With July’s ambulance response times to the most urgent 999 calls the worst on record and 152,000 ambulance crew hours lost due to delays in June, this summer has revealed the extent of the problems facing the ambulance service, with 10 trusts to be “black”. alert’ in a traditionally quieter era. Response times have collapsed – with some patients waiting several hours after a 999 call and 4,000 patients estimated to have been seriously harmed by delivery delays in June – prompting health leaders to warn that delays are the biggest safety risk facing the NHS. Ambulances outside a London A&E department (EPA) As news of the crisis dominates the front pages, The Independent was given exclusive access to join two senior paramedics from the London Ambulance Service. Facing the consequences of a broken social care system and a strengthened NHS, they say the pressure is mounting because they are “the only service that can’t say no”.
“One last resort”
The start of the shift is eerily quiet and the couple from Brixton Ambulance Station start their day with an unusual silence from the dispatch team. But the 20 minutes of stillness is exactly the calm before the storm as the first category two alert comes in – a man with a serious mental condition is in crisis. The blue lights come on and soon we arrive at the patient’s door. Mrs Walton, who is just 21, and Mr Chilvers, 27, speak calmly to the man. It’s turbulent, incoherent and delusional, but the pair work quickly to appreciate the danger they pose to themselves. As his behavior escalates, they are reluctantly forced to call in the police and an advanced paramedic to help get the man to hospital. The different priorities of the police and paramedics are clear as the officers wonder if it is possible to leave the man. A mix of drugs and his deteriorating mental health means he needs to be assessed in hospital, but without access to a number for his community mental health team, A&E is the only option. The decision to call the police to help restrain the man is not taken lightly, but he notes all the indicators in his own care plan for the need for a hospital assessment. It’s a difficult situation to watch as he is eventually restrained by six police officers and carried headlong into a caged police van. Paramedics are able to calm him down and he is taken to King’s College Hospital A&E, which is close to the Maudsley mental health hospital. A discord of beeps and alarms, along with shouting and trembling doctors, meet the team in an ambulance bay at the hospital, which is already full as three other ambulances wait to deliver patients. While waiting, the patient deteriorates again. Three hours pass between the first dispatch call and the time it is finally handed over to an A&E team – and these calls can be made at least once a day.
Covid is not gone
On leaving King’s College emergency department, a hospital notice warns that one ambulance has already been waiting four hours to deliver a patient and another has been waiting two. One of the crews has yet to see patients this morning and paramedics have started their shift watching the doors of an A&E ambulance bay for a chance to hand them over. Only 250 ambulances are available for the day. While that is more than the 156 on hold the night before, that number is only around half of what is needed, the Independent understands. At 12pm, we are the only ambulance available to dispatch in town. Paramedics transporting a patient to a London A&E (EPA) The calm of the morning becomes a distant memory as another “cat two” call comes in – a Covid patient struggling to breathe. The pandemic has hit the NHS like a big red bus this summer, at a time when calls to ambulance services have gone through the roof. While the country continues to “live with Covid”, the virus is still creating demand. As a bystander, it’s embarrassing to walk into a Covid patient’s home, but Harriet and John are unfazed and assess the woman. Although her Covid symptoms are nothing to worry about, an underlying health condition means the crew needs to take her to A&E. The wait is quicker this time, but King’s A&E is busier now, with patients everywhere, while the same ambulance crew we left behind 90 minutes ago are just leaving.
Combating wider failures
Paramedics, by the nature of their work, come into contact with all aspects of life and see first-hand how deprivation and social inequalities shape people’s health. After two years of outstanding health issues, and as the NHS tries to deal with its huge backlog, they are seeing patients who are seriously ill and need urgent care because their condition has not been treated. Calls to people whose main problems are not health related, but are a result of poor social housing or inadequate social care, are common. The ambulance service, which is reserved for emergencies, is just another part of the NHS, picking up the slack on a broken system. On our third call, we visit a man with learning disabilities who is bedridden and visibly unwell. This is not the harrowing story of a neglected care home resident, but an example of a caring environment where the man’s young carer shines. Discussing his patient with paramedics, the caregiver laments the bureaucracy and funding issues that prevented his patient from being moved to a home that can better support his needs. Like many others in the care industry, she is considering leaving the job because of the low wages. As the NHS faces unprecedented pressure, good care staff can often be the difference between a patient being taken to hospital and staying at home.
“There are no beds left”
We end the shift with a woman dealing with multiple health conditions, a mental health diagnosis and a complicated social situation. As we are dropped off at her home, she is in a vulnerable state and cries out in pain. Lewisham Hospital A&E Unit (PA) She is the last patient of the day and we take her to Lewisham A&E where eight ambulances and several police cars are queued up outside. The corridor is busy, with 12 patients in chairs, while others are wheeled in on trolleys. Every cabin is full and there are no beds. The location could be mistaken for a police station given the number of officers escorting intoxicated patients and people in mental health crisis. One officer says he spends at least two shifts a week in A&E. Fortunately the patient with us is “fit to sit” and we are able to hand her over to the hospital staff, leaving many patients and many ambulance crews in our wake. Exhausted after 12 hours, I leave with a renewed appreciation for frontline NHS staff.
“We can’t say no”
“999 is for life-threatening emergencies,” Harriet and John tell the Independent after their grueling 12-hour shift. The couple say this without judging their patients: their job is to attend regardless of the person at the end of the call. They are passionate about their role and want to help people in their time of need. However, like many paramedics, much of their time is spent on non-lifesaving calls. Most of the calls attended to today were called “category two”, with patients reporting symptoms of “difficulty breathing”, “chest pain” and “numbness”. However, members of the public could rightly question whether some of these patients needed an ambulance. John says: “Many of our problems are caused by social care and the underfunding of it. A&Es are busy because they can’t get people to wards and wards are full because they can’t get people into social care.” He adds: “We’re the only service that can’t say no. If someone calls 999 and says they have breathing problems, we have to go. You just don’t know. there are so many patients that we go to and if we got there 10 minutes later, they would be dead.” Admission rates are falling for all age groups, although they remain higher among the elderly (PA) Calls from people who do not need an ambulance put more pressure on call centres. During the heatwave in London, the wait for some 999 calls to be answered reached 10 minutes, the Independent understands, while the aim is for calls to be answered within 60 seconds. Any ambulance that is sent to a patient who could be making their own way to A&E or could be waiting for a doctor’s appointment is an ambulance that cannot be sent to a dying patient. “Covid is increasing, hospitals are so busy, doctors are so busy, so people are calling an ambulance to be seen by a clinician at home. I think we are dealing with the effects of so many people not going to the hospital [because of the pandemic] – their appointments were canceled and their health suffered – and so now we’re seeing the effects of people not being seen,” says Ms Walton. “We’re seeing a lot of diseases showing up late, cancers showing up late, people suffering from high blood pressure, so more people having heart attacks and strokes.” Both paramedics outline the need for more money. Mr Chilvers says: “We need more funding. For those life-threatening emergencies [for which] we’re not getting there fast enough. For stroke patients, millions of neurons die every minute, we don’t get you to the hospital, and the slower we get you to the hospital, the longer it will take for you to recover. “If we get to you several hours later, you might not get movement back in your arm and we won’t get there for those people. Those people who have waited a long time, there will be people who are really sick and people who are well….
