People in life-threatening conditions in England had a record wait for an ambulance to arrive last month.
Ambulances took 9 minutes and 35 seconds to receive the most serious of 999 calls in July, 29 seconds longer than in June and the same as the record in March.
In the equivalent month before the pandemic, July 2019, ambulances were more than two minutes faster in responding to these types of calls.
Heart attacks and strokes
People who had heart attacks or strokes in England waited more than half an hour longer for an ambulance to arrive in July compared to before the pandemic.
The average waiting time for these category 2 calls, classified as emergencies, was almost one hour, 59 minutes and 7 seconds last month, compared to 23 minutes and 19 seconds in July 2019.
The NHS The aim is that patients in this category do not have to wait more than 18 minutes on average for an ambulance.
Response times for these calls have deteriorated at a faster rate than those immediately life-threatening calls that are prioritized. But the decline is probably more important as they affect many more people.
Two thirds of 999 calls were classified as category 2 in July, compared with one in six that fell into the life-threatening category.
Glenn Carrington, UNISON Branch Chair of East of England Ambulance Service and a paramedic for 36 years, explained why.
“You might have ten ambulances on shift, but you’ll have nine of them waiting outside A&E, so we can only respond to the most immediate emergency.
“You might be on your way to someone who’s had a heart attack, but you have to turn around because you have another call about someone who’s not breathing.
“Sometimes what we think is the biggest need isn’t really, it’s just one that calls out the loudest. That’s why we have to reach out to everyone.”
Incidents classified as urgent accounted for around one in five 999 ambulance calls last month. The average waiting times for this were more than three hours.
The NHS target is that no more than one in 10 of these patients have to wait more than two hours to be seen. In July, one in 10 people waited more than eight hours.
Richard Webber, chief spokesman for the College of Paramedics said: “These cases are not immediately life-threatening but you do get cases like elderly people who have fallen and they are lying on the floor for 12 hours with a broken hip.
“They can wet themselves, they will be dehydrated and thirsty, lose fluid in their leg and of course their condition will deteriorate,” he added.
More 999 calls but ambulances do less
Although the number of 999 calls has grown, the number of patients that the ambulance service can handle has fallen. There has been an effort to try to treat more people over the phone to save ambulance resources and prevent people having to go to A&E.
“People call 999 and expect us to turn up in a few minutes. We can’t because we’re on hospital wards and it’s costing people their lives,” Mr Carrington said.
“It’s not the hospital’s fault because they don’t have enough beds. It’s not the ambulance service’s fault because they don’t have enough resources.”
Mr Webber says that if calls are higher than the number of incidents, it is because people are calling multiple times and asking where their ambulance is.
Where is it doing the worst in the country?
People who had a heart attack or stroke last month in the East Midlands had to wait almost twice as long for an ambulance compared to those in the South East. People in London, the east of England and the Midlands all had to wait more than an hour.
Even in the best performing area, people waited more than twice as long as the official NHS target of 18 minutes.
People with life-threatening conditions in the South West had to wait almost 12 minutes on average for paramedics in July, three minutes longer than those in London, the North of England and the West Midlands.
Why is this happening?
Mr Carrington and Mr Webber agree that the biggest problem is not being able to discharge hospital patients into social care.
Mr Webber said: “An ambulance crew would normally do seven or eight calls in a 12-hour shift. Now they spend three or four hours each time waiting to hand over patients so they only come two or three calls per shift. They are doing less than half the work they were before.
“You can put more ambulance crews on, but if you’ve lost half your productive workforce to queues, put a few crews on here and there’s no system solution. You have to unlock the things that stop the system.
“The main problem is social care – hospitals have patients they cannot discharge because there is no space in social care. Because the hospitals have too many patients, they cannot bring in the next cohort of patients.”
In July, an average of almost 13,000 hospital beds per day were occupied by patients who did not need to be there.
Mr Carrington says his record so far is a nine-and-a-half-hour wait to let a patient into A&E. He says that if ambulances are parked for this time, they cannot even provide air conditioning to keep the patient comfortable.
“Part of the beauty of the job is it’s never straightforward, but this used to be the time of year we get some rest. Well, it’s the worst I’ve seen it in 36 years. It’s heartbreaking, it’s absurdly terrible, it’s absurd.
“The NHS is in cardiac arrest and we’re jumping up and down on its chest trying to resuscitate it, but unfortunately I think it’s broken beyond repair. We’re just fighting to try and save what’s left.”
Professor Sir Stephen Powis, NHS National Medical Director, said: “Today’s figures show the immense pressure our emergency services are under with more of the most serious ambulance calls than the NHS has ever seen before, at levels more than a third higher than pre-pandemic.
“Recognising the pressure on urgent and emergency services, we are working on plans to increase capacity and reduce call times for the winter alongside our new contract with St John to provide additional support as needed.
“As the country faces another spell of high temperatures following last month’s record-breaking heatwave, it is vital that anyone who is unwell seeks advice or an NHS referral via 111 online or their local pharmacy, and only call 999 if it’s a life-threatening emergency.”
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