Ambulance trusts across the
UK have sounded warnings over patient safety as they struggle to balance their books before the new financial year begins next month. Two trusts in
England alone are predicting a combined deficit of almost £50m with chief executives saying they face “significant challenges” over the coming weeks. Hospital handover delays, outstanding debts and unfilled staff vacancies continue to put trusts under extreme pressure, which is having a knock-on effect on patient care. In London, vehicles may even start to be withdrawn from service due to delays in replacing ageing technology. Analysis of papers presented to ambulance trust boards over the past two weeks reveal the scale of the challenge confronting our emergency services, despite winter pressures easing . Patients waiting for hours in ambulances In February and March, almost 32,000 hours – equivalent to more than 2,000 12-hour shifts – were lost to hospital handover delays in the East Midlands alone. Of the delays, 50 per cent could be attributed to just two hospitals: Queen’s Medical Centre in Nottingham and Leicester Royal Infirmary. The pressures impacting East Midlands Ambulance Service (EMAS) are also affecting teams in other counties, as resources are diverted from neighbouring areas to respond to calls in Nottinghamshire and Leicestershire. Concerns were also raised to the EMAS board about the “unacceptable” practice of patients being taken from an ambulance for a scan or X-ray and then returned to the ambulance to continue to wait for a clinical handover. While ambulance trusts have a responsibility to monitor the patient and escalate any deterioration in the patient’s condition, once the ambulance arrives at hospital, the duty of care is supposed to transfer to medics. EMAS chief executive Richard Henderson said in his report to the board: “The pressures within the health system and in particular hospital handover delays continue to be a significant challenge for us, impacting on our ability to respond to patients and meet national standards… I anticipate that many of the challenges we are currently facing will continue into the new financial year.” Manik Arora, associate medical director at EMAS, told i : “Handover delays are not an ambulance and hospital only issue; they are a symptom of wider pressures across the NHS and social care systems. Our priority is of the safe, quality care of our patients. We continue to work with system partners to reduce the negative impact of delays on patients and our staff.” A senior official at Northern
Ireland Ambulance Service (NIAS) said that “waiting in the back of ambulance was becoming a normal part of the culture”. They said that there remain times when NIAS crews are working shifts of between 15-18 hours due to handover delays and that, while unacceptable, the practice continued. The Scottish Ambulance Service said it is continuing to see extended hospital turnaround times across many hospitals. “This remains an area of significant concern,” an official said. “Extended hospital turnaround times are affecting staff rest periods, ambulance availability, ambulance response times and shift over runs.” Financial woes The board papers also highlight the difficult financial situation several trusts find themselves in. In its plan for 2024/25, South East Coast Ambulance Service [Secamb] told NHS England it is facing a £28.1m deficit. 999 call answering targets are being missed due to “recruitment challenges, high staff turnover and low call performance”. Its board was warned: “This results in risks to patient safety, clinical effectiveness, patient experience, colleague experience and Trust reputation.” Secamb achieved a break-even position in 2023/24 through, in part, a one-off sale of surplus property and other one-off cost improvements, but its underlying position is a recurrent deficit when these are removed. The trust said it is not alone in facing financial difficulties – a number of NHS providers currently have draft deficit financial plans – and that it is working hard to improve its position ahead of the final submission date of 2 May. Read Next Cutting length of prostate
cancer MRI could save lives, new research reveals The pressures ambulance trusts face have had a direct impact on 999 response times. All ambulance trusts should respond to Category 2 calls – such as for heart attacks and strokes – in 18 minutes on average and respond to 90 per cent of Category 2 calls in 40 minutes. However, trusts were so far away from their target that in January 2023 NHS England set a new target of 30 minutes for Category 2 calls in 2023/24. The average response times for Category 2 calls from April to December 2023 for all ambulance trusts was 36 minutes 5 seconds. Secamb was one of the few trusts to average under 30 minutes. A Secamb spokesperson said: “We recognise the need to build on this by further by improving response times across all categories of call. We have improved retention of call handlers, which has helped improve call answer performance in recent months. We are committed to doing everything we can to further improve performance and will continue to work closely with our NHS system partners to improve the service we provide to our patients.” South Central Ambulance Service (SCAS) had a deficit of £16.8m at the end of 2023, which is forecast to rise to £21.9m by the end of this month its board was told last week. That forecast is based on an assumption of £5.2m of national funding “to support improved operational performance”. However, the cash injection had not been received by the end of March, its finance team said. The trust plans to be in a breakeven position by March next year. Ambulance trusts are trying to implement “cost efficiency plans” in a bid to break even before the new financial year begins next month. Sources at multiple trusts told i non-frontline staff who have left or are leaving are unlikely to be replaced in a last-ditch bid to make up financial shortfalls. Vehicles risk being taken from the road Ambulances in
London may start being withdrawn due to “considerable delays” to the national rollout of radio and mobile data systems to all trusts. The capital’s ambulances currently rely on older Mobile Data Terminals (MDTs), which paramedic crews use to get info from 999 call handlers, which need to be replaced. But London Ambulance Service (LAS) finds itself with a legacy system still in operation that is no longer available to purchase, and devices are rapidly reaching the end of their economic life. “Without an appropriate solution LAS will not be able to fit new vehicles with MDTs or replace those that break in service, potentially resulting in vehicles being withdrawn from service,” the trust board was warned at a meeting last week. An LAS source said the specific concerns about the availability of MDTs has been reduced and that a strong replacement process was underway. The trust is not projecting to be in a deficit for this financial year. Last year, just half of England’s 10 ambulance trusts were rated “good”, down from eight in 2022, according to the Care Quality Commission’s latest State of Care report . West Midlands had been the only trust rated “outstanding”, which changed to “good” in February following its latest inspection. Three trusts had an overall “requires improvement” rating. The report highlighted how the persistent problem of a system in “gridlock” has been compounded by the cost of living crisis, industrial action over the last 14 months and escalating workforce pressures. In her report to the board, North East Ambulance Service chief executive Helen Ray said: “The next few months will remain challenging.” Professor Julian Redhead, NHS England’s national clinical director for urgent and emergency care, said: “We know the colder months are always a time of increased pressure, which is why we started planning for winter earlier than ever before – including putting more ambulances on the roads, employing more call handlers, and opening hundreds more beds – and those measures have paid off, with [latest] data showing there were 1,531 more adult general and acute beds open last week compared to the same week a year ago, while the number of patients not discharged when medically fit was the lowest so far this year at 12,015.” Ageing and growing populations will place even more pressure on ambulance trusts over the next few years. For example, the population across the Southeast of England will grow by 2.5 per cent over the next five years and the number of people aged over 65 will increase by 12 per cent. This will lead to more patients with complex health needs. Ambulance trusts fear they will not have the resources to cope. Health officials say they are delivering an additional 5,000 permanent staffed hospital beds, which will help improve patient flow through A&E and reduce delays in handing over ambulance patients to emergency departments. They said a primary aim of its plan for recovering urgent and emergency care services is to boost ambulance capacity to improve response times alongside the delivery of new ambulances and specialist mental health vehicles. A Department of Health and Social Care spokesperson said: “We are committed to ensuring people get the emergency care they need, and we have already seen significant improvements in ambulance response times – with average Category 2 responses in February over 28 per cent faster than the same point in the previous year. “Under our £1bn Urgent and Emergency Care Recovery Plan, we have provided £200m in 2023/24 to expand ambulance capacity and improve response times, and our Long Term Workforce Plan backed by over £2.4bn, will train, retain and recruit hundreds of thousands more staff – including boosting the number of paramedics by up to 15,600.”