Hours not minutes waiting time for ambulance

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The RUH in Bath is one of the hospitals that has been badly affected by the crisis in ambulance waiting times, according to city MP Wera Hobhouse.

She told a London-based debate on the subject that residents have had to wait as long as 12 hours for an ambulance to arrive. One man was forced to sleep on the floor of a church whilst he waited for an ambulance.

Ms Hobhouse secured a debate in Westminster Hall on the issue and it was well attended by members from across parties and from different parts of the country.

During the debate, Wera called for the Government to take a number of measures to resolve the crisis. These include conducting a full inquiry into the issue, changing how data is collected on A&E wait times and funding additional hospital beds to prevent handover delays. She also noted the need for more investment into ambulance services and greater efforts to recruit new paramedics.

Commenting after the debate, Wera Hobhouse MP said: 

“Emergency care services are there for us in some of our darkest times. However, the Conservatives are failing to be there for the emergency services we rely on. 

“We need urgent action to tackle the waiting times for ambulances and emergency care. I hope that my debate goes some way to pressuring the Government to act.

“People are no longer confident that when they need medical help they can get it. A&E wait times are sky high and ambulance response times are now measured in hours instead of minutes. 

“Let’s be clear, this is not the fault of hospitals like the Royal United Hospital (RUH) in Bath. Our healthcare service is over-stretched. They work incredibly hard under extreme pressure and deserve to be commended for the work that they do. 

“The Conservative Government needs to start working with NHS staff to draw up a plan now.”

The text of Wera’s speech is below

I beg to move that the House has considered waiting times for ambulances and emergency care. I am pleased to introduce the debate and delighted to see so many Members here to discuss the highly concerning issue of the unacceptable waiting times our patients currently endure for emergency care. 

I hope everyone here agrees that our urgent and emergency care system provides a vital service, supporting a significant number of patients with a huge variety of medical conditions – ranging from acute emergencies and trauma to mental health crises, the care of our homeless population and elderly patients. Emergency care should be there for us all when we need it. Very few of us plan to attend an Emergency Department, yet we are all potential patients.

Covid-19 has had a very detrimental effect on our ambulance services. More and more people are calling the ambulance service because they are having difficulties accessing other more appropriate parts of the health service.

National NHS performance figures illustrate that our healthcare service does not have the capacity to meet demand. During May 2022, only 60% of patients were seen, admitted, or discharged within four hours from their time of arrival. Frankly, we should all be appalled by these figures, which demonstrate that the health service is unable to meet the needs of patients with the current level of resource and capacity.

I would like to share the example of the situation within the Royal United Hospital – the RUH – in my constituency of Bath because it demonstrates the severity of the problem and how hospitals are having to step in because the Government is refusing to.

There have been several cases of Bath residents waiting many hours for an ambulance. Recently, an elderly man was forced to sleep on the floor of a local church as it took 12 hours for an ambulance to arrive. A GP surgery ran out of oxygen to give a patient who was waiting for an ambulance, due to the length of time it took for the ambulance to arrive. 

Ambulance handover delays are a significant patient safety risk at the RUH and remain a major area of focus for improvement. Up to 90% of the causes for delays are linked to the availability of beds within the hospital. The RUH has consistently been running with a bed occupancy over 90% for the last year. This is significantly impacting the hospital’s ability to move patients out of the emergency department.

The RUH is one of the most challenged hospitals for “Non Criteria to Reside” (medically fit for discharge) patients within the South West. NHS England is reporting that the RUH has 24.3% of its beds occupied by patients who are NC2R/medically fit, which is the third-highest in the South West. 

This is driven by both gaps within the domiciliary or social care market. My local authority of Bath & North East Somerset have been short of 1,600 hours per week and community teams are struggling to recruit. Our local care group has an over 30% vacancy rate. The RUH is working with local authority colleagues to develop their own in-house domiciliary care to try and plug the current gap. 

NHS England is currently assessing the Trust and systems bids to try and help reduce the beds gap at the RUH. The hospital has recently launched a “Home is Best” transformation programme that is aiming to increase the number of patients who go home instead of into community hospital beds.

Our hospital in Bath is also working out ways of reducing the number of patients who need to go to the emergency department. This has included launching a new same-day emergency care offering for frailty patients which is helping to prevent patients who need admission.

