Rising number of patients die amid waits of up to 16 hours for ambulances

Ambulance patients in England and Wales died amid delays of up to 16 hours for paramedics to arrive last year, newly released figures show.

A rise in fatalities occurred as the NHS’s frontline services came under severe pressure, with reports of crews essentially operating ‘hospital cubicles’ while parked outside A&E departments. 

The picture across five trusts can be revealed as more than 10,000 ambulance workers with the GMB union and some of their colleagues with Unite prepare to take part in another day of strike action tomorrow.

In total, more than 500 patients were declared dead after 999 calls in 2022, a rise of around 100 on the previous year.  

The true number is likely to be higher as some NHS ambulance trusts did not disclose figures after the data was requested under the Freedom of Information Act (FOIA). 

In the East of England, there were 23 cases where life was pronounced ‘extinct on arrival’ in 2022, an increase of 11 on the previous year. The longest time to attend over the two years was 16 hours and one minute in 2022. The response was to a Category 2 incident which is classed as a serious condition — such as a stroke — requiring a rapid assessment.

A spokesperson for the East of England Ambulance Service said: ‘The NHS faced unprecedented demands recently and our ability to respond to patients was significantly affected by handover delays at hospitals.

‘We have been working hard to tackle this by recruiting more clinical staff and call handlers, and working closely with hospitals to reduce handover delays so we can reach patients more quickly.

‘We are now beginning to see improvements in response times and handover waits but the NHS remains under significant demand.’

In Wales, there were 412 cardiac arrest cases where the patient was ‘possibly alive at first point of contact’ before life was declared extinct.  

The number is a steep rise on the 345 cases in the previous year. 

The Trust stressed in its response that the data did not accurately reflect a link between delays and deaths, as at least 50% of cases in both years were ‘false positives’, with patients already being deceased or beyond help when crews attended. 

At East Midlands Ambulance Service, the figure for deaths on arrival following delays rose from 32 in 2021 to 46 last year.

The month with the highest number of cases was June last year, when there were seven recorded instances, according to the data. 

In its response, the Trust said: ‘We are unable to determine the exact point at which a person died if that occurs prior to our arrival.  

‘The figures stated will therefore also include a number of cases where the patient was actually deceased prior to the call being directed to us. We do not hold data that enables us to exclude these.’ 

Figures have previously been released for West Midlands Ambulance Service, showing 44 people were found to be dead when crews arrived in the 11 months to December, a six-year high.

The number was a rise on the total for the whole of 2021, when there were 22 cases of patients being dead on arrival. The service said at the time that the ‘vast majority’ of the incidents were due to long hospital delays and it was ‘working incredibly hard’ to speed up the process. 

Seven other trusts approached by Metro.co.uk  — London, North East, North West, South East Coast, South Western, Yorkshire and Scotland — either did not respond or said they were unable to provide data about deaths where there had been delayed responses.

South Central Ambulance Service initially disclosed eight cases of a patient being declared ‘deceased’ following a ‘treatment delay’ in 2021, which rose to 32 last year. However the service later said this response was incorrect as it had supplied an answer to a different FOIA request.

The London Ambulance Service has previously released figures showing that at least 64 patients died up to November 2022 after medical emergencies including strokes were upgraded to life-threatening status. The figure is a rise on the 46 people who died at the scene after C2 responses were upgraded to C1 in the whole of the previous year.

In December, one paramedic in the capital, speaking anonymously, told Metro.co.uk how staff are having to wait for ‘hours on end’ outside hospitals and staff are ‘exhausted’ after shifts.

At the time the figures were released, the service said it was ‘doing everything we can to reduce our response times’.

Darren Childs, from Ludlow, Shropshire, has previously told how he feared for the life of his daughter Myla, now aged two, on two occasions when there were delays to 999 responses. 

Mr Childs, himself a non-emergency ambulance worker, founded the Shropshire Needs Ambulances campaign and has supported staff on the picket lines since the strikes began in December.

He said: ‘These figures are shocking, but not surprising. I would say to the health secretary Steve Barclay that there are hundreds of people being pronounced dead amid delays, and ask what he is doing about it?

‘The figures for waiting times at A&E have improved slightly due to reduced demand during the strikes because people were asked not to call 999 unless it was an absolute emergency, but they will only get worse as time goes on.

‘The government needs to improve pay which will help to train and retain ambulance staff but health and social care staff across the board need a decent wage that reflects the rising cost of living and the need to free up hospital beds.’

The NHS target time for ambulances to respond to Category 1 patients — the most serious level of emergency call — is seven minutes.

The figures have been released after a year when A&E waiting times hit record levels and during a period of continued strike action by ambulance workers, nurses and other NHS staff.  

Ambulance handover delays outside emergency departments fell in January after hitting a record high between Christmas and new year. In England, 20% of patients waited at least 30 minutes in the last week of January to be passed over to A&E teams, down from 44% in December.

Paramedics, emergency care assistants, call handlers and other ambulance staff are due to strike over pay and conditions tomorrow.

The GMB union says that staff ‘can’t make ends meet’ due to what it terms as ’10 years of pay cuts, plus the cost of living crisis’.

Acting national secretary Rachel Harrison has said: ‘Delays up to 26 hours and 135,000 vacancies across the NHS mean a third of GMB ambulance workers think a delay they’ve been involved with has led to a death.

‘Ambulance workers have been telling the government for years things are unsafe. No one is listening. What else can they do?’ 

Lee Brooks, executive director of operations at the Welsh Ambulance Service, said: ‘Our emergency ambulance service exists to deliver life-saving interventions and take patients promptly to hospital, so it’s as frustrating for us as it is for patients when we can’t deliver that. 

‘We should be cautious when drawing conclusions about ambulance response times and patient deaths, especially given the complex nature of cardiac arrest and the way we gather information on these calls specifically, but the sad and well-documented reality is that avoidable harm is occurring to patients, not just in Wales but beyond. 

‘Ultimately, the longer a sick person waits for clinical intervention who really needs it, the poorer the outcome could be and as an ambulance service, we’re very alert to that and are profoundly sorry to all those who’ve had a poor experience.’

Mr Brooks echoed reports of paramedics across the country being tied up waiting to hand over patients to hospitals.

‘Hospital handover delays remain the single biggest reason we cannot get to some patients quickly,’ he said.

‘While crews are tied up at emergency departments, they’re unable to respond to other calls in the community, which means that some people are waiting a long time for help, sometimes many hours.

‘We continue to play our part to relieve the pressure across the entire health and social care system by treating and triaging more patients over the telephone and in the community and referring them to other parts of the NHS beyond the emergency department, as well as lobbying our Local Health Board and Welsh Government partners for meaningful, systemic change. The public can help by only calling 999 in a serious or life-threatening emergency, so that our precious resources are available for those who need us most.’

A Department of Health and Social Care spokesperson told Metro.co.uk that Mr Barclay wanted to ‘continue discussing’ a new pay deal with unions.

The representative said: ‘Our sympathies are with the family and friends of those who have lost loved ones. 

‘No one should be waiting longer than necessary for emergency care and we have outlined an ambitious and credible plan to fix it.

‘This plan is backed by record investment and aims to deliver one of the fastest and longest sustained improvements in emergency waiting times in the NHS’s history, including bringing down ambulance response times and A&E wait times. The health and social care secretary has been clear he wants to continue discussing with unions what is fair and affordable as part of the 2023/24 pay process.’ 

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