CRISIS IN THE AMBULANCE SERVICE

Capacity to handle 999 calls at risk, warns London ambulance service (The Guardian, 2 March 2018)

Britain’s busiest NHS ambulance service may no longer be able to answer all 999 calls quickly enough because its control rooms are chronically short of call handlers, it has warned.

The London ambulance service (LAS) disclosed this week that its capacity to respond to medical emergencies has been under threat because of a 20% shortfall in its control room staff.

Campaigners for patients have voiced alarm over the findings, saying the risk to the service could lead to people dying of strokes or heart attacks because an ambulance has taken longer than it should to reach them.

In a report presented to its board on Tuesday the LAS identified an acute lack of staff at its two main bases as a key risk to its ability to function. Listing the risks faced by the trust, it said: “The trust may be unable to maintain service levels due to insufficient staff in the emergency operations centre (EOC).”

The Patients Association said the LAS’s inability to recruit enough staff posed a direct threat to patients.

“The London ambulance service appears to be saying that it is likely that it will be unable to respond properly to medical emergencies due to a lack of staff. This is hugely worrying, but also the logical end point of underfunding the NHS over a sustained period,” said Rachel Power, its chief executive.

“The consequences for someone having a stroke or heart attack, for example, don’t bear thinking about. Lives are being put at risk as a direct result of political choices.”

A separate report to the LAS board noted that a call-handling action plan and a recruitment and retention plan with a focus on the EOC were now in place, and that vacancies within the EOC were currently running at 20% of the agreed establishment, compared with a national average of 15%. ...read more

 

Ambulance handover delays worst since first week of 2018 as NHS pressures continue (GP online, 22 February 2018)

A total of 13,302 patients waited more than half an hour to be handed over to hospital staff in the week to 18 February, while 2,948 waited more than an hour. Waits over half an hour were up 24% from the previous week, while waits of more than an hour were up 32%.

The figures reveal that pressure on hospitals is far from over despite the end of the national freeze on elective care that was in place through January, and in spite of evidence that flu levels are starting to ease.

Hospitals remain well above the target level of 85% bed occupancy considered safe, with 95% of hospitals beds occupied on average across England over the past week. Bed occupancy rates have now been at around 95% for six weeks in a row - with hospitals regularly completely full. ...read more

 

Nurses and GPs to be 'first responders' to 999 calls as winter crisis deepens (The Independent: 31 December 2017)

Nurses and GPs are to be sent to answer 999 calls ahead of ambulance crews in the latest evidence of the winter crisis engulfing the NHS, The Independent can reveal.

Health chiefs in the North East have told nurses and GPs they may have to act as “first responders” for patients who have fallen in their own homes or residential homes and may even need to administer painkillers, including intravenous morphine, if ambulances are delayed.

Bosses said the scheme was necessary because of a massive increase in demand and was intended to avert more “tragic” cases involving older patients with serious fractures and no pain relief. But senior doctors have said the move could affect patient safety....read more

 

NHS trusts forced to find new transport services as firms exit market (HSJ: 8 December 2017)

London hospital trusts have been forced to bring patient transport services in house or re-tender them as incumbent firms exit the market.

Barts Health Trust in east London has confirmed it is bringing its patient transport contract in house after provider ERS stopped providing the service. ERS is owned by American firm SRCL and also ran services across the east of England and Yorkshire.

The company had been running the service since July 2014. In its most recent board papers, the trust said its in house provision, which began in October, was cheaper.

London North West Healthcare Trust, which serves a population of more than 700,000 people from three hospital sites in outer London, was hit by the collapse of Essex based firm Private Ambulance Service last month.

The company employed more than 300 staff and also served Hertfordshire and Bedfordshire as well as the Royal Brompton and Harefield Hospitals Foundation Trust.

