CRISIS IN THE AMBULANCE SERVICE

Ambulance trust accused of jeopardising patients by sending cars (13 July 2017)

Health chiefs have been accused of putting lives at risk by sending cars instead of ambulances to emergencies. East of England Ambulance Trust is sending rapid response vehicles (RRVs) to 999 calls to hit targets, even when the patient needs an ambulance for transport to hospital, a paramedic has claimed, with the result that patients sometimes wait for hours for an ambulance to reach them.

Patient safety is being compromised by the trust’s focus on hitting response targets, the paramedic told the Health Service Journal (HSJ). Speaking on condition of anonymity, he said: “The trust has become so fixated with hitting the target by sending out RRVs to stop the clock.

“Care, patient safety and dignity are really being badly compromised. Everyone has horror stories. It’s as bad as I can ever remember.”

The paramedic said “elderly, frail patients” were sometimes left “lying on the ground waiting up to two or three hours for an ambulance to turn up”. “Often they’re in pain, maybe with a broken hip. When it’s in the winter, it’s often in cold, frosty conditions. Sometimes they are lying on a limb, and who knows what damage is being done as a result?” ...read more

 

Revealed: NHS Ambulances fail to reach most seriously ill and injured patients in time despite efficiency drive (The Independent: 1 May 2017)

Ambulances are failing to reach thousands of seriously-ill patients within the eight-minute target time, despite a dramatic reduction in the number of calls classified as urgent, The Independent can reveal.

Unions warned that lives are being put at risk by slow response times, even as the system is being “manipulated” to make it easier to hit government-imposed targets.

The revelations of worsening performance come from a trial being run in three of the country’s 10 ambulance trusts, which is aiming to streamline the service and ensure the sickest patients are dealt with quickly.

The number of calls categorised as needing an urgent response has been radically cut to enable ambulances to respond to 75 per cent of cases within eight minutes – a requirement that has not been met nationally since January 2014.

But exclusive figures obtained by The Independent show even though tens of thousands of cases have been stripped out of the urgent category, ambulances are still failing to meet the target.

In Yorkshire, the percentage of the most serious calls responded to within eight minutes fell to 67 per cent between May 2016 and January 2017, down from 71 per cent a year earlier. During the same period, the number of calls classified as requiring an urgent response fell from 235,200 to 53,300.

The number of most urgent calls taken by the South Western ambulance service between May 2016 and March 2017 compared to the year before was reduced from 308,000 to 44,600. But the proportion of calls hitting the eight-minute target remained stagnant at 70 per cent.

Ambulance staff union GMB accused NHS England of “manipulating” targets, saying: “At the end of the day, someone, if they haven’t already, is going to die from a lack of care.”...read more

 

Paramedics 'tampered with trackers' to avoid 999 calls at a scandal-hit NHS trust (The Telegragh: 20th Febraury 2017)

Paramedics at a scandal-hit NHS trust are accused of switching off ambulance tracking devices so they could avoid responding to 999 calls.

At least ten ambulance workers are under investigation for deliberate tampering with the trackers, so they could disappear for up to three hours at a time, putting patients at risk.

The revelations came as the current head of South East Coast Ambulance Service trust stood down in the wake of allegations that he was among those found responsible for bullying.

The Health and Care Professions Council (HPC) yesterday heard that patients in potentially life-threatening situations were left in jeopardy because of efforts to mislead control room staff.

At least 10 paramedics from the trust’s ambulance station in Guildford, Surrey, are accused of deliberate tampering.

Carl Hudghton, 29, yesterday admitted that his actions could have had “catastrophic” consequences for patients, adding to delays for patients in need of emergency help...Read More

 

Ambulance workers say new cost-cutting measure risks lives (The Guardian: 8 January 2017)

Paramedics have accused their own NHS ambulance service of endangering lives in a bid to save money by cutting a system under which they abandon meal breaks to respond to patients with life-threatening conditions.

