A&E redirecting increasing number of ambulances to other hospitals

A record number of ambulances were turned away from busy A&Es this winter and sent to other hospitals, preventing paramedics from responding to urgent calls quickly enough, according to a study.

The Nuffield Trust, a health thinktank, looked at NHS England data and found that nearly twice as many patients arriving in ambulances were turned away from hospitals and sent elsewhere this year compared with the same period over the last three years.

Ambulances were redirected 478 times over the three-month period from December to February, compared with an average of 249 times in 2013-14, 2014-15 and 2015-16. The NHS refers to such incidents caused by a lack of physical or staff capacity as “diverts”and says they should be a last resort.

The thinktank said this had a direct effect on paramedics’ ability to respond to emergencies – with none of the three main response targets having been hit since May 2015. Prof John Appleby, Nuffield Trust chief economist and lead author of the report, said: “There’s rightly been a lot of focus recently on the delays ambulance crews face in being able to hand over their most seriously ill patients at A&E.

“But what our research today has uncovered is the huge increase in the number of times this winter [that] ambulance trusts have been told they must take patients to another hospital altogether, because an A&E unit simply doesn’t have the capacity to accept any more patients.”

Of the 233,472 most serious category A calls received in January this year, at least 95% should have been responded to in 19 minutes. But 29,000 calls were not picked up within this timeframe, meaning 88% of responses met the target.

Richard Webber, national spokesperson for the College of Paramedics and a senior paramedic in the NHS, said: “While we are sympathetic to hospitals that are forced to implement diverts so that they don’t reach dangerous levels of overcrowding, in non-urban areas in particular the extra time taken to reach more distant A&E departments is significant.”

The report also found that paramedics were under increased pressure, with demand for the service rising at a faster rate than emergency admissions to hospital and A&E attendances. The Nuffield Trust said that morale in the sector was also poorer than other parts of the health service.

The figures come as the government faces calls to address growing demand on A&Es. In January, patients in England experienced the worst month of delays in emergency departments since a four-hour target was introduced 13 years ago.

Jonathan Ashworth, the shadow health secretary, said: “Theresa May has overseen a shocking and unacceptable decline in standards for the NHS this winter. Our ambulance services are under increasing pressure and we know that ambulance staff across England are really feeling the strain. They deserve much more support from the government.

“The truth is that years of under-investment by the Conservatives have left hospitals unable to cope with rising demand, and now shocking numbers of ambulances are being diverted because A&Es are stretched to the limits. The government urgently needs to set out what action they’re going to take to make sure patients and their families never have to suffer a winter like this again.”

An NHS England spokesman said: “Currently too many ambulances are dispatched to simply hit targets rather than attend to those patients most in need. This is why we’re carefully testing a change to the way in which the services can respond and will make our recommendations known in the coming weeks.”

A&E redirecting increasing number of ambulances to other hospitals

Private ambulances increasingly used to respond to 999 calls

Ambulance services are increasingly calling in private firms to respond to 999 calls in the latest sign that NHS care providers are struggling to cope with the sharply rising number of patients who need urgent medical attention.

The London ambulance service (LAS) has had the biggest increase among England’s 10 regional ambulance trusts. The amount it spent on private ambulance providers soared from £700,000 in 2011 to £10.1m last year, a thirteen-fold increase.

Cost of private ambulances

Many other NHS ambulance services are also spending more of their budgets on private firms because of their growing reliance on them to meet demand.

For example, the amount paid out by South East Coast ambulance service (Secamb), which covers Kent, Sussex and Surrey, rose from £5.8m in 2012 to £11.6m last year, though it spent even more than that, £14.5m, in 2014.

Similarly, Yorkshire ambulance service paid private services £1.85m in 2014-15 to respond to 10,862 incidents. Last year that jumped to to £7m for attending 38,821 incidents.

The number of calls for assistance in London to which private ambulances have responded rose from 5,024 in 2011 to 59,749 last year. The figure includes both 999 calls and non-urgent journeys to hospital or other medical appointments.

Number of private ambulance responses

The trend has sparked serious concern about the NHS’s chronic shortage of paramedics, which has coincided with big annual rises in emergency calls to all 10 ambulance services in England.

“Ambulance services are not something that should be flung out to the private sector,” said Tim Farron, the Liberal Democrats leader, who obtained the figures for London under a freedom of information request.

“We should not be offering this out to the lowest bidder. It’s not what people want or expect, and the NHS needs more paramedics.”

He said increasing demand was forcing NHS services to draft in private operators to ensure calls were answered on time. “Without the private providers we would currently not have enough resources to get to all the patients who need an ambulance.”

East Midlands ambulance service’s spending on private firms has also risen, up 15% from £4.47m in 2013-14 to £5.15m in 2015-16.

