Patients ‘at risk’ due to West Midlands Ambulance handover delays

West Midlands Ambulance Board has taken the unprecedented step of moving handover delays to the highest possible level.

It is the first time that any risk has been categorised at ‘rating 25’ for the service.

The rating was confirmed at a meeting on Wednesday (October 27) where the board of directors were told that the amount of time being lost to delays had reached previously unseen levels.

The knock on effect is that ambulances are not available to respond as quickly to 999 calls - where people are in need of urgent medical care.

The board heard that this has led to cases of patients dying while waiting for an ambulance.

In some cases the delays had lasted ‘multiple hours’ - and the West Midlands Ambulance Service board heard that at times the delays had been worse than those experienced by all the other ambulance services across the country put together.

In September alone, 1,375 hours were lost by crews stuck outside the Royal Shrewsbury Hospital, while at the Princess Royal the number of lost hours was 768.

They contributed to a total of more than 16,000 lost hours across the West Midlands that month.

Mark Docherty, director of nursing and clinical commissioning, warned that the situation was set to get worse over the coming months as a result of winter pressures.

How are delays at West Midlands Ambulance Service affecting patients?

Mr Docherty said: “Despite everything we are doing by way of mitigation, we know that patients are coming to harm as a result of delays.

“We know that there are patients that are having significant harm and indeed, through our review of learning from deaths, we know that sadly some patients are dying before we get to them.”

Mr Docherty said it was a “completely unacceptable situation”, and additional front-line resources had been deployed in an effort to get to more patients.

He said: “Some of these delays are not just an hour, some of them sadly are multiple hours.”

How is West Midlands Ambulance dealing with these delays?

Mr Docherty said: “It’s almost like we are having to change our monitoring systems because some of the monitoring was never built to record delays in excess of 10 hours, for example, but we know there have been quite a number of them [in the] year to date.

“The impact of a 10-hour handover delay is that the crew going in won’t ever return back to their shift on the road to deal with patients that they would normally have dealt with.

“It’s massively impactful on our response times.

“The number of hours we are losing is going up at a rate where it’s going to continue to cause significant harm – and indeed probably worse harm if it carries on as it is.

“If we follow the trajectory that winter normally follows it’s only going to get worse, and we will lose so many hours in December, January and February that it’s difficult to see how we will be able to respond to some patients in a time frame that’s acceptable.”

Urging the board to move handover delays to a risk rating of 25, Mr Docherty said: “We know for a fact that we are causing harm to patients and that harm is significant.

“The definition of the ’25’ risk, I would advise, is that the harm is almost certain and it’s going to be catastrophic, and I think we are at that place where the board now needs to move that risk to that level.”

Mr Docherty said the number of hours being lost to handover delays in the West Midlands were at times “worse than the rest of the country put together”.

Are ambulance crews being supported in the face of these delays?

Dr Alison Walker, the trust’s medical director, said the welfare of crews caught up in handover delays should also be considered, as well as that of staff in control rooms dealing with callers concerned that an ambulance had not reached them yet.

Dr Walker said: “I think it is worth recognising that patient harms are significant but there are also harms for our staff involved in these delays.”

What happens next?

WMAS deputy chair Wendy Farrington-Chadd said it was “disappointing” that the board was left with no option but to declare the most serious level of risk.

She said: “I do think we should be pushing more for solutions. I know that we are doing, but it just feels that with the acceptance of this risk level it’s almost like it’s beyond our control and that doesn’t feel like the right place for us to be as a board.

“The whole point of risk is that you can in some way manage it, and what we are saying almost by this categorisation is there is no way and nothing else we can do. We need to focus on the solutions in this.

“It’s not acceptable for patients or staff, and I don’t see the long-term solutions that need to happen to change this in the dramatic way that would need to alter that position particularly in the short term.”

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