Private Ambulance Service was providing non-emergency patient transport to LNWH since February 2016, having won a five year contract from a framework set up by the London Procurement Partnership....read more

 

Thousands of NHS patients enduring long ambulance waits, figures show (Sky News: 7 December 2017)

Thousands of patients endured long ambulance waits and almost 95% of hospital beds were occupied in the first week of the NHS winter, according to new figures.

The first winter pressure situation report published by NHS England also revealed that 11 accident and emergency departments were forced to divert patients away in the seven days to Sunday 3 December.

NHS leaders and opposition politicians said the figures show NHS services are under extreme pressure even before demand is expected to peak over the coming months.

The figures show that, on average, 10,184 patients every day waited for between 30 and 60 minutes in an ambulance before they were seen in hospital, with a daily average of 1,844 waiting more than an hour...read more

 

Ambulance trust accused of jeopardising patients by sending cars (The Guardian: 13 July 2017)

Health chiefs have been accused of putting lives at risk by sending cars instead of ambulances to emergencies. East of England Ambulance Trust is sending rapid response vehicles (RRVs) to 999 calls to hit targets, even when the patient needs an ambulance for transport to hospital, a paramedic has claimed, with the result that patients sometimes wait for hours for an ambulance to reach them.

Patient safety is being compromised by the trust’s focus on hitting response targets, the paramedic told the Health Service Journal (HSJ). Speaking on condition of anonymity, he said: “The trust has become so fixated with hitting the target by sending out RRVs to stop the clock.

“Care, patient safety and dignity are really being badly compromised. Everyone has horror stories. It’s as bad as I can ever remember.”

The paramedic said “elderly, frail patients” were sometimes left “lying on the ground waiting up to two or three hours for an ambulance to turn up”. “Often they’re in pain, maybe with a broken hip. When it’s in the winter, it’s often in cold, frosty conditions. Sometimes they are lying on a limb, and who knows what damage is being done as a result?” ...read more

 

Revealed: NHS Ambulances fail to reach most seriously ill and injured patients in time despite efficiency drive (The Independent: 1 May 2017)

Ambulances are failing to reach thousands of seriously-ill patients within the eight-minute target time, despite a dramatic reduction in the number of calls classified as urgent, The Independent can reveal.

Unions warned that lives are being put at risk by slow response times, even as the system is being “manipulated” to make it easier to hit government-imposed targets.

The revelations of worsening performance come from a trial being run in three of the country’s 10 ambulance trusts, which is aiming to streamline the service and ensure the sickest patients are dealt with quickly.

The number of calls categorised as needing an urgent response has been radically cut to enable ambulances to respond to 75 per cent of cases within eight minutes – a requirement that has not been met nationally since January 2014.

But exclusive figures obtained by The Independent show even though tens of thousands of cases have been stripped out of the urgent category, ambulances are still failing to meet the target.

In Yorkshire, the percentage of the most serious calls responded to within eight minutes fell to 67 per cent between May 2016 and January 2017, down from 71 per cent a year earlier. During the same period, the number of calls classified as requiring an urgent response fell from 235,200 to 53,300.

The number of most urgent calls taken by the South Western ambulance service between May 2016 and March 2017 compared to the year before was reduced from 308,000 to 44,600. But the proportion of calls hitting the eight-minute target remained stagnant at 70 per cent.

Ambulance staff union GMB accused NHS England of “manipulating” targets, saying: “At the end of the day, someone, if they haven’t already, is going to die from a lack of care.”...read more

 

Paramedics 'tampered with trackers' to avoid 999 calls at a scandal-hit NHS trust (The Telegragh: 20th February 2017)

Paramedics at a scandal-hit NHS trust are accused of switching off ambulance tracking devices so they could avoid responding to 999 calls.

At least ten ambulance workers are under investigation for deliberate tampering with the trackers, so they could disappear for up to three hours at a time, putting patients at risk.

The revelations came as the current head of South East Coast Ambulance Service trust stood down in the wake of allegations that he was among those found responsible for bullying.

