The ambulance crisis in Shropshire – We can’t go on like this

Over the last eight weeks, half of ambulances arriving at Shropshire’s two A&Es have had to wait al least 30 minutes to hand over their patients to hospital staff. The Shrewsbury and Telford Hospital Trust has been the fifth worst performing acute NHS Hospital Trust in England during the winter so far.

While ambulances are waiting to discharge their patients into the care of A&E staff, they are not available for other emergency calls. This increases the delays that injured or seriously ill people in Shropshire experience, especially in rural areas.

We also know that delays in handover can lead to worsened health outcomes for patients.

We urgently need to solve the problems in handover at the two A&Es. We need a return to locally based paramedic services including first responders and strengthened Minor Injury Units.

We can’t go on like we are. We can’t go on with A&E responses failing the people of Shropshire.

Words by Tracey Huffer, Shropshire Councillor for Ludlow East. Analysis by Andy Boddington, Shropshire Council for Ludlow North.

Every winter, the NHS conducts detailed monitoring of how acute hospitals are performing as winter pressures build up. We have now seen a full eight weeks of data for this winter from late November to late January [1].

Over those eight weeks, 49% of ambulances arriving at the two Shropshire A&Es have experienced handover delays of 30 minutes or more. During the same period, delays across England were very much lower at 20%. There were delays of 60 minutes or more for 27% of ambulances arriving at Shropshire’s two A&E departments, compared to 8% nationally.

There is clear evidence from a recent national survey that eight in ten patients suffer some degree of harm if handover is delayed for an hour or more, with around one in ten patients suffering serious harm [2].

The NHS Standard Contract states that handovers between ambulance and A&E must take place within 15 minutes, with none waiting more than 30 minutes. We are nowhere meeting that standard in Shropshire.

The handover delays at our hospitals are only part of the problems we are facing. If ambulances are queuing up outside A&Es, they are not available to pick up new patients. In many rural areas in Shropshire the wait for an ambulance can be lengthy at the best of times. Too often ambulances must now be brought in from tens of miles away because at times most our county’s ambulances are queuing at the hospitals waiting to discharge their patients into A&E.

It is not a problem with beds. There is no current shortage of beds in the two Shrewsbury and Telford Hospital Trust (SaTH) hospitals. Over the eight weeks to 23 January, 12% of adult and acute beds were vacant.

Five years ago, 22% of ambulances faced transfer delays of 30 minutes or more at the two A&E departments. The delays have more than doubled since. SaTH is now the 5th worst performing acute health trust in England for handover delays of 30 minutes or more and the sixth worst performing for handover delays of 60 minutes or more.

That’s not good enough and people in Shropshire deserve a better service from SaTH.

The problem clearly lies in getting patients into A&E, getting them triaged and then either discharging them or admitting them into the hospital.

This cannot go on. There have been a couple of falls here in Ludlow recently where people have had a suspected broken hip. They have had to wait more than an hour for an ambulance. There have been people who have been critically ill who have been lucky enough to survive the long wait for an ambulance and the long A&E handovers. And a few who have not been so lucky. GPs have had to abandon appointments to assist in local medical emergencies because no paramedics are available.

We need to work rapidly towards a solution to our worsening A&E crisis.

We need more first responder support in rural areas. Minor Injury Units like that at Ludlow Community Hospital need to be better publicised, open longer hours and have a strengthened medical team.

There must be a rapid and radical review of how our two A&Es are operating. They need more staff, especially more consultants. Future Fit, the project that was meant to work miracles in reshaping our hospitals, has failed. It has spent the best part of a decade in talks without any action to improve services.

Our emergency ambulance service must improve with more vehicles being based locally. But it is difficult to see how the service can improve when there are so many problems admitting patients into the county’s A&Es.

Notes

[1] The data used here a derived from NHS England, especially its Winter Daily Situation Reports (SitRep).

[2] The Association of Ambulance Chief Executives reported in November: “Over eight in ten of those whose ‘handover’ (from ambulance clinician to hospital clinician) was delayed beyond 60 minutes were assessed as having potentially experienced some level of harm; 53% low harm, 23% moderate harm and 9% (one patient in ten) could have been said to have experienced severe harm.”

[3] On average, around 9% of SaTH’s 6,000 staff were absent on any one day in the eight week SitRep period referenced in this article (average of 533 people a day). Of these, 40% were absent for Covid related reasons (average 212 people a day). This data refers to all staff, not just frontline staff. We do not have data for earlier years against which to benchmark the 2021/22 data.

Graphs