The Sunday Times - UK (2021-11-14)

The Sunday Times November 14, 2021 15

NEWS

Emily Saunders was one day into a Devon

holiday with her partner when she

tripped on some shoes outside her front

door. “I heard a crack and was in total

agony, sitting up holding my leg with my

foot flopping from side to side,” she said.

The accident happened at 8pm. At

2.30am, Saunders — a songwriter from

London who has an autoimmune disease

and asthma — was still lying outside on

the cold concrete. Her 999 caller said she

shouldn’t move but there were no availa-

ble ambulances: they were all queueing

at the nearest A&E, 18 miles away. “The

experience of not knowing when or even

if one would turn up was terrifying,” she

said.

She tried to hold her leg in place but

became too tired. “I had to let it flop out

of place as I gradually slumped horizon-

tally.” Saunders was relieved when

ambulance staff — gobsmacked that she

had been left outside in the cold — finally

arrived. Yet it would be hours more until

she made it to a hospital bed.

“We had to wait in an ambulance

queue until about 8am. The staff waited

THE PINCH POINTS

Emily Saunders only made it

on to a ward 24 hours later

I held my broken leg together for hours

over the end of their shift, waiting for

handover, plus they didn’t have a break

that day,” she said.

Her 12-hour wait between an ambu-

lance being called and getting into the

emergency room sounds like an outlier,

but it is increasingly common.

In September, 5,025 people waited at

least that time to be admitted, more than

in any month on record — and it is not

even winter. Saunders was not on a ward

until 8pm — 24 hours after her fall —

because of a lack of general space. She is

still there and not sure when she will get

out. “With zero ambulances available,

there must have been people with life-

threatening conditions who wouldn’t

have survived,” she said.

The data suggests she is right. Patients

with injuries that demand immediate

intervention or resuscitation — where a

second’s delay can mean the difference

between life and death — are waiting

more than nine minutes for an ambu-

lance to arrive on average, the longest on

record and two minutes over the target.

Patients who are not suffering the

gravest injury but are very badly hurt or

ill have even less chance of a prompt

response. In England, category 2 patients

include heart attack and stroke victims,

and people with burns or sepsis.

They are meant to be seen within

18 minutes; in October the average

wait was 54 minutes. For one in ten

unlucky category 2 calls — about 43,

patients last month — the wait is nearly

two hours.

waited several hours with their relatives

in pain.”

Demand is surging at the worst possi-

ble time. The past few months have

exposed the interdependence of the

health and social care systems.

Although nothing in healthcare is

simple, a causal link can be established

between what is happening in the care

sector and the problems in hospitals.

Patients are stuck in ambulances

because of bed shortages — because

patients taken in before them are not

being safely discharged to care homes

and the community.

The adult social care sector is about

112,000 workers short. Many carers have

been attracted by better-paid jobs since

the start of the pandemic, choosing to

earn more in delivery or retail.

The industry was also reliant on about

100,000 workers from Europe, many of

whom have decided to leave.

Since Thursday, anyone wanting to

work in a care home has had to be

double-jabbed, barring some exemp-

tions. The latest figures suggest more

than 45,000 workers in elderly care

homes may have become instantly in-

eligible and — allowing for a grace period

for medical exemptions — may have to

leave by Christmas.

This makes it extremely hard to safely

discharge patients from hospitals.

How bad is the problem?

The NHS stopped publishing national fig-

ures on “delayed discharges” at the start

of the pandemic, but there are signs that

in some hospitals nearly one in four beds

are lost to patients who cannot be sent on

from hospital.

At the James Paget Hospital in Norfolk,

where a patient died in the back of an

ambulance last month, board meeting

minutes suggest 96 out of 420 beds are

taken up with healthy patients.

At Nottingham University Hospitals

Trust, one of the biggest in the country,

222 patients are waiting to go home. One

recent Nottingham A&E attendee, Lisa

Cherry-Downes, said it was “standing

room only” in the emergency depart-

ment.

The 57-year-old was trying to have a CT

scan for a possible pulmonary embolism.

She had to sit on chairs that were marked

out of bounds for social distancing.

Hospitals are desperate to free up

space, but some fear patients are being

released prematurely.

Data on “failed discharges” is not regu-

larly updated, but Huckin says he is

increasingly being called out to treat

patients sent home without proper care.

“A patient I saw the other day had had

abdominal surgery and was not given any

pain relief,” he said. “We had to go back

to them because they were in agony. We

then had a stroke patient who was sent

back into her home, which wasn’t suita-

ble any more.

“There was no care package in place.

She’s been discharged — and obviously

had to go straight back into hospital again

because she couldn’t look after herself.”

Tom Calver Data Projects Editor

A woman’s 12-hour wait

to get to A&E is becoming

the norm as patients face

delays for ambulances

and treatment

months. If you’ve had pains for six

months, it’s not a heart attack. Others are

unable to get off the sofa because they’re

tired. One had a Covid jab and felt fever-

ish. They’re things that don’t require an

ambulance.”

During lockdown, patients postponed

seeking medical help, preferring to

“store up” problems, according to doc-

tors. Sajid Javid, the health secretary, has

warned that the NHS waiting list for pro-

cedures — already at 5.8 million patients

— could reach 13 million because of care

postponed during the pandemic. As life

returns to normal, demand is surging —

but not every ambulance request is

justified.

“We have a broken primary care sys-

tem,” said Huckin. “People are finding

that they’re number 27 in a queue for a

GP appointment, and they’ve hung up.

We’re getting reports of receptionists tell-

ing people, ‘If you want to be

seen face to face, you’ll have

to call an ambulance.’”

Morale, says Huckin,

is the worst he’s seen

in his six years as a

paramedic.

“We’re feel-

ing under-

valued. The

public get very

narky with

paramed-

ics, espe-

cially if

they’ve

In Scotland, MSPs have warned that

lives are being lost because of ambulance

handover delays. Last week Richard

Brown, 55, died on the stairs of his tene-

ment building in Glasgow after waiting

five hours for an ambulance.

Soldiers have been drafted in to drive

ambulances, and Pauline Howie, head of

the Scottish Ambulance Service, has

apologised. Scotland does not publish

monthly data, but in the year to March

2021, of the most urgent 999 calls, 71 per

cent were seen in less than ten minutes,

down from 81 per cent in 2018-19.

In Wales 65 per cent of all “red” call-

outs are meant to be answered within

eight minutes — but in September the fig-

ure was just 52 per cent.

Why are delays at unprecedented

levels?

David Huckin, a paramedic working in

Northampton, is busier than he has ever

been. Usually that would mean more

trips to the hospital. Not last week.

Last week he did four shifts and did

not go to the hospital once.

Many of his patients were

unwell but did not need emer-

gency care. “People say they

don’t feel well but just want

checking over,” he said. “Last

week we visited someone

who’d had chest pains — except

they’d been going on for six

1

Demand for ambulances is

heightened by a backlog of

health problems that has built

up during the pandemic and

the difficulty of seeing GPs

2

Ambulance delays are some of

the worst on record. Stroke

and heart attack patients are

having to wait 54 minutes on

average^3

When paramedics arrive at

hospitals with patients, there

may be no free beds. Some

wait hours and are treated in

the back of ambulances^4

Casualty departments are

becoming increasingly

crowded. The sick and injured

may face long waits,

sometimes left on a trolley^5

Hospitals have bed shortages

because care homes lack

places for recovered patients.

In some hospitals a fifth of

beds are taken up by the well^6

This is mainly because of a

shortage of carers. Many have

left during the pandemic to

take better-paid jobs; now the

unvaccinated must quit