Ambulance handover delays at Shropshire’s A&Es are a national disgrace – an inquiry is needed

Significant delays in handovers from ambulances to A&E departments continue at Shropshire’s two acute hospitals. This winter, half of ambulances arriving at the two A&Es experienced handover delays of 30 minutes. This much worse than the experience across England, where one fifth of ambulance handovers were delayed by 30 minutes or more over the same period. The national target is 15 minutes.

Ambulances that are stuck in the A&E queues are not available to answer new 999 calls. It is unacceptable that a fifth of ambulances are experiencing long handover delays in England. The handover delays at the Royal Shrewsbury Hospital and the Princes Royal Hospital (SaTH) are a disgrace. This winter, half of ambulances arriving at SaTH have suffered handover delays of 30 minutes or more (49% – the fifth worst performance in England). More than a quarter of ambulances have experienced delays of 60 minutes or more (27% – the sixth worst performance in England).

In this article, I look at key NHS statistics and conclude that there are enough beds, including critical care beds at SaTH. Bed blocking has halved in five years. The number of ambulances arriving at SaTH has decreased. Patient attendances at A&E have increased. And ambulance handover delays have rocketed.

Headlines

• SaTH is the fifth worst performing NHS hospital trust in England for handover delays.
• From December 2021 to February 2022, 49% of ambulances arriving at RSH and PRH had to wait 30 minutes or more to transfer their patients into A&E.
• Over the same period, 27% of handover times were for one hour or more.
• Historically there has been a shortage of beds at times. That’s history and around 90 beds have been unoccupied on average this winter.
• Bed blocking was also a problem historically but it has eased.
• The number of patients arriving at SaTH A&Es has increased by 13%. Across England, there has been no increase.

Handover delays at A&E

As the graphs above show, delays in handovers at the two acute hospitals managed by the Shrewsbury and Telford Hospital Trust have been significantly worse than the average so far this winter [1]:

• England: 20.6%
• Shrewsbury and Telford Hospital NHS Trust: 49.1%

The handover problem has increased nationally over the last five years but has got significantly worse at SaTH.

Patients arriving at A&E

The number of people arriving at A&E (whether by ambulance or other means) over the winter months has increased by 13% over the last five years rising from 8,263 to 9,452 patients a month. Across England, there has been no increases in the number of ambulances arriving at A&E. That poses a major question: why have patient arrivals at SaTH increased more than the national average? [2] [3]

Ambulances arriving at A&E

Pressure of ambulance arrivals at SaTH has reduced slightly recently. Over the winter  (December to February) of 2019/20 – before the pandemic – an average of 125 ambulances a day arrived at SaTH. This winter the number of ambulances has reduced to an average of 101 ambulances a day. The longer term picture shows that there are 13% more ambulance more arrivals at SaTH than in December to February 2017/18.

There can be little doubt that the increase in ambulance arrivals has contributed to the delays in handovers to A&E. However, handover delays have more than doubled in the last five years while ambulance arrivals have not increased.

Bed availability

There is no current shortage of beds in SaTH hospitals [4].

The number of beds varies slightly from day-to-day and occupancy varies rather more.

In the winter of 2017/18, December to February, there were around 690 general and acute beds available at SaTH, with an average occupancy of 94%. On one day, all beds were occupied.

In the winter of 2021/22, there were around 725 beds at SaTH with an average occupancy of 87%. Nationally, bed occupancy has been 92%.

SaTH has 22 adult critical care beds, of which an average of 14 beds have been occupied this winter. At the most, 19 beds have been occupied.

Bed blocking

Bed blocking, more formally known as delayed transfer of care, is a problem at many hospitals. NHS England stopped publishing statistics on bed blocking in February 2020 to focus efforts on the pandemic. In that month, there was bed blocking at SaTH for a total of 292 days. Five years earlier in February 2018, beds were blocked for more than twice as long, a total of 630 days [5]. While bed blocking remains an issue, it seems unlikely that delayed transfer of care has any impact on the ambulance handover problems.

Next steps

Councillor Tracey Huffer has already called for an inquiry led by Shropshire Council to identify where the problems are and what the solutions might be. The current scrutiny committee system at Shropshire Council does not have the resources to deal with an inquiry of this complexity. And the scrutiny committees lack teeth. It needs an independent select committee, led by Shropshire Council, to get to the bottom of what is happening and identifying solutions.

Separately, a campaign is underway to improve ambulance response times in the rural areas of Shropshire. That improvement is much needed but we are not going to solve the ambulance problem unless we eliminate excessive handover delays at our hospital A&Es. More ambulances allocated to the county won’t improve the problem with handover delays. The extra ambulances will just lengthen the queues outside A&E at the Royal Shrewsbury and Princes Royal Hospitals (SaTH).

Notes

[1] Each winter, daily reports are submitted from all acute hospital trusts across England. The Urgent and Emergency Care Daily Situation Reports (SitRep for short) cover from December to March though the date range varies a little each year. Unless otherwise stated, the data in this article covers the months of December to February, also at times described as winter.  

[2] The 2020/21 data are influenced by the pandemic. Ambulance activity was reduced and the handover delays consequently reduced. Attendances at A&E also dropped.

[3] A&E attendance data at major A&E (RSH & PRH). Data are for attendances at Type 1 Departments – Major A&E.

[4] SitRep data.

[5] Delayed transfer of care data.