On a cold and grey afternoon last week, senior paramedic Glenn Carrington once again faced a familiar but grim situation: a four-hour wait in a queue of ambulances outside a city hospital waiting to hand over a patient.
There was no risk to the patient on this occasion, but to Carrington, a paramedic for nearly four decades, the warning signs were clear: the NHS was starting to slide into another winter crisis.
“The reality is that the waits in the back of the ambulance are starting to build up,” said Carrington, 58, Unison branch chair for East of England ambulance service. “We have winter flu kicking in, a rising number of Covid cases and not enough staff.
“The worst is waiting in an ambulance with a patient and seeing them deteriorate. It’s heartbreaking.”
In January, prime minister Rishi Sunak outlined a plan to “stop the bottlenecks” and cut waiting times, billed as “one of the fastest and longest sustained improvements in emergency waiting times in NHS history”.
The plan – including 5,000 new beds, faster ambulance response times and shorter waits in accident and emergency – was intended to help stave off another winter crisis.
But as the Observer reveals this weekend, key targets for the plan have not been hit, with latest figures showing that in November 42,000 patients spent more than 12 hours in A&E waiting for a bed after a decision to admit.
Separate figures published by NHS England on Thursday confirmed Carrington’s experiences of mounting delays on the frontline. The data published on Thursday showed that 15% of ambulance handovers involving 12,797 patients in England in the week to 10 December were delayed by more than an hour.
This was up from 9%, or 8,239 patients, a fortnight earlier, according to analysis by PA Media, although officials cautioned the figures were not directly comparable.
“We are in a very similar situation to last year, with insufficient capacity and insufficient workforce,” said Dr Tim Cooksley, a consultant in Manchester and a past president of the Society for Acute Medicine. “I think the winter is going to be every bit as difficult as last year. It will be bad for patients who are going to have very long periods of time in corridors, suffering delays, which will cause them harm in spite of the best efforts of staff.
“It’s remarkably tough when you come to work and you’re seeing patients in corridors who have been there for a prolonged period. It’s harmful for the patient and it’s difficult for staff to work in these conditions.”
Cooksley added: “Morale is extremely low. We can’t continue to have short-term plans that are not deliverable in the timeframe.”
Sunak is under fire from Labour and the doctors’ union the BMA for not delivering on the pledges he made in January. The BMA said the government failed to deliver 5,000 new beds based on the most recent figures, but NHS England considers it is close to delivering the additional capacity.
Ambulance response times have improved compared with last year, but the target in Sunak’s plan of responding to category 2 calls within 30 minutes on average over 2023/24 has not been hit. And there are still long trolley waits in A&E units.
Tim Gardner, assistant director of policy at the Health Foundation, said trolley waits of 12 hours or more rarely happened a decade ago, but in November there were about 1,400 a day in England, similar to November a year earlier.
“It indicates that hospitals are running at capacity and are having problems discharging patients,” he said. “On average, every day around 13,000 hospital beds are occupied by patients who no longer need acute care.”
Gardner said these patients were stuck in hospital because of delays and shortages in the community care required to support them.
He added that the scale of the winter challenges would be affected by the number of flu and Covid cases, as well as cold weather snaps. The NHS also had to contend with strike action by junior doctors for three days next week and six days from 3 January.
“An annual winter crisis doesn’t have to be inevitable,” he said. “Just because there aren’t any short-term quick fixes doesn’t mean there aren’t solutions. But it does require longer-term sustained action.”
Jessica Morris, a fellow at the Nuffield Trust, said the latest winter weekly performance figures showed the NHS was under severe strain. She said: “The last few months have been following a very similar trajectory to last year, and we know that [A&E] waiting times spike in December.”
Prof Philip Banfield, BMA council chair, said: “We are still short of beds, have huge rota gaps and patients are not getting the care they need or deserve. The waiting list is still unfathomably long, cancer and emergency department performance targets are being missed, and ambulance handover delays are unacceptable. Meanwhile, demand and workload in general practice are unsustainable.”
Banfield said doctors were the solution to the challenges, not the problem. The narrative needed to shift from doctors being a cost the country could “ill-afford” to a necessary investment.
Carrington does not criticise the doctors for the delays, but the paramedic says concerted action is required to recruit and retain staff and improve working conditions. “We don’t blame the hospitals and we don’t blame the doctors,” he said. “But it’s going to be a terrible winter.”
