Patients in one part of Wales are currently spending in excess of 30 hours in the back of ambulances waiting to be transferred into A&E, it has been revealed. An email sent to GP surgeries across Cwm Taf Morgannwg University Health Board on Tuesday and forwarded to WalesOnline states that "significant acute site pressures" are leading to excessive waits for patients to be admitted into hospital.
One GP who was sent the email said they were "aghast" at how unsafe emergency services had become and described the 30-hour wait as "clearly dangerous". They added that such delays were having a huge knock-on effect on the ability of ambulance crews to reach distressed 999 patients in their communities.
It is understood a 'business continuity incident' was declared in Cwm Taf Morgannwg UHB on Tuesday - the highest level of escalation, meaning there is more demand than capacity. It typically results in very large numbers of patients in A&E, lengthy ambulance delays and numbers of patients waiting for beds increasing significantly. More importantly, it means there is no immediate resolution that will get the system back into a positive position. The health board confirmed on social media that its three A&E departments in the region should be avoided unless the patient has an urgent or life-threatening illness or injury.
Read more: More than 700,000 patients in Wales are now waiting for planned treatment on the NHS
In response to the email, a GP working in the area who wished to remain anonymous said: "The NHS and social care sector is full of examples of wonderful frontline staff who go above and beyond. There are, of course, some inefficiencies - however, I think these are generally overstated.
"The main problems are increases in demand and lack of supply. However, the lack of supply is only in certain places along the chain – but presumably in key places and hence the acute and worrying worsening in the speed of the service. The equation is fairly simple – a service can be two out of the following three: cheap, good quality, and Fast. Unfortunately it can't be all three at the same time."
Latest Welsh Ambulance Service figures emphasised the scale of the task the NHS trust is facing. In April barely half (51.2%) of immediately life-threatening "red" calls were reached within the target time of eight minutes in April - and Cwm Taf Morgannwg UHB, which covers RCT, Merthyr Tydfil and Bridgend, was below the Welsh average (46.8%). Only Betsi Cadwaladr UHB (46.2%) and Hywel Dda UHB (39%) recorded poorer performances last month. Staggeringly, two-thirds of "amber" call patients - which include strokes - took over an hour to reach, with only 18% arriving within 30 minutes.
However, ambulance chiefs stress many of problems with the day-today running of the service are being caused by factors out of their control, particularly handover delays where patient spend longer than 15 being transferred into emergency departments due to a lack of beds. Between January and March 2022, 70,171 hours were "lost" to handover delays, which was way up on the 21,598 over the same period the year before. You can read more about that here.
Lee Brooks, executive director of operations at the Welsh Ambulance Service, said on Tuesday: "There have been challenges at hospital sites across the Cwm Taf Morgannwg University Health Board area today and regrettably there have been waits close to and in excess of 30 hours for a patient to be transferred from ambulance to emergency department staff.
"Naturally, we are concerned about the impact of this not only for those individual patients, but also for patients in the community who may have experienced longer waits for ambulance help to arrive. Our staff are working as best they can for as many patients as possible and we will support the health board in efforts to recover the situation."
Meanwhile in April, Cwm Taf Morgannwg UHB's three emergency departments struggled to see patients in a timely manner. Just over half (51.6%) of patients visiting Princess of Wales Hospital in Bridgend were seen within four hours, and the picture wasn't much better at Prince Charles Hospital in Merthyr Tydfil (57.1%) or the Royal Glamorgan Hospital in Llantrisant (68%). Some 1,192 (8.6%) patients spent in excess of 12 hours at the three departments in April before being admitted, transferred or discharged.
Dr Suresh Pillai, vice president of the Royal College of Emergency Medicine Wales, said: "The health system is broken; patients in the community face long waits for ambulances; patients in ambulances face long waits to be handed over to the emergency department; patients in emergency departments face long waits for a bed; and vulnerable and elderly patients medically fit to be discharged remain in hospital for longer than necessary because social care support is scarce.
"We know that in emergency medicine in Wales we have a shortage of at least 100 consultants, as well as widespread shortages of junior doctors, trainees and nurses trained in emergency medicine. Added to severe bed shortages and a crisis in social care, these are all contributing to the dire situation in urgent and emergency care. In order to tackle the crisis, we must see meaningful action to recruit more staff, open more beds, and address the issues in social care.
"Staff are burnt out and distressed, morale is low, and patients are becoming increasingly worried about the situation. We cannot continue in these circumstances. If another month passes with further deteriorating performance and new record lows, more and more patients will come to harm."
A spokesperson for Cwm Taf Morgannwg UHB posted on Facebook on May 24: "There are still long waiting times at all three of our emergency departments today as we prioritise our most seriously injured and ill patients. Thank you to those of you who are helping us – help you – by choosing the right service, the right way at the right time.
"If your situation is not life-threatening or an emergency, there are other services rather than ED available for you – helping you avoid an extended wait. The online NHS 111 Wales symptom checker is a great place to start https://111.wales.nhs.uk/ "
Cwm Taf Morgannwg UHB's executive medical Director Dr Dom Hurford said: "We are continuing to experience exceptional demand across our whole health board, particularly in our emergency departments (EDs). We want to reassure our communities that we are working together with all of our key partners, including the Welsh Ambulance Service and our three local authorities in Bridgend, Rhondda Cynon Taf and Merthyr Tydfil, to do all we can to improve the situation quickly for our patients.
"Social care teams are working hard trying to discharge patients from our hospitals with the right package of care for their needs. That will mean there will be more beds available for the patients coming through our EDs, which in turn will reduce ambulances waiting outside EDs to hand over patients to us. Our GPs and primary care colleagues are also working under enormous pressure from urgent and routine appointments.
"We are sorry for those of you who will, unfortunately, have first-hand experience of the delays and long waits for care that we are currently seeing, but we do need to thank you for working with us and for your patience and understanding. Please know that, as always, the safety of our patients, our communities and our workforce remains our number one priority."