Nationally, the lack of staffed beds has resulted in staggering numbers of patients waiting beyond twelve hours after the decision is made by the A&E doctor. There have been more patients waiting 12 hours or more from decision to admit this year than there have been in the entire reporting period leading up to 2022.

In May, there were over 19,000 patients waiting 12 hours or more from the decision to admit. Yet, research from the Royal College of Emergency Medicine shows that this number only represents the tip of the iceberg. We know that far greater numbers of patients endure waits of 12 hours or more if you start the clock as soon as the patient steps foot into the A&E. There are many more patients enduring extremely long waits and because they are not captured by this metric. As policymakers we need to understand the true scale of the problem. If we do not know about these extreme delays our patients are enduring, we cannot take action.

These delays mean that they are not able to respond to 999 calls from critically ill patients. Instead, they are being held in ‘stacks’ of hundreds each day where staff are forced to prioritize even the most serious cases. Alongside having to wait in corridors and sometimes even outside the hospital with the patients, unable to have them treated and unable to respond to new emergency calls.

We must think carefully about what this means. Behind every statistic is a patient. These patients are stuck. They have no choice but to wait for a bed to free up so they can be admitted and continue to receive the most appropriate form of care. Unfortunately, some of these patients end up on trollies in crowded corridors with many other patients. We should be treating these patients with dignity. We know crowding is dangerous and is linked to avoidable harm and in some cases, death.

The pressures facing the NHS, that have been building over the past decade, yielded detrimental consequences on the Emergency Medicine workforce and patients. This has resulted in staff considering reducing hours, changing careers, or retiring early. Emergency staff face constant abuse from those left waiting – but it is not the fault of emergency staff.

The Royal College of Emergency Medicine’s Retain, Recruit, Recover report detailed findings from their survey of Emergency Medicine clinicians. They found 59% of respondents experienced burnout during the second wave of the pandemic and described their levels of stress and exhaustion from having worked the second wave as higher than normal. Their report found that operational pressures, patient safety and staff wellbeing are intrinsically linked. 

In 2021, The Royal College of Emergency Medicine highlighted a UK wide shortfall of 2,000 to 2,500 Whole Time Equivalent Emergency Medicine Consultants. Our population’s health and wellbeing needs are the greatest they have ever been. We cannot afford to lose further workforce in our population’s time of need.

It is clear this is a serious issue, life or death for many patients. But for those who are suffering from serious but not necessarily prioritised issues it is the elderly and frail patients that are being hit the hardest. 

While it is easy for the Government to point the finger at hospitals and management, it is clear this needs to be addressed centrally. This is not an issue exclusive to Bath or North Shropshire but rather a national crisis, shown by the variety of MPs here today. 

What’s more, the consequences of a failed social care system, which does not allow for the timely discharge of patients who are medically fit to leave the hospital, has resulted in further crowding and corridor care in our hospitals.

The Chief Executive of NHS England recently acknowledged the important role social care plays in supporting patient flow through hospitals. The Government must outline the steps they will take to ensure the social care system is adequately equipped ahead of next winter

Last Autumn, the NHS published a 10 Point Plan for the Recovery of the Urgent and Emergency Care System. It had no targets, nor timelines. It lacked any indication of how progress will be reported. Yet it detailed how the whole system would work together to recover urgent and emergency services, focusing on the immediate and medium-term activities. The plan aimed to “to mitigate against the current pressures felt across systems and improve performance in all settings”. The NHS 10 Point Plan did not deliver as promised.

The Liberal Democrats have been sounding the alarm for months, calling for an urgent investigation into England’s ambulance services and a review of ambulance station closures. But the Conservative government keeps turning a blind eye to this disaster.

We are calling for more investment in local ambulance services, an urgent campaign to recruit more paramedics and enabling trusts to restore community ambulance stations in rural areas in Devon where waiting times are unacceptably long. 

The Liberal Democrats are calling for a formal inquiry. We are also calling for the Government to fund thousands of extra beds to stop handover delays at A&Es so that ambulances can get back on the road as soon as possible.

The NHS Standard Contract 2022/23 was recently amended to change the way in which 12 hour waits in A&Es are calculated. As a result, A&Es are now collecting 12-hour data from the patient’s time of arrival. Despite this, the Government and NHS England have not indicated when this data will be publicly available. We know there are no easy fixes to the operational pressures experienced by our NHS but publishing these figures nationwide will allow for transparency across the system, which in turn should lead to improvements. Can the Minister confirm the timetable for the publication of this important data? —