Health & Fitness: Record-breaking ambulance waiting times could get ‘significantly worse’ in winter, chiefs warn

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A combination of rising Covid cases and a lack of social care workers is set to make the response times for ambulances across England even worse this winter, according to the emergency services’ national body.

With nearly 13,000 medically fit people a day not being discharged in England due to the lack of community health and social care provision that they require in their homes, ambulances have been waiting outside hospitals for up to 23 hours before being able to transfer their patients to a bed.

The long waits have caused huge delays in ambulance response times because crews and paramedics have been left to wait outside emergency departments before setting off to the next callout.

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According to the Association of Ambulance Chief Executives (AACE), the delays could get even worse in the winter as the cold weather and rise in Covid cases lead to an increase in 999 medical calls.

“There’s significant fears that thing will get significantly worse than the current crisis, which is already unprecedented,” a spokesman for the AACE told i.

“All UK ambulance services are facing significant issues due to handover delays at some hospital emergency departments.

“This is a system wide issue which means that in some cases there are indeed problems caused by hospitals not being able to discharge patients who are medically fit to leave, because social care arrangements have been unable to be made appropriately and safely.”

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The latest available figures for June show that 11,000 people waited outside for at least three hours in an ambulance before being found a bed. Pre-pandemic the spokesman for the AACE said this figure would have been “no more than a handful”.

The June figures also showed that almost 6,485 people waited in ambulances outside hospitals in England for more than four hours, while 3,925 waited over five hours. A further 494 waited longer than 10 hours, with the some waiting for up to 23 hours.

A spokeswoman for NHS England said: “The July figures show the challenges faced by staff freeing up beds throughout July, with only 40 per cent of patients able to leave hospital when they were ready to.

“Pressures in areas like social care continued to impact the ability to discharge patients, meaning on average there were 12,900 patients a day who spent more time in hospital than needed – an 11 per cent rise on June.”

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The worst affected of the seven NHS England regions is the South West, where ambulance crews are now regularly spending their entire shift outside a hospital after picking up their first patient of the day.

Ambulances in the region – which includes the counties of Gloucestershire, Devon, Dorset, and Cornwall as well as the cities of Bristol and Bath – are taking more than three hours to respond to patients with suspected heart attacks or strokes across Cornwall, in what is believed to be the worst reported system-level performance across England.

The region has more than 3,000 patients that should be discharged on a daily basis, which accounts for around one in four of the 13,000 patients that are not being discharged despite being medically fit.

Adrian South, deputy director of clinical care at the South West Ambulance Service Foundation Trust, said: “We’ve got around 3,000 in beds across the South West because those patients can’t be discharged.

“Ultimately, wards cannot accept patients from the emergency department. That then results in emergency departments not being able to accept patients from us and that’s where the current challenge stems from.”

In an attempt to stave off the crisis facing hospitals and ambulance services, NHS England is preparing local services for additional winter pressures by creating the equivalent of 7,000 more beds through a mixture of new hospital beds, “virtual ward” spaces and initiatives to improve patient flow over the coming months.

Virtual wards remotely support people at the place they call home, including care homes. The support can include remote monitoring using apps, technology platforms, wearables and medical devices such as pulse oximeters.

The NHS will also recruit more call handlers across the country so that we have at least 4,800 staff working in 111 and 2,500 in 999 call rooms to deal with higher demand.

The Department of Health and Social Care was contacted for comment.

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