Eliminate ambulance queues, hospitals told after deaths linked to handover delays

Hospitals in England have been ordered to “eliminate” ambulance queues after two deaths were linked to handover delays.

It came after NHS chiefs warned of “catastrophic harm” being caused to patients in a growing crisis, with some dying before they could be reached because so many ambulances were stuck outside hospitals.

Prof Stephen Powis, the national medical director of NHS England, has written to all trust chief executives urging them to take action to ensure ambulances are not left queuing outside hospitals.

It follows reports of two deaths of patients subjected to handover delays outside accident and emergency departments: one following a five-hour wait at Worcestershire Royal Hospital, and the other taking place at Addenbrooke’s Hospital in Cambridge.

Ambulance leaders have described the “highest level of emergency activity in history” and reports from around the country paint a bleak picture of ambulances queuing for hours outside busy hospitals.

On Tuesday, the West Midlands Ambulance Service Trust warned that delays were causing “catastrophic” harm to patients and put itself on the highest risk level.

Mark Docherty, the trust’s director of clinical commissioning and strategic development, told the trust’s board that despite best mitigation efforts, “we know patients are coming to harm” and admitted some patients were “dying before we get to them”.

Describing the situation as “completely unacceptable”, he said: “We know for a fact we are causing harm to patients and that harm is significant. And the definition of 25 [risk level], is that harm is almost certain – and it’s going to be catastrophic. I think we’re now at that place.”

Documents from the trust board show one patient was cared for by ambulance staff for “over 13 hours”.

The separate letter from NHS England bosses to all acute hospitals states that handover delays represent “unacceptable clinical risk” both for patients waiting in ambulance queues and those in the community whose emergency care is delayed.

“Given current performance and the risk to patient safety, we must however press to identify further solutions to eliminate all handover delays,” said the letter from Prof Powis and Pauline Philip, the national director for emergency and elective care at the NHS.

Patients who arrive at hospital by ambulance are supposed to be handed over from paramedics to hospital staff within 15 minutes.

Martin Flaherty, the managing director of the Association of Ambulance Chief Executives, reported 35,000 handover delays of at least an hour outside hospitals last month, compared with 4,700 in April.

Latest NHS data for England shows the busiest September on record. Major A&Es treated more than 1.39 million people during September, the highest ever for the month.

Ambulances responded to a record 76,000 life threatening callouts, while 999 took nearly one million calls in September.