North West ambulance service used to pay only St John Ambulance and the British Red Cross to supplement its own services. But in 2014-15 it began using private providers for the first time, spending £998,741 on seven firms during that year, including QAS Ambulance (£244,365) and Trust Medical (£206,744).

Paul Woodrow, the director of operations at LAS, said: “We have seen a 45% increase in the number of life-threatening incidents in the last five years, responding to 504,685 category A incidents in 2015-16 compared with 347,659 in 2010-11. To continue providing a safe service to Londoners, we use three carefully selected providers in a similar way to hospitals employing agency nurses.”

Crews employed by all three providers “are appropriately trained at either paramedic or emergency medical technician level and carry the same equipment as our crews”, he said.

However, some NHS paramedics claim that private ambulance personnel are not always as well trained as them.

One Secamb paramedic said: “We as crews think they are not as well trained as us and we regularly have to travel with them and the patient to hospital because they cannot cope.

“They are good people but don’t have the same level of training as Secamb staff. This is not good for the patient as their skill set is well below ours. Often they call up asking for para backup, meaning they can’t manage that patient.”

LAS spending on private firms increased almost seven-fold inside one year, from £700,000 in 2011 to £4.8m in 2012, and then more than doubled inside the next 12 months to just under £10m in 2013. It fell slightly in 2014 to £9.2m but then rose to £12.2m in 2015, before falling to £10.1m last year.

Paul Evans, the director of the NHS Support Federation, a research group, said: “Ambulance services sit at the epicentre of the crisis in health and social care services and it’s not surprising they are struggling to cope with demand, but even so this is a shocking escalation in privatisation.

“Resorting to private providers is not the answer if we want to secure safe and effective emergency services. The evidence shows that they use fewer paramedics than NHS crews, which impacts upon patient safety as they will inevitably be sent to treat patients that they are not qualified for and leads to more situations where more experienced staff have to be sent to take over.”

Late last year Coperforma, a private transport firm, had to hand back the £63.5m contract it had held only since April for taking patients in Sussex to non-urgent hospital appointments after a series of blunders. Some of those involved cancer patients, and led MPs and others to describe its service as “a shambles”.

Evans said: “That shows that there are serious flaws in outsourcing theses vital services.”

Christina McAnea, the head of health at the Unison union, said: “Strained NHS finances have led to staffing shortages where shifts aren’t covered and ambulance services have no option but to call on private companies to fill the gaps.

“But the millions of pounds used hiring private ambulances would be better spent filling vacancies and holding on to those highly skilled staff who are leaving in droves.

“Ministers must accept that by continually slashing budgets they are forcing ambulance services into short-term solutions for urgent long-term problems. This helps no one.”

Private ambulances increasingly used to respond to 999 calls

Ambulances taking longer to attain critically sick patients, says Labour

Ambulances outdoors Tameside common hospital in Ashton-beneath-Lyne. Photograph: Christopher Thomond

Lives are being put at danger since ambulances are taking up to three minutes longer on average to reach the most critically unwell sufferers than three many years in the past, in accordance to Labour.

Chaos at accident and emergency departments means ambulances are trapped in queues outside, which has a knock-on result on the time it requires to deal with 999 calls, the celebration mentioned.

It pointed to data published by the Well being and Social Care Details Centre that display group A ambulance callouts, which relate to lifestyle-threatening situations such as heart attacks and strokes, are taking an common of 67 seconds longer than in 2011.

That rises to two minutes and 21 seconds in the east Midlands, taking its response time just in excess of the target eight minutes. In the east of England, there has been an increase of two minutes and 48 seconds, although it nonetheless meets the response necessity.

Dale Webb, director of analysis and info from the Stroke Association, stated: “When stroke strikes, the blood supply to element of your brain is lower off by a clot or damaged by a bleed which brings about brain cells in the affected area to die, so time misplaced is brain lost. Lengthening ambulance times are regarding due to the fact stroke individuals need to get to professional treatment method as quickly as achievable.

“The faster someone arrives at a specialist stroke unit the quicker they should receive the right remedy and the far more most likely they are to make a better recovery.”

The shadow wellness secretary, Andy Burnham, mentioned the figures have been evidence that the prime minister, David Cameron, “cannot be trusted with the NHS”.

He said: “These figures raise actual concerns that lives are getting place at threat by the chaos in the NHS.

“Hospital A&ampE departments have missed the government’s waiting time target for the last 51 weeks working. This crisis in A&ampE has trapped ambulances in queues outdoors hospitals – leaving the subsequent caller facing longer, agonising waits. More and more calls are currently being attended by police autos and even fire engines on David Cameron’s watch.

