Lives are at risk because 999 callers face unacceptable and appalling waits for ambulances in England, the country’s top emergency medicine doctor has said.
Dr Katherine Henderson, the president of the Royal College of Emergency Medicine, said pressure in the NHS was now so severe that it was breaking its “basic agreement” with the public to treat the sickest in a timely way.
In an extraordinary intervention, Henderson said urgent and emergency care was in a “deeper crisis than ever before”, and for the first time in its history the NHS could no longer stick to its “contract” with the nation to promptly reach seriously ill patients who dial 999.
Patients with life-threatening conditions such as heart attacks and strokes are having to wait far too long for emergency care, she said, and vulnerable older people are in some cases spending all night on the floor at home after falling.
The rapidly escalating crisis is being caused by soaring demand, enormous staff shortages in the NHS and social care that have been worsened by Covid-related absences, and a drastic shortfall of hospital and care home beds.
“The true barrier to tackling this crisis is political unwillingness,” Henderson said. “The current situation is breaking the workforce and breaking our hearts.”
Hospitals are facing record demand from patients coming forward after two years of the pandemic, while struggling to discharge patients because of the crisis in social care.
As a result, Henderson said, doctors are struggling to find any space for patients arriving at A&E. That is causing record delays in ambulances handing over patients, which is leading to waits of up to 22 hours for 999 callers.
In an interview with the Guardian, Henderson said she had no choice but to sound the alarm over the “shocking” and “staggeringly bad” delays to emergency care because the mounting crisis was dangerous and putting lives at risk.
“It’s not acceptable,” Henderson said. “It’s a very, very significant loss of that basic agreement with the public about the NHS, which is that if you dial 999 and you need an ambulance – which an old person who has fallen downstairs does need – you’ll get one in a timely way.
“And we’ve broken that contract with the public. It feels shaming to me that we’re in this situation. We’ve got elderly, vulnerable people at home who need an ambulance … and we can’t get them in.”
The results of a survey conducted by the Royal College of Emergency Medicine, shared exclusively with the Guardian, reveal the scale of the crisis. Eighty per cent of clinical leads at emergency departments nationwide reported holding ambulances every single day in the last week, a 15% increase on the same survey in December.
More than half of clinical leads (55%) reported their longest patient stay in A&E in the last three days as being over 24 hours, the survey shows. Nearly a quarter (23%) said their longest patient stay was over 48 hours.
“The fact that there’s anybody in that category is shocking, but the fact that over 50% of departments have people over 24 hours … that is staggeringly bad,” said Henderson. “There’s no clinical reason why a patient should be there, really, more than six hours. The fact that there’s anybody in the more-than-48-hour category is just unbelievably appalling.”
Delays in moving 999 patients from ambulances to A&E and then to a ward are having a catastrophic effect on ambulance response times, Henderson said. Ambulances in the south-west have the worst record of any of England’s 10 ambulance trusts for the most urgent calls for four out of the past five months, according to a Guardian analysis of data from NHS England.
In February, the month for which the most recent data is available, its average response time to the most urgent category 1 calls – patients in life-threatening conditions – was 11 minutes and 39 seconds, the second highest since the NHS began publishing data in 2017. By contrast, ambulances in the north-east, which had the best record in February, reached the average category 1 call in six minutes and 37 seconds.
A spokesperson for the South Western ambulance service said it was experiencing a sustained period of high demand, and handover delays at hospitals were preventing its crews from getting back out on the road.
Unison’s deputy head of health, Helga Pile, said: “The colossal demands on the ambulance service in the south-west are being mirrored across the UK. Dealing with repeated peaks of pressure with a depleted workforce is taking a huge toll.”
National category 1 response times have also been getting longer in the year to February. In the most recent month, the average category 1 response time in England was eight minutes and 51 seconds, above NHS targets setting out that all ambulance trusts must respond to category 1 calls in seven minutes on average.
Even after 999 patients have been picked up an ambulance, taken to A&E and a decision has been made to admit them to hospital, many then face further waits while staff try to find them a bed on a ward, Henderson said. As well as being “incredibly undignified”, waiting on trolleys in corridors can lead to patients’ conditions deteriorating while A&E staff move on to the next patients coming into the department.
Corridors are becoming so crowded with patients waiting for beds on wards that staff are resorting to desperate measures, Henderson said. “We’ve all started having to use office areas and storage spaces that you can quickly convert into a cubicle.”
Some patients are having the entirety of their care delivered in the back of an ambulance outside a hospital. “It’s surreal,” Henderson said. “We’ve almost moved emergency medicine into the car park.” She said she cannot recall an April when the pressure on the NHS has been as severe as it is now.
Daisy Cooper MP, the Liberal Democrats’ health spokesperson, said: “Record waiting times for ambulances are leading to heartbreaking stories of people waiting hours for an ambulance to arrive, leading to devastating consequences for patients and their families.”
She said ministers had “turned a blind eye” to the crisis in ambulance services and emergency care that was leaving many patients “waiting in pain and distress”.
NHS England said staff were working “flat out” amid increasing numbers of Covid patients, record high A&E attendances and tens of thousands of Covid-linked absences, while still tackling the care backlog. A spokesperson said patients should still “come forward for care” if they need it.
A Department of Health and Social Care spokesperson said: “The government is absolutely committed to supporting the NHS and improving patient experience. Claims to the contrary are entirely baseless.”
