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East Midlands Ambulance Service delays mean thousands of wasted hours

today1 September 2022 1

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Ambulance bosses say that every hospital in the East Midlands is on their “worry list” with “problems everywhere” concerning delays, amounting to thousands of wasted shifts.

In East Midlands Ambulance Service NHS Trust’s annual general meeting held on Thursday, September 1, leaders shone a light on issues relating to hospital handover delays.

They did not pull any punches in re-stressing how much pressure the ambulance service is under, with hospital handover delays linked to widespread strain on the whole NHS system.

Ben Holdaway, the trust’s director of operations, said: “We used to have problems at one or two acutes (hospitals with A&E departments) across our region, predominantly Leicestershire and Lincolnshire, we are now seeing it across the board, we have problems everywhere.

“When we talk to those acutes, it is the same challenges that they face which is around the system coming together to answer that flow issue.

“I am not more concerned about one area than the other, I think they are all up there now on our worry list and we are working with all of the systems to try and improve that.”

The “flow” issue which Mr Holdaway refers to is the impact of delays throughout each stage of a patient’s stay in a hospital.

This starts with an increased demand for emergency services and at A&Es, through to people staying longer in hospital due to health conditions which may be more progressed following the pandemic backlog, and culminating in delays to be discharged from hospital as a result of a shortage in care home space and social care packages for treatment at home.

On ambulance handovers he said that while there is a national target to take no longer than 15 minutes to transfer a patient into a hospital, the trust’s average over the past year was 40 minutes.

He said that this also shows some handovers are even longer, with “some over an hour”.

Mr Holdaway said that, in total, over the past year, the trust had lost 125,500 hours due to hospital handover delays, up from 59,759 in the previous year – an increase of 110 per cent.

This, he said, equates to 10,458 wasted 12-hour shifts, 29 shifts a day, in which paramedics are sat waiting outside hospitals with their ambulances, not responding to incidents.

He detailed that an ambulance crew would typically expect to respond to four or five incidents per shift.

Mr Holdaway said that in the past year the ambulance service has averaged a 999 call every 25 seconds, with more than 1.2 million calls in the past year – an increase of 200,000 compared to the previous year.

However, he said “something that we have never seen before” is to experience days within July which have a similar level of 999 calls as New Year’s Eve, which is the busiest day of the year for the trust with associated planning in advance.

He said the trust has a 999 call every three to four seconds on New Year’s Eve and there have been “days in the middle of July where we are having to do (answer calls) the same”.

Mr Holdaway said the EMAS 999 call centres in Nottingham and Lincoln saw a “huge spike” in calls associated with the first extreme heatwave – for which there was the country’s first red alert – but did not experience the same for the second less-extreme heatwave.

He said that while incidents and calls have increased, the number of responses from ambulances have not risen, with patients often diverted to other health facilities.

Outside of this, Nichola Bramhall, the trust’s director of quality improvement and patient safety, said there had been “far more” serious incidents in the past year than in the one before.

She said there had been 74 serious incidents logged, up from 38 – almost double.

A serious incident is defined as: “Acts or omissions in care that result in; unexpected or avoidable death, unexpected or avoidable injury resulting in serious harm – including those where the injury required treatment to prevent death or serious harm.”

Ms Bramhall said 185 deaths had been reviewed and that in one case the incident was found to be linked to “poor care” from the trust, with all others not finding any link to care from the trust.

Earlier this year, Richard Henderson, chief executive at EMAS, wrote in a report that delays at hospitals were one of the trust’s “main operational challenges”.

He said these delays “impact on our resourcing and our ability to consistently provide a timely and safe service to our patients”.

In June, the Healthcare Safety Investigation Branch published an interim report into hospital handover issues. Its national investigation found that “demand on services, the availability of beds and patient flow through acute hospitals (including the discharge of patients to social and community care) have affected the ability of ambulances to hand over patients to emergency care”.

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