Shropshire 'ran out of ambulances' due to long queues outside hospitals

West Midlands Ambulance Service’s nursing and clinical commissioning director Mark Docherty said ambulances from other areas provided cover during the period, but response times suffered.

Hospital handover delays are causing major problems for ambulance services across the country, with waiting times increasing across the West Midlands.

The region's ambulance service recently warned that patients were being put at "catastrophic risk" as a result of the delays and moved the risk rating to the highest possible level for the first time in its history.

Mr Docherty said a region-wide “Community Rapid Intervention Service” would relieve the pressure by taking over some less critical cases, and Shropshire, Telford and Wrekin Clinical Commissioning Group (CCG) planning director Sam Tilley said a date to begin was being negotiated with NHS England.

They were speaking during a discussion of the CCG’s winter urgent and emergency care plan at the countywide Joint Health Overview and Scrutiny Committee.

The report, written by Mrs Tilley, said: “Shropshire, Telford and Wrekin, along with many other areas nationally, is experiencing increasing delays in ambulances being able to hand over their patients.

“The occurrence of ambulances having to wait outside emergency departments is not acceptable and we are committed to doing all we can to improve this situation.

“The causes of ambulance handover delays are multi-factorial and, as such, all elements of our UEC [urgent and emergency care] improvement work will help to improve this situation.”

Her report listed alternatives to unnecessary A&E attendance that the county’s health system was promoting, including the use of the non-emergency 111 line to direct patients to urgent treatment centres, minor injury units and GP surgeries.

National ambulance standards divide patients into four categories – 'category one' covers patients with life-threatening injuries or conditions, while 'category four' covers the least-urgent cases, where the service could advise patients to see a doctor or pharmacist instead of attending itself.

Mr Docherty said category three was “the category we’re really struggling with at the moment”.

He said: “That could be a frail elderly person that has fallen, maybe outside, so they do need a quick response but we’re really struggling because of delays at the hospital.

“One of the things we are going to try is an automatic referral into the community rapid-response teams. We’re going to give them one name across the whole region, called CRIS (Community Rapid Intervention Service).”

Using CRIS teams to attend category three calls would “offset part of the impact of the handover delays” and provide a quicker response to the patients themselves.

Mrs Tilley said: “This is a discussion that took place with NHS England last week. We are agreeing a roll-out date when we will go live with this system across the whole of the West Midlands.”

“We’re then left with the issue of handover delays,” Mr Docherty said.

“Across our region the graph is going up everywhere. What that means is we’re going to run into trouble sometime.

“Two weeks ago today we ran out of ambulances in Shropshire and Telford. What I mean by that is every single ambulance we had was stuck outside a hospital with a patient on.

“That doesn’t mean people were not getting any response, but when we run out of ambulances in Shropshire, Telford, Birmingham, the Black Country, you’re not going to get anything very quickly.

“This isn’t about blame or pointing fingers. This is about us all acknowledging that we’re in a very difficult position.”

Mrs Tilley said both money and the workforce were constraining the health system’s ability to act.

“We know, at the moment, we have significant workforce challenges for a number of reasons, Covid being one of them,” she said.

Noting that the committee meeting itself was not socially distanced, despite “extremely high prevalence rates in our community”, she said it was “really important for agencies such as ourselves who are dealing with this problem to set an example to our public”.

The continued spread of coronavirus, she said, “is hugely impacting our workforce and without our workforce we cannot make the level of improvement we want to make”.