Health Service Journal May 25th 2022 https://www.hsj.co.uk/west-midlands/exclusive-ambulance-service-will-collapse-by-august-predicts-its-nursing-director/7032502.article?mkt_tok=OTM2LUZSWi03MTkAAAGEmQAX6Npiu_dzUnqyayYtP1ollSxmFRLVxDhwF0Un0-n410CYmkiILW30HBJXT5tcagX6fFcLEHwVBoAa25ZBUtqU_MFk53eW6AnOb4SNOK2Kb88
West Midlands Ambulance Service chief calls out NHSE and CQC over ambulance delays
· Mark Docherty claims patients dying every day as over 100 deaths are linked to SIs
· Nursing director predicts system will collapse in August, with no ambulances available
· Hospital discharge delays branded “criminal” when teenagers “dying on the street”
A struggling ambulance trust could face a ‘Titanic moment’ and collapse entirely this summer if the region’s worsening problems with hospital handover delays are not taken more seriously, its nursing director has told HSJ.
Mark Docherty, of West Midlands Ambulance Service, said patients were “dying every day” from avoidable causes created by ambulance delays and that he could not understand why NHS England and the Care Quality Commission were “not all over” the issue.
He revealed that handover delays at the region’s hospitals were the worst ever recorded, that rising numbers of people were waiting in the back of ambulances for 24 hours, and that serious incidents have quadrupled in the past year, largely due to severe delays.
Shropshire, Staffordshire and Worcestershire are experiencing particular problems – Royal Stoke University Hospital recorded the highest number of handover delays over an hour in April with 1,588, while Shrewsbury and Telford Hospital Trust was not far behind with 1,263.
More than 100 serious incidents recorded at WMAS relate to patient deaths where the service has been unable to respond because its ambulances are held outside hospitals, according to the minutes of the trust’s March quality and safety committee.
Mr Docherty said the situation was now so serious that he is predicting the service will collapse in August.
‘Titanic moment’
“Around 17 August is the day I think it will all fail,” he said. “I’ve been asked how I can be so specific, but that date is when a third of our resource [will be] lost to delays, and that will mean we just can’t respond. Mathematically it will be a bit like a Titanic moment.
”It will be a mathematical certain that this thing is sinking, and it will be pretty much beyond the tipping point by then.”
He added: “It would make me the happiest person in the world if everyone in the system proves to me that actually the ambulance service in the West Midlands isn’t going to fail on 17 August, and I’ve got it completely wrong.”
Mr Docherty said there needs to be a focus on discharging hospital patients who are fit to leave in order to free up beds for those arriving by ambulances.
He described the large number of medically fit patients occupying hospital beds as “criminal…when I’ve got teenagers dying on the street from things that are completely reversible”.
The nursing director claimed NHSE officials had downplayed tackling the problem of delayed discharge, stating that the trust needed to “focus on things they can control”.
Mr Docherty also queried why the CQC had issued improvement notices about hospital corridor care, but not about handover delays.
Deaths ‘entirely predictable’
WMAS was one of the first trusts to bring national attention to the issue of handover delays when it raised its risk rating for handover delays to 25 in October, the highest in its history.
“The 25 reflects that patients are dying every day that shouldn’t be dying every day,” said Mr Docherty.
“Their deaths are entirely predictable, and of a scale that means we need to be taking this really seriously.”
He added: “All of the issues that we’re building for the future are huge. And I don’t know why the CQC are not all over this, I don’t know why NHS England is not all over this.”
Previous national responses to handover delays have included telling all trusts to “immediately stop delays” in October, while regionally, a top-level summit is planned this summer to tackle delays in Shropshire.
In April, the Association of Ambulance Chief Executives called on NHSE to “accelerate their activities to find immediate solutions to delays” after it emerged 40,000 people were put at risk while waiting in ambulances.
Last week, it emerged ambulance trusts would be getting £150m to aid with response times.
An NHS spokesman said: “The NHS has been working hard to reduce ambulance delays and £150m of additional system funding has been allocated for ambulance service pressures in 2022-23.
“There is no doubt the NHS still faces pressures, and the latest figures are another reminder of the crucial importance of community and social care, in helping people in hospital leave when they are fit to do so, not just because it is better for them but because it helps free up precious NHS bed space.”
The spokesman also highlighted other measures being used to tackle handover delays, including an investment of additional £130m since September 2021 in 999 and 111 services to improve timeliness of response to patients in the community.
Systems across the country are also being encouraged to take a range of actions, including increasing numbers of hospital beds within infection control guidelines, bespoke support for challenged trusts, and the development of escalation plans to identify delays and risks as they happen, they added.
Victoria Vallance, CQC’s director of secondary and specialist healthcare, said the regulator is continuing to support efforts by providers through its programme of system-wide urgent and emergency care service inspections.
She added: “There is no doubt that the current impact of escalating pressure on the NHS is severe – with unacceptably long delays for patients waiting for ambulances or waiting for admission to hospital clear manifestations of the problems services face.
”There are very real concerns about the significant risk to patients and the impact on paramedics and hospital staff as they do all they can to deliver safe care under the most demanding circumstances, and we have highlighted these concerns in our public board meeting. We will continue to monitor services and use our regulatory powers where necessary.
“The problems of capacity in urgent and emergency care services have been building over many years, and we know from our work with frontline emergency department clinicians that currently patient flow is incredibly challenging. There are no simple solutions, but close working between providers, commissioners and all other parts of the health and care system will be essential to safely manage risk going forward.”
Representatives for the Shropshire and Staffordshire systems and trusts highlighted various upgrades and investments to emergency departments, enhanced triage, and same-day emergency initiatives which have been rolled out to help reduce handover delays.
‘Catastrophic’ patient harms to be raised at summit
Mr Docherty is due to raise the case of Jamie Rees, who collapsed on New Year’s Eve 2021 while out with friends in Rugby, at a safety summit later this week.
The 18-year-old died of a cardiac arrest after delays led to an ambulance responding in 17 and a half minutes instead of the target of seven.
His mother, Naomi Issit, said her “selfless” son, whom she described as “cheeky, laidback but very clever and witty”, deserved better.
She told HSJ: “All we can do for Jamie now is to get something changed. The thought that this could happen to someone else just strikes fear in us. They [the NHS] don’t seem to be able to come up with a solution to these delays. Surely somebody somewhere eventually is going to sit up and say, there are young people dying.
“It’s bad enough when elderly people are dying needlessly but he was 18. He had his whole life ahead of him, and it’s just torn away from him, and nobody seems to want to change anything to put that right.”
His case is set to be raised alongside that of a 52-year-old from the Shropshire area who has been left disabled for life after a delay led to him not being able to quickly access a thrombectomy.
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