999 patients forced to wait up to five hours for an ambulance, Telegraph investigation reveals

Laura Donnelly
Patients in the most grave emergencies are supposed to receive a response within eight minutes - PA

999 patients classed as “life threatening” are being forced to wait hours for an ambulance, with delays of up to five hours in some cases, an investigation has found.

Under NHS targets, patients in the most grave emergencies - which include cardiac arrests, airway obstructions and strokes - are supposed to receive a response within eight minutes, in 75 per cent of cases.

But the target has been repeatedly missed in recent years, amid growing pressures on emergency services.

Now Freedom of Information disclosures reveal that thousands of patients are being forced to wait far longer, with desperately time-sensitive emergencies being left for hours.

Last night patients’ groups described the disclosures as “alarming” while the Royal College of Emergency Medicine (RCEM) said the delays were “unacceptable”.

We are profoundly concerned that people with life-threatening medical needs are apparently increasingly likely to face unacceptably long waits

Chairman of the Patients Association

The figures show that in some cases, patients have been forced to wait more than five hours - even though their case has been classed as “life threatening” by 999 call handlers.

In total, more than 8,000 such cases waited more than 30 minutes for a response over a six week period, Freedom of Information disclosures reveal.

The longest wait was in Portsmouth, on January 2, when a call to South Central Ambulance Service (SCAS) resulted in a wait of five hours five minutes for an ambulance, even though the case was classed as life-threatening.

The greatest delay among such cases at North West Ambulance Service (NWAS) trust came three days later, when a patient from Accrington in Lancashire waited almost three and a half hours for a response.

In Boston, in Lincolnshire, a case classed as life-threatening waited almost two hours for an ambulance, later the same month, figures from East Midlands Ambulance Service (EMAS) show.

Dr Chris Moulton, vice president of the RCEM, said such delays were “absolutely unacceptable”.

But he said ambulance services were under unprecedented pressure, with the whole healthcare system “struggling at every pinch point”.

Figures show that in some cases, patients have been forced to wait more than five hours Credit: Alamy 

The A&E consultant said too many ambulances were being forced off the road, because paramedics were stuck in casualty units, as patients faced long waits to see a doctor or nurse.

But he also urged the public to do more to reduce pressures on ambulances, with too much reliance on 999 for minor cases.

Liz McAnulty, Chairman of the Patients Association, said the findings were “alarming” and a signal that the NHS was facing a major crisis.

“Ambulance services must respond in a timely and effective way – this can be literally a matter of life or death,” she said.

“We are profoundly concerned that people with life-threatening medical needs are apparently increasingly likely to face unacceptably long waits,” she said, calling for a boost for health service funding.

Longest waits for calls classified as “life threatening” by ambulance trust | Source: FOI covering first six weeks of 2017

Under the NHS system of ambulance prioritisation, life threatening calls are sub-divided into two categories: Red 1 - the most time critical  - covering cardiac arrests, breathing difficulties - and Red 2, covering other  serious urgent cases, such as strokes.

All are subject to the eight minute time target, because the chance of survival depends on a speedy response.

Many of the longest waits - including the delay of over five hours - fell into the Red 2 category.

But some extremely lengthy waits involved red 1 patients.

One patient, classed as “red 1” waited 58 minutes for an ambulance in Spalding, in Lincolnshire on 20 January, amid a shortage of EMAS ambulances. The trust said the case had later been found to have been incorrectly coded, though it was thought to be more serious at the time.

A further 87 red 1 cases were forced to wait at least 30 minutes for a response, even though the category is focussed on those with cardiac arrests and breathing difficulties.

And 8,140 red 2 patients waited at least 30 minutes for a red 2 response, including those left for several hours.

Pilot schemes are underway in the NHS that give call handlers longer to assess cases before sending out an ambulance  Credit: Alamy

The new figures, which cover the first six weeks of this year, come amid attempts to reform the system of ambulance responses, with trials which allow call handlers longer to assess calls. 

Ambulance services in England have not hit the eight minute target since 2013/14, official figures show, with just 68.6 per cent of red 1 calls receiving a response in eight minutes in 2016/17, along with 62.3 per cent of red 2 calls.  A lower 65 per cent target has been met in Wales since it abandoned all other ambulance time targets.

The ambulance service is facing significant pressures partly because too many ambulances are dispatched to simply hit targets

NHS England

SCAS said it was experienced “increased demand” on 2 January, resulting in the five hour delay.

The trust said the call, which involved a fall at home, was initally categorised as lower priority, but reasssed by call-handlers to become red 2.

“Throughout this delay our clinical support desk was in contact with the patient to discuss their care and to apologise for our delay to them,” the trust said.

A spokesman said a large number of ambulances were waiting to hand over patients at the local hospital, with paramedics caring for patients in the backs of vehicles.

NWAS apologised for the delays for the patient who waited almost three and a half hours.

“In many of the red 2 cases identified, patients’ conditions will have changed and warranted an upgrade from the less serious ‘green’ category, for which there are no national performance standards, to the ‘red’ category which requires a quicker response,” a spokesman said.

Ben Holdaway, deputy director of operations at EMAS said: “We are sorry that some of our patients have had to wait for an ambulance. The patient who waited for 58 minutes was conscious, breathing and alert as such other calls to patients who were unconscious had to take priority.

Pilot schemes are underway in the NHS that give call handlers longer to assess cases before sending out an ambulance response. Health officials say too many ambulance are being sent out when it later turns out they were not needed.

About | 999 ambulance response targets

An NHS England spokesman said: “The ambulance service is facing significant pressures partly because too many ambulances are dispatched to simply hit targets rather than attend to patients in need. For this reason we have been testing a change to the way in which ambulance services respond.

“These trials - an idea that has come from doctors and paramedics - are designed to get to the most urgent patients in the quickest possible time, and improve the service for all patients who dial 999.”

 

Jacqualine Davies, 49, died after waiting more than an hour for an ambulance, even though her case had been classed as “life-threatening”.

Her family called 999, when she began to experience chest pains and breathing problems, and the call was categorised as category A - with an eight minute response target.

But it took 42 minutes for the NHS to send out a single paramedic to her home in Monmouth, despite two more calls from her desperate daughter and sister.  

By then Mrs Davies’ heart had stopped, after a series of violent fits. Even once it was restarted, with adrenaline injections, it was over an hour before an ambulance arrived from across the border in England to take her to hospital.  She died nine days later after suffering from irreversable brain damage.

Her son Mathew, a secondary school teacher, said his mother had died as a result of “systematic failures” by the Welsh Ambulance Service, which he said attempted to cover up its errors.

A coroner said “significant failings” by the service contributed to Ms Davies’ death, in January 2011.

The delays reaching the mother of two were exacerbated because the battery of a rapid response vehicle was not charged, the inquest heard.

The coroner only became aware of the errors, when the trust accidentally sent him a draft report into the incident, in addition to a final version which made no mention of the failing.

Mr Davies, 32, from Shrewsbury, said the loss of his mother in such circumstances had been “emotionally and mentally traumatising” for the family.

“The shocking thing is there has been no accountability for this,” said Mr Davies, who has since campaigned to improve provision of ambulances in Wales.

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