Crews at the South East Coast ambulance service (Secamb), which covers a huge swath of south-east England, were told that they would no longer be paid overtime for abandoning their breaks to respond to some 999 calls including emergencies involving strokes, seizures and breathing problems. The instruction came as it emerged that medical staff across the UK faced an unprecedented demand on emergency resources last week.

Paramedics have warned that patient safety and lives could be put at risk because it will lengthen the service’s response times, which its boss recently admitted were already poor.

Ambulance crews will no longer be paid the £25 they receive each time they interrupt the single – and unpaid – 30-minute meal break they get during their 12-hour shift in order to answer a Red 2 call, which can involve someone with chest pains or car crash casualties.

The Patients Association said the policy was short-sighted and the welfare of patients should never be sacrificed in a quest for savings. It comes as NHS governance grew into a major political issue in the wake of three patient deaths at Worcestershire Royal hospital last week.

On Sunday, Theresa May rejected the British Red Cross’s claim that hospitals and ambulance services were under such pressure that it constitutes a “humanitarian crisis”. The prime minister made clear she would not be producing an NHS rescue plan....read more

 

Ambulances too slow to reach seriously ill patients, says report (The Guardian: 30 November 2016)

Ambulances are failing to reach dying and seriously ill patients fast enough as the service creaks under the strain of high demand, according to a report.

Only one of the UK’s 13 ambulance services, the Welsh ambulance service, is meeting the target to reach patients with life-threatening conditions within eight minutes, a BBC investigation has found.

Freedom of information requests by the broadcaster found more than 500,000 hours of ambulance crews’ time in England, Wales and Northern Ireland was wasted waiting at A&E to hand over patients to hospital staff.

Dr Mark Holland, president of the Society for Acute Medicine, said the significant strain on the NHS was due to the government’s failure to accept the social care crisis.

He said: “The government has continuously failed to acknowledge the scale of the crisis in social care and the record numbers of delayed discharges in our hospitals as a result – a significant factor in the buildup of pressure on our hospitals.

“Having the support and infrastructure in place to discharging medically fit patients safely is central to releasing pressure on emergency departments, acute medical units and ambulance services.

“It is essential that clinical and political leaders ramp up the pressure and hold the health secretary and government to account on this issue before it is too late.”

NHS England’s ambulance lead, Prof Jonathan Benger, said the rising number of calls the service received was a major factor in the delays.

He told the BBC: “In the face of rising demand it is not surprising we are having difficulty meeting these targets. It is time to look at the system.”....read more

 

NHS spend on private ambulances trebles in four years (BBC News: 26 May 2016)

NHS spending on private ambulances for 999 calls in England has trebled in four years, BBC research has found.

Ambulance trusts paid private companies and voluntary organisations £68.7m to attend emergency calls in 2015-6, compared to £22.1m in 2011-2. They respond to all types of calls.

NHS England said 999 calls for ambulances rose 4.5% last year.

Unions attacked "creeping privatisation" and called for more money for staff recruitment.

The ambulance service in England took 861,000 emergency phone calls in March 2016 - which equates to 27,800 a day - compared to 22,400 calls a day in March 2015, a rise of 24%.

Contractors include private firms and charities such as St John Ambulance and the British Red Cross....read more

 

Ambulance delays linked to 35 deaths in past five years (The Guardian: 23 May 2016)

Thirty-five patients have died in the past five years after delays of up to six hours in an ambulance reaching them and mistakes by 999 call handlers and ambulance crew, coroners have warned.

The deaths – which include a nine-month-old baby, two other children, a student nurse, a mother-to-be and an 87-year-old woman with dementia – have exposed how NHS ambulance services, faced with sometimes chronic shortages of vehicles and staff, are struggling to cope with demand.

Coroners in England and Wales have issued official warnings called prevention of future deaths notices highlighting problems with lack of resources, an inability to respond quickly enough to 999 calls and poor care that have caused, contributed to or been involved in the 35 deaths, inquiries by the Guardian have shown.

