How close to death do you need to be to get an ambulance in England?

File photo dated 06/01/23 of Ambulances waiting at an Emergency Department (A&E) at the Royal London hospital in London, as Ambulance handover delays outside hospitals in England have fallen to their lowest level this winter, NHS figures show.
The ambulance service in England in in the midst of an unprecedented crisis (PA Images)

England’s ambulance service is facing its toughest challenge in recent history. A combination of funding cuts, staff shortages and a social care crisis is bed blocking hospitals and leaving paramedics - already burned out after working on the pandemic frontline - unable to reach critically ill people.

Delays in handing over patients who arrive by ambulance to the care of hospital doctors are at record highs. The number of ambulance arrivals at hospital is also peaking this year.

So, how sick do you have to be to get an ambulance in England right now? Yahoo News UK explains in 12 points

Ambulance response categories are assigned to patients by 999 call handlers (Yahoo News UK/Flourish)
Ambulance response categories are assigned to patients by 999 call handlers (Yahoo News UK/Flourish)

How quickly will an ambulance arrive? This - or whether you get one at all - depends on how your case is categorised by 999 call handlers. Category one includes patients at immediate risk of death, such as those not breathing or suffering a severe allergic reaction. Category two calls are emergencies such as a suspected stroke.

Who is getting an ambulance? Almost all category one callers have a paramedic with them within 10 minutes, slightly above the target of seven minutes. But category two callers fare badly. They should receive an ambulance within 18 minutes, but waited an average of 92 minutes in December.

Why is this happening? Ambulances are not available to be released to new callers because they are stuck in lines outside A&E departments waiting to hand over patients to hospital medics. The target for wait times is just 15 minutes, but handover wait times are at their longest ever recorded.

How long are ambulances crews stuck outside A&E? This time last year only a quarter (25% per cent) of ambulances were waiting 30 minutes to hand over patients. By the end of December 2022 it had reached 44% per cent.

This is clogging the system. On the evening of 12 December there were 600 patients awaiting an ambulance in Greater Manchester while 100 ambulances were sitting waiting outside the region’s A&E departments still caring for the patients they’d already picked up.

What has social care got to do with it? Paramedics can’t hand over their patients to A&E because emergency doctors can’t find beds on hospital wards to transfer patients into. This is often because medically fit patients can’t be discharged unless they are safe at home. Council funding cuts over the last decade means there is very little at-home care available for vulnerable people.

So how many people are stuck in hospital beds? Only 37% of medically fit patients were discharged from hospital in the first week of January, leaving 63% of potentially free beds still filled with patients who didn’t need to be there. That clogs up beds – and leaves ambulances waiting outside.

Staff shortages are also a problem. Paramedics are warning of a recruitment crisis. Even before the pandemic, they were quitting the job due to dissatisfaction. Now almost half report that they are suffering from burnout due to “overwhelming” workloads.

LONDON, UNITED KINGDOM - 2023/01/11: Ambulance workers are seen during a demonstration outside Waterloo Ambulance Station. Unison members of the LAS (London Ambulance Service) walked out for 12 hours from 11 am on Wednesday, Jan 11, to demonstrate for better pay and to rally support for ambulance workers. (Photo by Tejas Sandhu/SOPA Images/LightRocket via Getty Images)
Ambulance workers have staged a number of walk-outs this winter, with further industrial action planned. (Getty Images)

Staff anger is leading to walkouts. This also affects the service ambulances can provide. A new wave of strikes were announced on Thursday.

What does this mean for patients? Ambulance gridlock is leading to preventable deaths. According to Dr Adrian Boyle, president of the Royal College of Emergency Medicine, 500 people a week are dying because they are unable to access emergency treatment from ambulance and A&E staff. NHS England says it does not accept this figure.

Paramedics are left unable to provide care. Ambulance workers say they are unable to attend patients suffering from cardiac arrest or who have suffered serious falls. In Bury, a hospital trust chief apologised after a man died in the back of an ambulance waiting outside Fairfield General Hospital for three hours. The West Midlands recorded a 37-fold increase in the number of deaths while awaiting an an ambulance between 2020 and 2022.

People are having to get themselves to hospital. Ambulance staff are now telling relatives of patients with non-category one calls to drive them to A&E instead of suffering long waits.