The Health and Care Professions Council (HPC) yesterday heard that patients in potentially life-threatening situations were left in jeopardy because of efforts to mislead control room staff.

At least 10 paramedics from the trust’s ambulance station in Guildford, Surrey, are accused of deliberate tampering.

Carl Hudghton, 29, yesterday admitted that his actions could have had “catastrophic” consequences for patients, adding to delays for patients in need of emergency help...read More

 

Ambulance workers say new cost-cutting measure risks lives (The Guardian: 8 January 2017)

Paramedics have accused their own NHS ambulance service of endangering lives in a bid to save money by cutting a system under which they abandon meal breaks to respond to patients with life-threatening conditions.

Crews at the South East Coast ambulance service (Secamb), which covers a huge swath of south-east England, were told that they would no longer be paid overtime for abandoning their breaks to respond to some 999 calls including emergencies involving strokes, seizures and breathing problems. The instruction came as it emerged that medical staff across the UK faced an unprecedented demand on emergency resources last week.

Paramedics have warned that patient safety and lives could be put at risk because it will lengthen the service’s response times, which its boss recently admitted were already poor.

Ambulance crews will no longer be paid the £25 they receive each time they interrupt the single – and unpaid – 30-minute meal break they get during their 12-hour shift in order to answer a Red 2 call, which can involve someone with chest pains or car crash casualties....read more

 

Ambulances too slow to reach seriously ill patients, says report (The Guardian: 30 November 2016)

Ambulances are failing to reach dying and seriously ill patients fast enough as the service creaks under the strain of high demand, according to a report.

Only one of the UK’s 13 ambulance services, the Welsh ambulance service, is meeting the target to reach patients with life-threatening conditions within eight minutes, a BBC investigation has found.

Freedom of information requests by the broadcaster found more than 500,000 hours of ambulance crews’ time in England, Wales and Northern Ireland was wasted waiting at A&E to hand over patients to hospital staff.

Dr Mark Holland, president of the Society for Acute Medicine, said the significant strain on the NHS was due to the government’s failure to accept the social care crisis.

He said: “The government has continuously failed to acknowledge the scale of the crisis in social care and the record numbers of delayed discharges in our hospitals as a result – a significant factor in the buildup of pressure on our hospitals...read more

 

NHS spend on private ambulances trebles in four years (BBC News: 26 May 2016)

NHS spending on private ambulances for 999 calls in England has trebled in four years, BBC research has found.

Ambulance trusts paid private companies and voluntary organisations £68.7m to attend emergency calls in 2015-6, compared to £22.1m in 2011-2. They respond to all types of calls.

NHS England said 999 calls for ambulances rose 4.5% last year.

Unions attacked "creeping privatisation" and called for more money for staff recruitment.

The ambulance service in England took 861,000 emergency phone calls in March 2016 - which equates to 27,800 a day - compared to 22,400 calls a day in March 2015, a rise of 24%.

Contractors include private firms and charities such as St John Ambulance and the British Red Cross....read more

 

Ambulance delays linked to 35 deaths in past five years (The Guardian: 23 May 2016)

Thirty-five patients have died in the past five years after delays of up to six hours in an ambulance reaching them and mistakes by 999 call handlers and ambulance crew, coroners have warned.

The deaths – which include a nine-month-old baby, two other children, a student nurse, a mother-to-be and an 87-year-old woman with dementia – have exposed how NHS ambulance services, faced with sometimes chronic shortages of vehicles and staff, are struggling to cope with demand.

Coroners in England and Wales have issued official warnings called prevention of future deaths notices highlighting problems with lack of resources, an inability to respond quickly enough to 999 calls and poor care that have caused, contributed to or been involved in the 35 deaths, inquiries by the Guardian have shown.