In five of the cases the patient would or might have lived if either the ambulance had got there sooner or the attending crew had provided better treatment, coroners said....read more

 

Ambulance privatisation descends into 'total shambles' (The Guardian: 12 April 2016)

Hundreds of patients including people with cancer and kidney failure have missed important appointments for treatment because ambulances did not arrive to take them to hospital, after privatisation of NHS non-urgent transport services in Sussex this month.

Some elderly patients have had to wait more than five hours for ambulances and been stuck at hospital for long periods after their appointments because the transport service, now run by the private firm Coperforma, has proved so unreliable.

Patients, relatives, NHS bodies and local MPs have severely criticised the service’s performance, and a trade union representing ambulance crews said it was an “absolute shambles”. The NHS organisations that awarded the four-year, £63.5m contract have now launched an investigation.

A host of problems have arisen since Coperforma replaced the NHS’s South East Coast ambulance service (Secamb) as the provider of non-emergency patient transport services on 1 April....read more

 

Patients suffering cardiac arrests left without help because maps did not work (Telegraph: 4 March 2016)

Patients suffering cardiac arrests were left without help because a scandal-hit ambulance trust used a failed maps system, an investigation has found.

Secret protocols authorised by Paul Sutton, the head of South East Coast Ambulance trust, meant that thousands of 999 calls were counted as receiving an 8 minute response, just because the patient was within 200 metres of a heart-starting device.

The unauthorised scheme meant that national targets were achieved regardless of when help was sent - and whether or not the patient could be helped by a defibrillator.

Now an investigation has been told that failings in the trust’s mapping system meant that call-handlers sometimes could not even tell callers where to go to find the life-saving equipment.

Incredibly, calls were counted as receiving an 8 minute response, simply because the caller was within 200 metres of the public access devices – even if they had almost no chance of finding it...read more

 

Ambulance services claiming minor cases as emergencies to hit response targets (The Telegraph: 14 February 2016)

Ambulance services are claiming that minor cases are in fact emergencies in a trick to hit Government targets, it can be revealed.

NHS trusts are allegedly re-classifying non- emergency cases as urgent if they know that paramedics are close by. Such cases should not be covered by targets which state "life threatening" cases should receive a response in 8 minutes.

But paramedics are being sent to minor cases which happen to be nearby, then classing them as emergencies, in a bid to improve performance against the targets, whistleblowers claim.

It means that truly life-threatening cases could be forced to wait longer, while targets appear to be achieved. The tactic is being used to improve ambulance service response times to avoid being penalised financially for missing the targets...read more

 

NHS spending on private ambulances soars to meet demand (The Telegraph: 10 August 2015)

Ambulance services are becoming increasingly reliant on the private sector to cope with rising demand on the NHS.

In 2014-15, England’s 10 ambulance services spent £57.6m on private or voluntary services - an increase of 156 per cent since 2010-11.

The College of Paramedics criticised the reliance on the private sector as a “short term solution”, saying that the ambulance service needs to find more sustainable options as there are “currently not enough paramedics to provide a safe and effective service”.

[...]

The last year saw the NHS spend record amounts on private ambulance services, as it forked out £41m to companies such as Medical Services Ltd and ERS Medical.

The top spender on private services was the South Central Service, spending £12.3m in 2014-15. The trust had 250 vacancies open at the end of last year.

 

NHS crisis: Thousands of patients sent taxis instead of ambulances after ringing 999 (Express: 16 July 2015) 

A staggering 6,300 patients in London were taken to A&E in private taxis between September and February, according to shocking new figures.

The Yorkshire Ambulance Service even used taxis for 'Red 2' calls – the code for potentially life-threatening cases such as suspected strokes.

The figures come as experts claim the country's 11 ambulance trusts face a major shortage of paramedics.

