Ambulance pressures leading to patient harm, chiefs warn
Ambulance chiefs have issued a stark warning about pressure on the service over the number of 999 calls waiting for a response.
West Midlands Ambulance Service's Trust Board (WMAS) held an extraordinary meeting earlier this week where it upgraded the 'risk status' for 'call stacking' for both 999 and 111 calls to '25'.
'Call stacking' is the term for the number of calls where patients are waiting for the dispatch of an available ambulance to help.
The trust agreed to move to the '25' status – the highest and most severe available – after considering a report which said there had been "several cases where severe patient harm has occurred due to the awaiting allocation of dispatch".
It is only the second time the trust has ever rated any risk categories at '25', the first being in October where hospital handover delays were identified as leading to patients being put at "catastrophic risk” of harm.
The pressure on the service across the region has continued to increase over recent months, with ambulances spending up to 16,000 hours waiting outside hospitals just during September.
Papers considered by the board this week stated: "This is the highest risk level available and follow the board decision to recently increase the Hospital Delay Risk Assessment, because of the belief that patient harm is almost certain in these cases."
It explained that hospital handovers were at the root of the delay in being able to dispatch ambulances, with many still delayed at hospitals as patients wait in the back of vehicles for an available space inside the building.
The report states: "By having large numbers of incidents unallocated, undoubtedly the greatest risk is to patients in the community who cannot receive a timely and appropriate ambulance response. This is because of ambulances being unable to handover their patient at hospital, preventing further deployment."
The trust has introduced a new measure called 'co-horting' to try to alleviate delays at hospitals.
Co-horting involves spaces being set up outside several hospitals in the region, allowing ambulance staff to base themselves in an area outside the hospital, where one crew can look after up to six patients, allowing five ambulances to get back on the road.
The report explained: "The trust has secured co-horting areas at several sites, which enables a single crew to cohort up to six patients, releasing the other five crews to ensure greater response to patients waiting in the community – this is supported by HALO [Hospital Ambulance Liaison Officer]. Daily attendance at multiagency meetings continues where discussions centre around current demand, activity, and progress on current actions as well as ideas for greater improvements."
Confirming the decision to move to the '25' rating, WMAS's director of clinical commissioning, Mark Docherty, said staff were working "tirelessly" to get to patients as soon as they can.
He said that discussions are continuing with other health organisations to help get more ambulances free to respond to emergencies.
“We continue to do everything possible to get to patients as quickly as possible and review the situation constantly to try and find further solutions," said Mr Docherty.
“Unfortunately, the whole of the NHS remains under severe pressure which is being felt intensely in our service in the West Midlands and hospital handover delays do mean patients are waiting longer for an ambulance to come to them in the community.
“We are working with all local partners across the health and care system to reduce delays so crews can respond to the next incident as quickly as possible, and staff and volunteers continue to work tirelessly to respond as soon as we can."