In five of the cases the patient would or might have lived if either the ambulance had got there sooner or the attending crew had provided better treatment, coroners said....read more

 

Ambulance privatisation descends into 'total shambles' (The Guardian: 12 April 2016)

Hundreds of patients including people with cancer and kidney failure have missed important appointments for treatment because ambulances did not arrive to take them to hospital, after privatisation of NHS non-urgent transport services in Sussex this month.

Some elderly patients have had to wait more than five hours for ambulances and been stuck at hospital for long periods after their appointments because the transport service, now run by the private firm Coperforma, has proved so unreliable.

Patients, relatives, NHS bodies and local MPs have severely criticised the service’s performance, and a trade union representing ambulance crews said it was an “absolute shambles”. The NHS organisations that awarded the four-year, £63.5m contract have now launched an investigation.

A host of problems have arisen since Coperforma replaced the NHS’s South East Coast ambulance service (Secamb) as the provider of non-emergency patient transport services on 1 April....read more

 

Patients suffering cardiac arrests left without help because maps did not work (Telegraph: 4 March 2016)

Patients suffering cardiac arrests were left without help because a scandal-hit ambulance trust used a failed maps system, an investigation has found.

Secret protocols authorised by Paul Sutton, the head of South East Coast Ambulance trust, meant that thousands of 999 calls were counted as receiving an 8 minute response, just because the patient was within 200 metres of a heart-starting device.

The unauthorised scheme meant that national targets were achieved regardless of when help was sent - and whether or not the patient could be helped by a defibrillator.

Now an investigation has been told that failings in the trust’s mapping system meant that call-handlers sometimes could not even tell callers where to go to find the life-saving equipment.

Incredibly, calls were counted as receiving an 8 minute response, simply because the caller was within 200 metres of the public access devices – even if they had almost no chance of finding it...read more

 

Ambulance services claiming minor cases as emergencies to hit response targets (The Telegraph: 14 February 2016)

Ambulance services are claiming that minor cases are in fact emergencies in a trick to hit Government targets, it can be revealed.

NHS trusts are allegedly re-classifying non- emergency cases as urgent if they know that paramedics are close by. Such cases should not be covered by targets which state "life threatening" cases should receive a response in 8 minutes.

But paramedics are being sent to minor cases which happen to be nearby, then classing them as emergencies, in a bid to improve performance against the targets, whistleblowers claim.

It means that truly life-threatening cases could be forced to wait longer, while targets appear to be achieved. The tactic is being used to improve ambulance service response times to avoid being penalised financially for missing the targets...read more

  

Archive of earlier stories

 
 
 

More on quality:

HOSPITAL CARE/A&E

GP SERVICES/OUT OF HOURS/111
 
RATIONING
 
PRIVATE CLINICS
 
DELAYS IN HEALTHCARE
 
      

Examples of problems (by provider)

Ambuline/Arriva - Payment witheld as patient transport service misses targets

Ise Valley Ambulance service (no longer active) -CQC finds that staff backround checks and CRB's have not been carried out

Events Medical Services LTD - CQC finds patients at risk due to inadequate records being kept

Arriva - Ambulance service receives 100 complaints in a month

          - Leicestershire patient transport needs ‘urgent’ improvement

          - Patient stranded for three hours

NSL - Patient 90 minutes late for appointment as private ambulance gets lost

      - last chance for NSl after user complaints

      - Kent NSL patient transport service criticised

      - patient stuck at hospital for seven hours

 

  

Recent reports:

Quarterly survey of NHS financial directors by The King's Fund - February 2013 report

 

‘Making it better? Assuring high-quality care in the NHS

NHS Confederation discussion paper on the quality of care in NHS following the Francis report - February 2013

 

Care Quality Commisson State of Care report 2011/12

Annual survey by the Care Quality Commission

“Overall CQC is finding that the increasing complexity of conditions and greater co-morbidities experienced by people are impacting on the ability of care providers to deliver person-centred care that meets individuals’ needs. It is also seeing increasing pressures on staff, both in terms of the skills required to care for people with more complex conditions and in terms of staff numbers.”

 
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