Many private minicabs are instead staffed by technicians – some with just a few weeks training, according to the College of Emergency Medicine.

Kathryn Murphy of the Patients Association criticised the findings, released under Freedom of Information laws.

She: "The thing that concerns me is that just because the service is under pressure doesn't mean that you should compromise the safety of patients."

Last month it was revealed that the London Ambulance Service's spending on minicabs has more than doubled since 2013 – soaring from £132,000 to almost £300,000.... read more

 

Nearly £8 million cost of private ambulances to cope with 999 demand (Leicester Mercury: 30 January 2015)

Bosses at East Midlands Ambulance Service (Emas) have spent nearly £8 million on hiring private companies to help cope with emergency calls, according the latest figures. A total of £4.3 million was spent between April 2013 and the end of March last year. A further £3.5 million has been spent between April 1 and the end of December last year. Officials said the extra help is needed to deal with increased demand.

Over the Christmas and New Year period Emas crews across the region dealt with 5,448 more calls - an eight per cent increase - on the same period the previous year. Bosses are recruiting more front line to help meet demand but with three years at university to be trained to paramedic level it will be sometime before they can take to the road. It is hoped that an extra 80 staff will join Emas by the end of the year and that reliance on private and voluntary services will be reduced. Tim Slater, Emas general manager for Leicestershire and Rutland said: “Voluntary and private ambulance services provide us with additional resources when we experience significant increases in the number of 999 calls received.... read more

 

 Ambulance Services Spent £5m On Private Crews (2 March 2015: Orange News)

Ambulance services were forced to spend more than £5m hiring private crews and charities to cope with the winter A&E crisis as tens of thousands of hours were wasted queuing outside hospitals, a Sky News investigation has found.

Over the four weeks covering the last two weeks of December and first two weeks of January, some 1,780 days of operational time was lost because hospitals were too full to admit patients.

The 42,726 hours of delays are equivalent to taking 64 ambulances out of service at the same time.

On 11,203 occasions over that period crews waited more than an hour to hand over emergency patients, the figures show.

Patients experienced handover delays of more than half an hour 39,523 times.

One service said the delays its crews experienced were twice those of the previous winter.

As a result of the delays and the unprecedented pressure, services had to pay for private ambulances to respond to calls instead landing them with a bill of £3.79m.

They also spent £1.23m on charity-run ambulances such as Red Cross to help ease the crisis.... read more

 

Archive of earlier stories

 
 
 

More on quality:

HOSPITAL CARE/A&E

GP SERVICES/OUT OF HOURS/111
 
RATIONING
 
PRIVATE CLINICS
 
DELAYS IN HEALTHCARE
 
      

Examples of problems (by provider)

Ambuline/Arriva - Payment witheld as patient transport service misses targets

Ise Valley Ambulance service (no longer active) -CQC finds that staff backround checks and CRB's have not been carried out

Events Medical Services LTD - CQC finds patients at risk due to inadequate records being kept

Arriva - Ambulance service receives 100 complaints in a month

          - Leicestershire patient transport needs ‘urgent’ improvement

          - Patient stranded for three hours

NSL - Patient 90 minutes late for appointment as private ambulance gets lost

      - last chance for NSl after user complaints

      - Kent NSL patient transport service criticised

      - patient stuck at hospital for seven hours

 

  

Recent reports:

Quarterly survey of NHS financial directors by The King's Fund - February 2013 report

 

‘Making it better? Assuring high-quality care in the NHS

NHS Confederation discussion paper on the quality of care in NHS following the Francis report - February 2013

 

Care Quality Commisson State of Care report 2011/12

Annual survey by the Care Quality Commission

“Overall CQC is finding that the increasing complexity of conditions and greater co-morbidities experienced by people are impacting on the ability of care providers to deliver person-centred care that meets individuals’ needs. It is also seeing increasing pressures on staff, both in terms of the skills required to care for people with more complex conditions and in terms of staff numbers.”

 
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