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Ambulance delays skyrocket as A&E ‘litmus test’ reveals intolerable winter

Winter pressures across the NHS have caused chaos for emergency services over the festive period, with delays of over 30 minutes hitting nearly one in five ambulances.

Leading figures within the health service say the situation is “becoming intolerable” as adult bed occupancy figures for critical care have averaged more than 82% between Boxing Day and the New Year, rising to highs of 95% at certain points over winter.

Figures from NHS England’s winter daily reports show that more than 13% of ambulances were delayed on New Year’s Eve by between 30 and 60 minutes, with a further 6% taking over an hour to reach patients.

Niall Dickson, chief executive of the NHS Confederation, argues the figures show that pressures are being felt across every part of the health service, describing A&E delays as a “litmus test” for the rest of the system.

“Staff are working at full capacity to deliver the right care, but the pressures are becoming intolerable,” he said. “Figures from the last six weeks show the number of people arriving at A&E has remained fairly consistent – but today’s results highlight the increasing number of people experiencing delays in ambulances as they arrive.

“The stats also mask the pressures which can be seen across all parts of the system – in social care, community and mental health services, as well as at the hospital front door and in our ambulance services.

“These delays cause distress to patients and their families but emergency departments are seen as a litmus test for the rest of the system. If the health service cannot cope at its front door, what lies behind it will also be struggling.”

The NHS National Emergency Pressures Panel (NEPP) has already told hospitals around the country to cancel any non-emergency procedures, leading many people to have operations delayed and even prompting health secretary Jeremy Hunt to apologise to patients.

Health service bosses had planned heavily for mounting winter pressures, but the figures have been higher than the same period last year.

Richard Murray, director of policy at the King’s Fund, explained why the numbers are so concerning: “Although these weekly data have not been fully validated, if they are right then hospital bed occupancy – a good proxy for the pressure hospitals are under – has been at even higher levels than last year.

“Given that last winter was one of the most challenging that hospitals had faced for well over a decade, it is worrying that many hospitals are already under significant pressure as they struggle to cope with increasing demand for their services.”

At least two of England’s ambulance service providers have had to up their Resource Escalation Action Plan (REAP) level to 4 because of the massive increase in calls received this winter, with the East of England Ambulance Service Trust having to resort to private providers after calls reached 50% higher than normal rates.

NHS Providers’ director of policy and strategy, Saffron Cordery, commented: “The figures reflect what we are hearing from the NHS frontline that despite planning more meticulously than ever before, the level of demand for services means severe pressures remain across the health and care system.

“Overall bed occupancy remains well above recommended safe levels, but would almost certainly be significantly higher without the extensive preparations put in place to deal with winter pressures.

“Ambulance services are under strain with delays at high levels, and 39 A&E diverts in place this week. This coupled with the highest number of ambulance arrivals this winter has a knock-on effect for A&E departments.”

She welcomed the NEPP response, but argued that lessons need to be learned from this year and that leaders must be realistic about what services can deliver with the funding available.

Already looking to next year, NHS England CEO Simon Stevens has said that the health service may look to increase the number of ‘drunk tanks’ which are run in 2018 – as hospital visits for acute alcohol intoxication is one of the main reasons for people to be in care over during the Christmas period.

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