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NHS patients dying in back of ambulances stuck outside A&E, report says.


People are dying in ambulances and up to 160,000 more a year are coming to harm because they are stuck outside hospitals, unable to be taken into to hospital accident and emergency departments (A&E), a damming report says.

Patients are also dying soon after finally being admitted to hospital after spending too long in ambulances, while others are dying at home because paramedics are trapped at A&E and cannot answer 999 calls, said the report by NHS ambulance service chief executives in England.

In addition, about 12,000 of the 160,000 are suffering “severe harm” such as a permanent setback to their health. These include people with health emergencies such as heart problems, chest pains, epilepsy, sepsis, and Covid-19 because more paramedics have to wait for longer to transfer patients to A&E staff.

Ambulance logjams outside hospitals have become a major NHS problem A&E staff struggle to find beds for patients due to Covid-19, the record demand for care and their inability to discharge patients medically fit to leave.

That has left A&E staff having to limit the number of patients in their unit, which sometimes leads to long ambulance queues. The problem has become more serious recently as all NHS services face unprecedented demand for care.

The report, seen by the Guardian, was written by the Association of Ambulance Chief Executives (AACE) and is based on official NHS figures, which until now were secret. AACE represents the chief executives of England’s 10 regional ambulance services, all of which have recently had to declare an alert after facing the greatest ever demands for help.

It concludes that: “When very sick patients arrive at hospital and have to wait an excessive time for handover to emergency department clinicians to receive assessment and definitive care, it is entirely predictable and almost inevitable that some level of harm will arise.

“This may take the form of a deteriorating medical or physical condition, or distress and anxiety, potentially affecting the outcome for patients and definitely creating a poor patient experience.”

It does not say how many patients a year die due to ambulances delays but adds: “Some patients have sadly died whilst waiting outside emergency departments, or shortly after eventual admission following a wait. Others have died while waiting for an ambulance response in the community.

“Regardless of whether a death may have been inevitable, this is not the level of care or experience we would wish for anyone in their last moments. Any form or level of harm is not acceptable.”

AACE studied all handover delays lasting more than an hour across the 10 ambulance trusts on 4 January 2021, and the resulting harm. It used the data to estimate how many patients a year suffer a deterioration in their health, or need much more invasive treatment, such as surgery, as a direct result of a long wait to see doctors and nurses.

It concluded that: “If these results are extrapolated across all handover delays every day, the cases of potential harm could be as high as 160,000 patients affected a year. Of those, approximately 12,000 patients could potentially experience severe harm as a result of delayed handovers.”

Ambulances are meant to transfer patients to A&E staff within 15 minutes, with none waiting more than half an hour. However, queues of as many as 15 ambulances at a time have been building up outside hospitals because hard-pressed staff are too busy to accept them.

Hospitals are under such pressure that about 190,000 handovers a month – around half the total – now take longer than they should, AACE’s report said. Paramedics warned that patients suffering health difficulties at home, or another setting, have also been put at risk because delays outside A&Es means they cannot respond quickly to 999 calls.

A Department of Health and Social Care spokesperson said: “NHS England and Improvement has given ambulance trusts an extra £55m to boost staff numbers for winter, helping them to bolster capacity in control rooms and on the frontline.”