“For individuals who have suffered cardiac arrest or a stroke, each and every second counts and that is why this slump in specifications can’t proceed.

“Urgent action is needed from the government to turn issues around. Slower 999 response is but yet another signal of an NHS heading in the incorrect path underneath this government. Their failure to get a grip on the A&ampE crisis is now getting a knock-on effect on the safety of our ambulance services. It is a lot more evidence that David Cameron basically can’t be trusted with the NHS.”

Ambulances taking longer to attain critically sick patients, says Labour

Anger more than refusal to send ambulances to 999 calls

In latest years, England’s ten NHS ambulance trusts have set up techniques to “triage” 999 calls and minimize the numbers taken to Accident &amp Emergency departments.

Overall health officials say this kind of schemes must be expanded, alongside a controversial national 111 phoneline, in buy to alleviate pressures on hospitals and ambulance solutions.

The report by the Care High quality Commission (CQC) discloses that a lot more than 300,000 calls to 999 ambulance companies are now getting resolved every year by means of telephone suggestions only, in an initiative recognized as “Hear and Treat.”

But the CQC survey of 3,000 recipients of the service suggests a lack of self-assurance in the program, with many individuals left baffled or fearful following becoming advised an ambulance would not be sent.

Amid individuals who have been not sent an ambulance right after speaking to one phone handler, 27 per cent felt the motives for not totally explained to them.

When patients felt they were offered a total explanation, 17 per cent still disagreed with the choice not to send paramedic out to them.

In complete, 11 per cent of those who were offered healthcare advice over the cellphone explained they did not have self-confidence in the phone handler who took their phone.

The polling identified most people could recognize the health care tips they were offered over the telephone, but seven per cent could not, even though 13 per cent did not agree with the tips they were offered.

Professor Sir Mike Richards, Chief Inspector of Hospitals at the Care Quality Commission, explained: “When a person rings ‘999’ they are in evident distress and they need to be listened to and allowed to discuss their considerations. In most cases, this looks to be taking place.”

“As ‘Hear and Treat’ is a phone suggestions service, it is actually critical that clear guidelines are provided, which folks comprehend and can follow. With seven % of men and women reporting that they did not realize the guidance that was provided to them, ambulance trusts must appear into this more.

“We value the significance of public feedback and how people’s experiences are driving enhancements. We anticipate NHS trusts to use the survey findings to recognize the place improvements are necessary.”

David Griffiths, nationwide skilled advisor for ambulance and urgent care at CQC mentioned: “The results of this survey show a higher level of all round satisfaction, despite the fact that there are some places for improvement.

“Ambulance services carry on to experience increases in the number of 999 calls they acquire, so it is crucial that absolutely everyone recognises the need to use ambulance resources wisely. This is a particularly true in rural places in which travel distances and time to hospitals can be extremely significant.

“We anticipate to see enhancements in the areas which we have recognized, so that ambulance services offer ’Hear and Treat‘ solutions that are risk-free and successful.”

Anger more than refusal to send ambulances to 999 calls

Ambulances taking longer to attain stroke and heart attack victims

An ambulance rushes to an emergency. Charities say lengthening response instances could end result in some sufferers dying. Photograph: John Li/Getty Photographs

Ambulances are taking longer to reach individuals with life-threatening conditions right after obtaining a 999 get in touch with, NHS overall performance information reveals.

In some parts of England ambulances are taking nearly two minutes longer than two many years in the past to get to patients who have suffered a stroke or heart attack or been stabbed, for instance.

Response times deteriorated in nine of the 11 regional NHS ambulance providers in between December 2011 and December last yr, the most recent efficiency figures published by NHS England demonstrate.

Well being charities warned that the lengthening waiting occasions could outcome in some sufferers dying. “Every single 2nd counts if someone’s getting a heart assault or stroke. Sadly each 7 minutes an individual in the Uk dies from a heart assault”, stated Amy Thompson, a senior cardiac nurse at the British Heart Basis.

The East of England ambulance support saw the greatest rise in response instances for category A calls, involving the most critically unwell patients. Its median response time went up more than the two many years from 295.2 seconds to 405 seconds – an improve of 109.8 seconds.

That ambulance service has been beset by troubles over the length of time it will take to attain some individuals, prompting criticism from nearby MPs, patients and well being unions. Its interim chairman, Geoff Harris, stood down on Tuesday just before a Care Good quality Commission report stated that it had not done ample to boost response instances to 999 calls.

A nearby coroner last yr described ambulance crews as “chaotic” following presiding over the inquest into the death of three-month-old Bella Hellings. Paramedics took considerably longer than nationwide targets call for to reach her property in Thetford, Norfolk.

