Ambulance Pressures Today and Everyday

By Liz Harris   

The stark images of queues of Ambulances lining up outside of Emergency Departments is an unmistakeable and bleak warning signal of a whole system that is in trouble and not delivering the healthcare that we would expect in this country.

Paramedics and our ambulance colleagues turn up to work every shift to make a difference to someone’s life, to improve life, to save a life. They don’t go to work to be stood in a queue for hours and hours. This is an appalling waste of the NHS’s most valuable asset, its staff. And for every ambulance in that queue that is one less available to respond to the next 999 call, hence the long waits for an Ambulance that the public are having to experience and endure currently.

Paramedics and their Ambulance colleagues know that while they are stood in that queue, 999 calls are coming in and other patients are waiting, maybe even their own family and friends are waiting. Not only do they know this, they can hear it too. Ambulance staff carry radios and in some areas call centre staff will broadcast a plea to them to call clear and available, as they have 999 calls waiting or one of their colleagues working alone on an ambulance car is with a seriously ill patient and asking for assistance. The echo of the message resonates along the queues of paramedics standing by their occupied stretches at ED, powerless to respond.

This reality is unabating and has a detrimental effect on their personal and professional wellbeing. Paramedics are arriving at people who have deteriorated, and people who have died because of the delay in the time it’s taken the ambulance to get there, the guilt and the burden of this builds over time. Having to repeatedly manage this and the often overwhelming but totally understandable fears and frustrations of affected families is exhausting.

The situation is just as grim for the Emergency Control Centre staff too, the 999 call takers and Ambulance Dispatch teams, who arrive at work to computer screens full of what we call ‘stacking calls’, that’s hundreds of 999 calls waiting for an ambulance to become available, with the painful knowledge that they will never get to the bottom of that stack and manage to deal with everyone, no matter how many hours that they work.

The situation is breaking our ambulance workforce and breaking our hearts.

Paramedics and ambulance colleagues are currently seeing the usual mix of patients including anecdotally more calls to people experiencing significant difficulty with their mental health. Covid has lengthened pre-planned waiting times so people have had their treatments and procedures delayed, which leads to more urgent complications that might now require 999 or ED. And of course, we currently have the high temperatures contributing towards more demand on healthcare.

Hospitals are seeing more people accessing through the ‘front door’ of the ED or 999 and together with not enough people leaving and going home through the back door, it means that hospitals have many more patients than they have the capacity or the space for. The discharging of patients from hospital is a really important factor to highlight as the process of getting someone home from hospital requires an efficiently functioning system including adequately funded community and social care services.

The sustainability of an underfunded and overstretched NHS is not a new debate. Neither is the increase in demand for ambulance responses or the long ambulance handover delays seen at the moment. It must be remembered that this situation did not just arrive during the dark nights of the pandemic. Many of these issues have been repeatedly highlighted by a range of organisations for over 10 years. The difference now, is that the scale of the issues are beyond what any of us have ever experienced. We are way beyond the point of increased risk, we are facing a public health crisis, and if those in government could wholeheartedly accept and acknowledge this as a reality, that could be the first step towards tangible and implementable solutions.

Within the demoralising and desperation of this unfolding catastrophe, it is really important to not apportion blame to specific areas of the NHS or organisations within it, it’s not the Ambulance Services fault, it’s not the EDs fault, it’s not the GPs fault, it’s not the patient’s fault.

There is no simple solution, not to a complex and chronic problem such as this. This situation is a result of many intertwined issues. An historical lack of funding, a lack of systemwide planning with regards to developing connected and integrated 24/7 services, and a lack of setting out what the future workforce looks like in terms of numbers and skills required to deliver the healthcare needed.

The College of Paramedics will continue to push hard and lobby alongside our healthcare colleagues in the hope that the emotive words and appalling truths in the headlines will instigate some real change that makes a positive difference to paramedics working lives, the care that they can provide to the public and the ambulance sectors capacity to deliver a safe and effective service to those in the most need.

Liz Harris, Head of Professional Standards