time lost when crews could have been responding to other incidents.

Based on its detailed information about the length of handover delays, AACE has produced an estimate of the likely number of patients harmed while waiting to he handed over, using a model initially developed in research published last year. This found 85 per cent of those who waited more than an hour could have suffered potential harm.

The AACE report said that patients who waited the longest were at greatest risk of some level of harm and the risk of severe harm tripled for those waiting for more than four hours compared with waiting for 60 to 90 minutes.

The harm calculated does not include as a result of the ambulance crews being held up and therefore not able to attend other incidents.

AACE managing director Martin Flaherty told HSJ: “We expect the situation to be no better when we collate our figures for April.

“The most significant problem remains hospital handover delays which continue to increase exponentially, with tens of thousands of ambulance hours being lost due to hospital handover delays, causing enormous knock-on effects out in the community, where delays in people receiving the ambulance resource they need are the obvious result.

“However, the human cost, in terms of direct harm that is being caused to patients through these combined delays at hospitals and in the community, as well as to the health and wellbeing of our ambulance crews, is substantial.

“This is why we are looking to NHS England and Improvement and the Department of Health and Social Care to accelerate their activities in terms of finding immediate solutions where handover delays are avoidable and unnecessary. Ambulance staff will continue to do their best to deliver the best patient care they can, under extremely difficult circumstances, while AACE and its members will continue to work with all stakeholders to try and mitigate harm, but we need more help from the top to achieve this.”

Yesterday HSJ reported that Deborah Lee, the chief executive of Gloucestershire Hospitals Foundation Trust – which has had very high numbers of ambulances waiting to handover patients at A&E – was driven to hospital with a suspected stroke rather than waiting for an ambulance.

The national issue has been linked to hospital occupancy, fuelled by delayed discharges and a lack of staff, along with absences, particularly in social care services, and reduced capacity/flow due to covid infection control measures.

And last week we revealed how delays in ambulances reaching patients – which are often linked to handover delays reducing the availability of crews to respond to 999 calls – were leading to more serious incidents. West Midlands University Ambulance Service FT said that half the SIs were due to delays in reaching patients “resulting in harm, serious harm and deaths”.

An NHS spokesperson said: “While ambulances responded to the highest number of calls on record over the last financial year, hospitals, ambulance trusts and social care providers are working closely together to see patients as quickly as possible as well as ensuring patients leave hospital as soon as they are fit to do so.

 “NHS services are working collaboratively – including with AACE’s members – in line with actions set out for systems to prevent ambulance handover delays..”