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Thousands of ambulance shifts lost as 999 crews in east of England wait longer than anywhere else in the country to offload sick patients at hospitals

PUBLISHED: 09:09 04 August 2016 | UPDATED: 11:59 04 August 2016

Ambulances stacking up outside A&E at the Norfolk and Norwich University Hospital. Picture taken earlier this year. Picture: DENISE BRADLEY

Ambulances stacking up outside A&E at the Norfolk and Norwich University Hospital. Picture taken earlier this year. Picture: DENISE BRADLEY

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The number of patients waiting in ambulances to be transferred to hospitals’ A&E departments has reached “epidemic levels”, according to the region’s 999 trust.

CCGs agreeing ‘handover reductions’ with hospitals

A spokesman for the Ipswich and East Suffolk CCG, the lead commissioner for the ambulance trust, said: “We are all focused on making sure that people get the help they need, particularly when people are likely to be at their most vulnerable.

“The CCG and East of England Ambulance Service Trust (EEAST) are working to improve these performance issues.

“More broadly we are working as systems of care to make sure people get the right care at the right time.

“Hospital trusts work with local CCGs to reduce handover delays. The delays are often caused when emergency departments are at their busiest.

“This does impact on EEAST’s capacity to respond to patients requiring help in an emergency.

“CCGs are agreeing handover reductions with individual hospitals in their localities and this will continue to be monitored robustly. We know that people want to support their NHS, and they can by using services appropriately.”

Despite health chiefs across the emergency care sector last year pledging to cut patient handover delays by 25pc - the amount of hours paramedics spent queing outside A&E actually rose by 38pc, this newspaper can reveal.

A total of 54,900 hours were lost across the east of England region between April 2015 and March 2016, according to East of England Ambulance Service Trust’s (EEAST) figures - the worst in the country.

That is the equivalent of 4,575 12-hour double-staffed ambulance shifts.

An EEAST report on handover delays found: “Handover delays at some hospitals across the east of England are now endemic and

have reached epidemic levels.”

Ambulance, hospital, and clinical commissioning group (CCG) leaders say they are working together to reduce the problem and that it forms part of the wider pressures facing the NHS.

But - with four of the region’s hospitals named among the 20 worst-performing in the country for handover delays (one of which is the Norfolk and Norwich Hospital) MPs are concerned.

Former health minister Norman Lamb, the MP for North Norfolk, warned patients’ lives were at risk.

“This issue is another symptom of a system under intolerable pressure,” he said.

“The knock-on effect is distressing - paramedics can’t get away from hospitals to life-threatened patients.

“There is a very real danger that these delays will result in patients losing their lives.

“The problem is that the ambulance service is under massive pressure in rural areas.”

He said a “resettlement” for the NHS and social care was needed to improve services.

A spokesman for the N&N said it was working with partners to reduce the number of patients taken to hospital by ambulance - because 50pc of those patients are discharged the same day.

The spokesman said patients who do not need emergency help can use the Norwich Walk-in Centre on Rouen Road or the Minor Injuries Unit at Cromer Hospital.

Meanwhile Clive Lewis, Labour MP for Norwich South, said the fact that the region’s mental health trust is in special measures, the N&N is in financial special measures, and the region has the worst ambulance handover delays in the country equalled “a local NHS crisis”.

He said the answer of changing senior NHS managers had been “tested to destruction in Norfolk” and instead called for an end to “under-funding of the NHS”.

“Funding for our health and social care system is not keeping pace with soaring demand,” Mr Lewis added.

“That’s the message senior NHS managers here need to be shouting from the rooftops.

“This under-funding is a political choice not an economic necessity - you can’t claim cuts are needed to curb the deficit and then slash taxes for the wealthiest and large corporations.”

Dr Therese Coffey, Conservative MP for Suffolk Coastal, said she would write to the chief executives of the three worst performing hospitals in the east of England and NHS England to challenge them on how they plan to reduce delays.

“Unfortunately there are still major problems on handovers at hospitals despite their efforts,” she said. An EEAST spokesman said: “Continuing hospital handover delays are a symptom of the increased 999 activity we have experienced.

“Long delays in placing our patients into the care of hospital staff have significant consequences for service delivery and directly impact on our ability to respond to patients in the community. We continue to work closely with hospitals, clinical commissioning groups, NHS Improvement and NHS England to address hospital handover delays, which have risen since 2014.”

What do the hospitals say?

The hospital experiencing the biggest handover delays in East Anglia is the Norfolk and Norwich (N&N), which also treats the most patients conveyed by ambulance in the east of England.

A spokesman said the number of ambulance arrivals has gone up by 69pc since 2008/09 while A&E attendances have risen by 42pc.

On a daily basis the N&N’s A&E accepts almost twice as many patients from ambulances than the next busiest hospital.

And a spokesman said the hospital was working with its healthcare partners to avoid bringing patients to its A&E if their care-needs could be better met elsewhere.

The spokesman added: “While we would never discourage patients from seeking our help, approximately 50px of the patients arriving by ambulance are discharged home later the same day.

“We are confident that, with good partnership working between ourselves and the ambulance trust, we can help many of these patients access more appropriate urgent care.

“The Emergency Department always treat patients in order of clinical priority which includes those in ambulances as well as self-presenting at the department.”

The N&N was fined £220,800 for its handover delays in 2015/16.

Sue Watkinson, director of operations at James Paget University Hospitals NHS Foundation Trust, said the James Paget Hospital, Gorleston, was not fined for ambulance handover delays in 2015/16.

“We worked closely with our ambulance colleagues to put in plans to support ambulance offloads.

“The hospital is usually in the top five acute trusts for positive speed of ambulance handovers.

“The main reason for causing ambulance handover delays is when we see large numbers of ambulance arrivals in a short space of time. “Additionally when bed availability in the hospital is not as we would like, then this can have a negative impact on ambulance handovers.”

She said measures to reduce delays included having a hospital ambulance liaison officer at A&E to stream patients into other healthcare services.

A spokesman for Queen Elizabeth Hospital, King’s Lynn, said: “We have dedicated cubicles where ambulance patients are assessed prior to their care being given in the most appropriate areas of the department.

“The ambulance service also gives pre-alerts.

“The hospital has agreed protocols with the ambulance service and we also have robust escalation processes in place.”

More than 2,500 hours have already been lost outside Norfolk’s acute hospitals so far this financial year.

Figures for April, May, and June show paramedics have queued for around 2,547 hours in the first three months of the year.

So far in 2016/17 the JPH has the second-best figures of the 18 hospitals that make up the east of England region.


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