Airport-style “arrival lounges” are being trialled in London A&Es in a bid to stop patients spending hours stuck outside in ambulances, the Evening Standard can reveal.
The initiative has been launched at Queen’s hospital, in Romford, and could be expanded to “many” outer London hospitals to improve care and release ambulance crews to respond to “massive numbers” of 999 calls.
London Ambulance Service (LAS) said the volume of calls this month has returned to a peak last seen at the outset of the pandemic in March last year, with almost 7,000 calls a day to 999 and 5,000 to its 111 non-emergency helpline.
At the same time, delays in handing over patients at overloaded emergency departments are so long that on one night recently about 100 of the 250 ambulances on duty in the capital were effectively out of action at any one time.
The use of “ambulance arrival lounges,” run by paramedics and hospital emergency staff, is being pioneered to address what LAS fears will be the busiest winter in its history.
Daniel Elkeles, in his first interview since becoming LAS chief executive, told the Standard the lounges — set up in an unused part of the hospital — allowed patients to be safely monitored as they waited to be seen in A&E.
“This is a shared endeavour,” he said. “It’s not like hospitals are being deliberately difficult – the hospital has a capacity problem too.
“It’s quite a tense environment when your A&E staff are really busy looking after the people in A&E, the ambulance staff have brought their patients and they’re queueing in a corridor, and they’re stressed about their patients being on a trolley in a place that is completely inappropriate.”
Last month there were 303 incidents when ambulance patients waited more than an hour outside Queen’s, plus 195 at Whipps Cross, 178 at North Middlesex, 173 at Northwick Park, 163 at Barnet and 158 at Princess Royal.
Handovers are meant to take no more than 15 minutes. Across London last month, patients waited a total of 8,049 hours more than the target, according to LAS data.
Mr Elkeles, the former chief executive of Epsom and St Helier NHS trust, said: “Having senior clinicians from both A&E and the ambulance service working together to work out ‘how do we make this best for our staff and our patients?’ is really important.
“Nobody likes ambulances queuing and having corridors of patients. Anything that avoids that is really good for patient care.”
Mr Elkeles said waits for an ambulance had also lengthened. “Category two” emergencies, which include some types of heart attack, should have a response within 18 minutes.
But since he took over last month the average category two response time has never been less than 30 minutes, and at times almost an hour. The latest figures are an average of almost 48 minutes.
But Mr Elkeles said London was less badly hit than other parts of the country, mainly because it has more hospitals.
The LAS response to the most serious emergencies has only recently exceeded the seven-minute target, by an average of 25 seconds.
Other initiatives include not always taking patients to the nearest A&E, but utilising central London hospitals that may be less busy as people continue to work from home.
For example, this could involve patients in east London being taken to the Royal London, in Whitechapel, rather than to Queen’s, he said.
The LAS also plans to revert to the pre-pandemic strategy of deploying solo paramedics in fast cars, bikes or motorbikes – which will return to the road next week – in a bid to treat more people at the scene.
At the start of the pandemic, paramedics were switched to double-crewed ambulances because so many covid patients had to be transferred to hospital.
Mr Elkeles wants to recruit more front-line staff, and make a career in “para-medicine” more appealing to the capital’s diverse communities. He appealed to Londoners to show “community spirit” and look out for vulnerable neighbours this winter.
He said: “Delays in answering the phone is the biggest risk the NHS has. The second biggest risk is when someone has phoned 999 and we have prioritised they need a response within 18 minutes, but we can’t get there.
“That is why the handover issue is so important to solve. You have a huge amount of potential risk that no-one is able to quantify, to ensure that people aren’t coming to harm.”
Earlier this week a patient died from cardiac arrest stuck in an ambulance outside “extremely busy” Addenbrooke’s hospital, in Cambridge.
Mr Elkeles said crews were encouraged to report any delays that caused harm to patients.
“It’s inevitable that if people have been waiting a long time, and we haven’t been able to triage them to know that the wait was going to be appropriate, that some people will come to harm,” he said.
“I’m not aware of anybody who has come to such huge harm, like the example of dying in the back of an ambulance in Cambridge. I would feel very responsible if that happened.
“The long waits must be causing some harm. You can’t deny that.”