NHSE director admits ‘huge cost’ to cutting ambulance delays

Sarah-Jane Marsh told NHS England’s board meeting on Thursday that emergency departments and hospital wards are now taking more “risk” by taking extra patients in a bid to get ambulances back on the road quicker.

In the previous two winters, big increases in handover delays have driven large numbers of very long waits for ambulances, leading to deaths as people wait for a 999 response. 

This year, many fewer hours have been lost to ambulance delays, although the total number of delays of more than 60 minutes is approaching the same as last winter. Emergency department waits in November and December were better than last year, although still much worse than pre-covid and a long way below targets. 

But Ms Marsh said the improvement was a result of hospitals agreeing to take more patients into EDs and acute wards, even when they did not have space or staff to properly care for them.

She said: “It’s come at a huge cost. Some of the things we have achieved are because we have moved pressures around in the system.

“We have moved risk out of people’s houses and from the back of ambulances, and in some cases we’ve moved that into emergency departments [and] wards, that have had to take the pressure of taking additional patients.

“Next year one of our learnings is that we need to have a really big focus on what is happening inside our hospitals [so] we decongest some very crowded areas.”

Nick Hulme, chief executive of East Suffolk and North Essex and Norfolk and Norwich University Hospitals Foundation Trusts, who was speaking as a guest at the NHS board meeting, reinforced the point.

He said Norfolk — where the meeting was being held — had seen much improved handover delays in recent months, but added: “We have quite simply moved the risk from people’s homes, onto additional people being cared for in the wards, and that is really difficult for [hospital] staff.” Some were put in areas not meant for housing patients. Mr Hulme said a culture change had been achieved by persuading clinicians their actions were saving the lives of patients who would otherwise be stuck waiting for ambulances. But Mr Hulme warned the improvement remained “fragile”.

NHSE CEO Amanda Pritchard said that, while performance was improved, the efforts had piled pressure on staff.

Ambulances are losing an average of 26 minutes per accident and emergency arrival to handover delays so far this winter, compared with 42 minutes last winter. 

Many trusts have adopted a version of the “continuous flow” model which was devised by the North Bristol Trust – whereby A&E patients are sent to wards at regular intervals irrespective of bed capacity in a bid to free up emergency departments to take in ambulance arrivals more quickly. Hospitals’ directors have privately said there are large numbers of patients being placed in corridors this winter, and “boarding” additional patients into wards, which are already at full capacity.

The average response time for a category 2 call in December 2023 was 45 minutes and 57 seconds. This is half the average time in the same month in 2022, which was one hour, 32 minutes and 55 seconds.

But patients are still seeing very long waits in A&Es. Four hours performance for all emergency patients stood at 69.4 per cent in December – which was only slightly better than the 65.2 per cent recorded in the same month last year. A total of 151,295 12-hour A&E waits from time of arrival were recorded in December – 11.3 per cent of all attendances – this was the largest proportion of long waiters since the data was first published last February.