The services is also beneath scrutiny more than the truth that it took an ambulance two hours to get to Paul Nelson, a 26-yr-outdated chef who collapsed at house in Blakeney, Norfolk, and later died of a brain haemorrhage.

In the north-east of England the response time for 999 calls enhanced by 51 seconds from 330 to 384 seconds whilst West Midlands ambulance service cars are now taking an further 49.eight seconds to reach emergency patients compared with two many years ago and those in the South East Coast ambulance services some 49.two seconds much more.

Only two ambulance providers enhanced their response time: in the South Central spot (34.eight seconds more rapidly) and the Isle of Wight (15 seconds fewer than in 2011).

“These figures reveal lives becoming place at risk due to the fact of the expanding chaos in England’s A&ampEs,” stated Andrew Gwynne, the shadow well being minister. “Outside bursting A&ampE departments, 1000′s of sufferers are waiting in the backs of ambulances. The paramedics can’t discharge sufferers and so cannot reply their subsequent get in touch with. People dialling 999 – even for patients in a life-threatening problem – face agonising waits when each 2nd counts.”

Regardless of getting asked to do so, NHS England refused to react directly to the longer waiting occasions or explain them, amid concern that the ageing population, cuts to social care and overcrowded A&ampE units might be factors.

A spokeswoman , which seeks to increase care for patients, stated it could not comment on ambulance performance just before it took more than duty for the NHS final April. But she added that performance had improved with seven services, and worsened with only four, given that December 2012.

Even so, she additional that: “As eight out of eleven ambulance trusts have not met the common this month there is plainly more operate to be completed to make positive people get a consistent, large quality support.”

Ambulance services have to respond to 75% of class A calls inside eight minutes. The data displays that the median was less than that in all eleven services in December. Individuals should get “a large quality, quick and secure support wherever they reside”, she additional.

Lord Howe, the health minister, stated: “Despite the ambulance service obtaining busier, efficiency towards all 3 specifications has enhanced on the very same time last year with a higher proportion of ambulances arriving on scene in beneath eight minutes, prepared to aid individuals who require help the most.

“But we know winter is a tough time for the ambulance service and NHS England has taken early action to assist, offering £15m to reduce quick pressures.”

Ambulances taking longer to attain stroke and heart attack victims

Use of ambulances by above-90s to go to A&E rises by 81%

Examination by Labour demonstrates 300,370 individuals over the age of 90 have been taken to A&ampE by ambulance in the final yr. Photograph: Bethany Clarke/Getty Images

The amount of extremely elderly individuals needing to go to hospital by ambulance has risen 81% given that 2009-ten, in accordance to new figures.

Analysis by Labour showed that 300,370 men and women more than the age of 90 were taken to A&ampE by ambulance in the last 12 months, a considerable rise on prior years. In 2009-ten, the figure was 165,910.

The data comes from tables of ambulance exercise in England, published by the Health and Social Care Details Centre.

Labour stated the figures confirmed that cuts to social care funding have been driving up the want for hospital interest amongst the elderly, who usually suffered a range of situations.

Andy Burnham, the shadow health secretary, explained data in the Residence of Commons library showed that regional authority spending on grownup social care had been lower by £1.8bn given that 2009-10. “These surprising figures expose the expanding crisis in older people’s care on David Cameron’s observe,” he mentioned. “The government’s extreme cuts to social care have left 1000′s of older folks without having the help they want – at risk of going into hospital and receiving trapped there. It is one of the root leads to of David Cameron’s A&ampE crisis.

“It is appalling to believe that, every week, there are thousands of frail and frightened people speeding by means of our towns and cities in the backs of ambulances to be left in a hectic A&ampE.”

“This is typically the worst location for them to be and a disorientating expertise that can result in true distress. With suitable help in the house, this could all be prevented.”

Burnham stated it did not make financial sense to lower assistance to men and women in their homes: “It is no reply to the challenges of the ageing society to let our hospitals to turn into more and more full of older men and women. David Cameron must take private charge and reverse these terrible trends.”

Caroline Abrahams, charity director at Age Uk, stated: “It is crucial that older people receive the treatment and care they need to have and sometimes this indicates going to hospital. Nonetheless, we know that, in some situations, currently being admitted to hospital is the consequence of not getting good high quality care at residence.

“Access to substantial high quality social care is more and more hard as numerous crucial companies are withdrawn or reduced as a outcome of the present crisis in care.

“Smarter pondering about how to prevent people reaching crisis point and by meeting their requirements will not only improve the encounter and outcomes for individuals but also has the possible to save income.

“The core of the problem is that funding for social care has failed and is even now failing to preserve up with growing demand. Legislative reform is essential but pointless unless of course sufficient funding is in place.”

Use of ambulances by above-90s to go to A&E rises by 81%