Welsh Ambulance crews “often only seeing only one patient per shift” due to handover delays

Ambulance crews are often only seeing one patient each shift, with up to 30,000 hours of emergency capacity lost every month to handover delays, a committee heard.

The Senedd’s health committee quizzed representatives of the Welsh Ambulance Services University NHS Trust amid concerns about response times and delayed transfers of care.

Colin Dennis, chair of the trust’s board, said ambulance crews report they would regularly see five to eight patients in a shift five years ago but today it is one or, occasionally, two.

Asked if the public can have confidence, Mr Dennis said the service is being transformed from an old-fashioned transportation service to provide a higher level of clinical care.

Mr Dennis was less optimistic that issues with patient flow are going to be solved in the short term, pointing to continuing problems with discharge into social care and increasing demand.

‘Enormous pressure’

He suggested Wales is unlikely to see dramatic changes in the eight-minute response times to “red” calls or the rates at which ambulances are turned around outside hospitals.

He told the committee: “The health sector itself is under enormous pressure.”

According to latest statistics, the ambulance service responds to about 50% of immediately life-threatening calls within eight minutes, significantly short of the 65% all-Wales target.

The non-executive chair said: “I liken a lot of this to trying to walk up the down escalator – the faster and quicker you walk, the faster the escalator is moving in the wrong direction.”

Mr Dennis assured MSs the trust’s finances are under control with a balanced budget, adding that performance is equal to and, in some cases, better than elsewhere in the UK.

‘Avoidable harm’

Jason Killens, chief executive of the trust, apologised to anybody who has had to wait too long for an ambulance or faced waiting in the back of a vehicle before being admitted.

He explained: “The reason that we have response delays in our communities is not because we don’t have enough ambulances, it’s because our ambulances aren’t available to us.”

Mr Killens said the root cause of the problem is that ambulances are waiting at A&E departments to hand over their patients but he stressed it is not unique to Wales.

Pressed about the extent to which delays are compromising patient safety, Mr Killens said an Association of Ambulance Chief Executives report warned of avoidable harm.

He told MSs: “It’s something like one in 10 patients is subject to some level of moderate or severe harm or death associated with a response or handover delay.”

‘Excessive strain’

Mr Killens said the number of hours per month of lost emergency ambulance capacity has been static in recent years but it rose from 6,000 in 2018/19 to up to 30,000 now.

He disagreed with trust being characterised as in crisis, saying services are getting to more patients with life-threatening conditions more quickly than ever before.

Mr Killens, who gave evidence to a coroner’s court this week after a woman waited 22 hours for an ambulance before her death, said the trust has 140 emergency ambulances.

He recognised: “From the public’s perspective – success or failure is how quick we turn up.”

Andy Swinburn, executive director of paramedicine, warned an “outdated” model of taking everybody to A&E creates excessive strain in parts of the NHS that cannot cope.

‘Abysmal’

Mark Drakeford, the former first minister, raised concerns about 1,700 people currently being in hospital while clinically fit for discharge.

Prof Drakeford posed a deliberately provocative question, asking if less money should be spent on ambulances to instead fund services that help get people out of hospital.

Warning of the ambulance trust’s “abysmal” productivity figures, he said: “We’re spending an awful lot of money on ambulance staff doing very little.”

Mr Killens stressed that staff cannot respond to more patients because they are waiting at A&E with an average handover of more than two hours when it should take 15 minutes.

He argued the public largely recognises and understands that the reasons behind delays are often beyond the control of the ambulance service.
‘Profound impact’

Prof Drakeford asked about the impact of the pandemic, pointing out that the ambulance service met its targets every month in the four years leading to March 2020.

Mr Killens said the crisis had a profound impact and the trust is still managing some of the effects, with absence rates yet to return to pre–pandemic levels.

Prof Drakeford warned poor industrial relations have been a feature of the ambulance service for decades, with the highest sickness levels in the Welsh NHS.

Mr Killens said the trust has focused on building relationships with trade unions, meeting representatives every month, and the absence rate has halved from its pandemic peak.

Asked about the workplace culture within the ambulance service, he acknowledged problems with pockets of poor behaviour from some staff, commiting to tackling this.

By Chris Haines, ICNN Senedd reporter