‘There is no question patients are coming to harm’: Ambulance trusts on ‘black alert’ as 999 demand soars

Patients are coming to harm because of long waits in the back of ambulances, an NHS chief executive has admitted, as ambulance services across England report record emergency demand.

A leaked briefing to staff at West Midlands Ambulance Service, seen by The Independent, said patients were being delayed outside hospitals for hours, meaning ambulances could not respond to 999 calls.

Some staff working for the trust have faced delays of four hours or more at the end of their 12-hour day waiting to transfer a patient to A&E staff.

Six out of the 10 busiest days ever for the West Midlands service have been this month, with 36,336 999 calls between 1 and 7 July, a 32 per cent rise on the same period in 2019.

On 5 July, the trust recorded its busiest day ever, with 5,455 emergency 999 calls.

The situation in the West Midlands is not unique, with four out of the 10 ambulance trusts having declared ‘black alerts’ or level 4 incidents in the past few days due to overwhelming demand.

This includes London Ambulance Service, the South Western Ambulance Service, East Midlands Ambulance Trust and the North West Ambulance Service.

West Midlands chief executive Anthony Marsh told staff the situation was unacceptable and the problems at hospitals were getting worse.

“You have told us how late finishes are impacting your lives and your mental health. It is also having a serious detriment to patient care with tragic consequences in some cases.

“It cannot be right that we are not able to get to some category two patients in a timely manner – these are patients with heart attacks and strokes where time really matters. There is no question that patients are coming to harm.”

He added that too many NHS trusts were “simply ignoring” advice from the Care Quality Commission to take over the management of patients when an ambulance arrives at A&E, due to lack of beds, indirectly transferring the problem to paramedics.

The briefing revealed June had been the second worst month for patients waiting over an hour to be handed over at A&E, with 4,649 incidents. This time spent waiting was the equivalent to 760 staff working 12-hour shifts.

In some cases paramedics have been forced to “cohort” patients with another crew, so paramedics can end their shifts on time. But that can lead to longer delays for the remaining crew.

The West Midlands trust is now negotiating with hospitals to bring in a new policy to try and make sure paramedics are not left waiting with patients for hours after their shift is meant to have ended.

The briefing said a new approach would mean hospitals being alerted to staff approaching their end of shift so they could be helped. But with A&E staff under so much pressure, it’s not clear what more they could do.

The briefing to staff said: “This current situation is unacceptable and leads to fatigue, poor morale, has impacts on patient safety and potentially non-compliance with the Working Time Directive.”