From the frontline: ‘Eventually a patient will die 50 yards from A&E due to queuing’
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When our hospitals are full, ambulances are forced to queue outside, keeping them from getting to other patients. Here, an East of England Ambulance crew member - speaking anonymously - explains what this means for patient safety and why things have to change.
I have two rules, do no harm to a patient, and that no patient should be kept waiting.
The way patients are made to wait in ambulances at hospitals is appalling and I strongly believe we treat animals better.
Being made to wait in an ambulance once at hospital is poor dignity and welfare, isn't very quiet or private and generally is no way to care for a human being needing medical treatment. If we looked after animals that way we would all be prosecuted for cruelty, so why are patients suffering?
On occasions there are upwards of 15 ambulances waiting to offload patients at Norfolk hospitals, with wait times varying from a few minutes to up to five hours depending on how full the hospitals are.
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Patients are triaged as to how sick they are when arriving at hospital and this has some bearing on the wait times, however being on an uncomfortable stretcher in a noisy box isn't dignified, comfortable or private.
Hospitals have a duty of care for all their patients, and given the state of the health system as a whole, hospitals are unable to discharge as quickly as they would like, leading to reduced availability of beds for new patients.
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The impact of this is that when new patients arrive at A&E, due to little movement within the hospital and no beds being available, they are forced to queue outside on an ambulance.
There have been occasions when so many ambulances have been queuing that open broadcasts have been made requesting back up for life-threatening calls, with no close resource able to respond. This means patients have a longer wait to get an ambulance, targets are missed, and patient safety is at risk.
Extra ambulances have been put on over winter to cover increased demand, however once they are all stuck at hospital, there isn't as many available to respond to calls if the hospital is full and there is no bed movement.
My concern with this all is that eventually a patient who is on hospital grounds, 50 yards from A&E will die in an ambulance due to queueing.
My other concern is due to the loss of out-of-hours GP cover, reduced community beds and people living longer thanks to the advances in medicine, we simply cannot keep up with demand. I strongly feel that an ambulance should be awaiting the patient, not the patient awaiting the ambulance.
Current pressures that we face are as follows:
• Increased 111 calls at weekends, from patients who normally want to speak to a doctor but end up with an ambulance.
• Increased emergency calls generally, There is a lot of social and health deprivation around. There is a sizeable elderly population also in North Norfolk, often with little resource around to respond quickly.
• As a consequence of delays at hospital, low acuity calls such as falls take longer to respond to. Elderly patients who stay on the floor for longer than an hour are at increased risk of mortality and needing surgery or hospital admission. I have had experience of responding to low acuity calls some 12 hours later and frankly being ashamed to say sorry and feeling very frustrated at the suffering the patient has endured waiting for us.
The hospital at Cromer, which is only open 8am to 8pm for minor injuries, needs to become a full 24/7 A&E hospital.
The hospital in Norwich I feel isn't big enough to cope with the increased demand countywide and the travel times involved from the coast to Norwich only adds to poor patient experience in my view.
The public need better educating on what an ambulance is for, it isn't for cut fingers or stubbed toes or simply for transport to hospital, it's for life-threatening medical emergencies such as strokes or heart attacks.
More community beds again. Too many cottage hospitals or respite centres have closed due to lack of funding or staff.
On balance this winter so far doesn't appear to be as bad as last despite additional ambulances. Patients are still waiting and the queues are still there at times.
They aren't going away any time soon, however how long will it take to make changes needed to improve patient wellbeing and experience?
I look after my patients well and so do all my colleagues. But things need to change now before any more come to harm.
What the organisations say...
Mark Davies, chief executive of the Norfolk and Norwich University Hospital (NNUH), said: 'Everyone at NNUH is passionate about providing the best possible care for our patients and staff across the trust are working hard to treat patients as quickly as possible.
'Every winter is a challenging time for the whole NHS and this winter is no exception.
'We were prepared and put in place a number of projects to increase capacity and our staff are doing a phenomenal job delivering excellent patient care following a spike in emergency attendances in the first two weeks of 2019.
'We've experienced a 17pc increase in emergency ambulance arrivals this winter (more than 150 a day) and we are working closely with EEAST to ensure patients are treated as quickly as possible.
'Our teams are working closely with our partners in the NHS, social services and local councils to help patients to return home when they are medically well enough to leave hospital.'
Dorothy Hosein, interim chief executive at East of England Ambulance Trust, added: 'Learning from last year we have worked hard with our NHS partners to improve our patients' experience and to keep people safe.
'We would like to thank our staff who have worked tirelessly, particularly through the winter period so far.
'However it remains a busy time of year across the health service and some patients have waited longer than is ideal.
'We have invested in our control rooms with more call handlers to answer 999 calls and more experienced paramedics and nurses to care for our patients from within the control room when we are unable to respond as quickly as we would like.
'We aim to assess and monitor our most vulnerable patients – including older people – at an early stage. While these patients may not be as unwell as people who are in a critical condition, we respond as quickly as we can.
'Patient experience and safety is our top priority when our clinicians are waiting to handover to the hospital staff.
'We are working with our NHS partners to achieve the best outcome for all our patients - both in the community and those already at or in hospital - as we manage these waits.'