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30 November 2021

“It’s every 999 caller’s worst nightmare”: Why aren’t ambulances reaching people in time?

A baby fits for two hours. A cancer patient suffers suspected sepsis for seven hours. A man is left to die of an aneurysm at home. We look inside the autumn crisis plaguing the NHS.

By Anoosh Chakelian

At 3.55am, 14 November, Sarah-Jane Paull was woken by her two-year-old Scarlett’s epilepsy monitor. She was having a seizure.

Paull, 30, who lives in a rural part of Newquay, Cornwall, called 999. She knew it could mean life or death.

In May, she and her husband had to perform CPR on Scarlett themselves, guided down the phone in the eight minutes they waited for an ambulance. In July, doctors worked on her on a resuscitation table for an hour, after she was immediately blue-lighted to the hospital.

This time was different.

After 15 minutes, waiting desperately at the end of the farm lane leading up to their house, no ambulance arrived.

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“When they said ‘no one’s coming’, my heart was thumping in my chest”

They called again. No crew was available. They were number 38 in a queue of emergencies; 37 others needed assistance before their daughter, who has cerebral palsy and uncontrolled epilepsy.

“When they said ‘no one’s coming’, my heart was thumping in my chest,” says Paull. “That is every parent’s worst nightmare – well, it’s every 999 caller’s worst nightmare.”

Her daughter had been lying unresponsive on the sofa for 15 minutes, her heart rate rocketing and eyes flickering.

“I could see her heart thumping in her chest,” Paull recalls. “To look at your child’s eyes and they’re not responsive, fitting, knowing no one was coming, was unbelievable.”

They made the difficult decision to take her to hospital themselves – a 35-minute drive when, at any time, their daughter’s airways might become restricted.

Throughout the agonising journey, Paull dreaded having to pull over and give CPR on the roadside. “We hoped we hadn’t made the wrong decision trying to get her there ourselves.”

“To look at your child’s eyes and they’re not responsive, knowing no one was coming, was unbelievable”

By the time she was medicated, Scarlett had been fitting for two hours in what is known as a “cluster” of repeated seizures. While she received excellent care at the hospital, her mother says the outcome could have been very different.

“It could’ve been a person with a heart attack, a seizure is just as life-threatening and dangerous,” she says. “We’ve watched her in a critical state before. I think that’s the most harrowing thing, that I know how bad she’s got before.”

Currently fundraising for life-changing treatment to help Scarlett live a pain-free life, Paull tells me her experience “shows things are really stretched” in the ambulance service. “It’s not an issue with the staff, it’s not a personal grievance, it’s the system they’re working in.”

Scarlett is not alone. Ambulances are taking longer to reach patients than ever before across most of England.

Data by Ben Walker

The average wait for an ambulance is now double that of 2019, at one hour 17 minutes, according to analysis of NHS England figures by the law firm Bond Turner.

For life-threatening emergencies, the wait has increased to 80 seconds longer than the eight-minute target.

Even blue-light patients who need resuscitation can end up waiting an hour before getting into hospital, reveals Jade*, a 33-year-old paramedic from London who has worked in the ambulance service for six years.

“They’re waiting longer, so we’re getting to them sicker”

“You should go straight into resus [the area of an A&E department where people are taken to be resuscitated], but the average I would say is half an hour now, and 45 minutes, an hour, isn’t unheard of,” she says. “We just have to keep managing the patient in the back, and hope for the best they don’t deteriorate and don’t die.”

She says the situation is “100 per cent” the worse she’s seen it, and patients are dying as a result.

“Because they’re waiting longer for an ambulance, we’re getting to them sicker,” she says. “When it comes to strokes and heart attacks, literally every single minute is their quality of life or even their life.”

Breast cancer patient Ursula Ann Martin, 58, from Woolavington, Somerset, was left waiting seven hours for an ambulance when suffering from symptoms of sepsis.

“I had a really high temperature, chronic diarrhoea – I’ve never felt that ill in all my life. I felt like I was dying,” she recalls.

“I just assumed they’d be there within the hour because sepsis is very serious,” she says. “But it took seven hours. I got the idea that I wasn’t important and was just left to die.”

Sepsis is a significant risk for chemotherapy patients, who are more vulnerable to infection because of their weaker immune systems. Late intervention can lead to organ failure, and a patient should receive antibiotics within the hour.

Martin had been instructed to call a special emergency number for the hospital if she experienced any of the symptoms, and was terrified help would come too late. As it turned out, it wasn’t sepsis: it was a life-threatening reaction to her chemo, which was immediately withdrawn.

Bristol GP Lucy Pocock recently called an ambulance for a six-year-old girl suffering from breathing difficulties, who she had put on oxygen in her surgery.

The ambulance never came.

“I would’ve expected them to have arrived within half an hour for a sick child,” she says.

As the surgery reached closing time at 9pm, and she feared the oxygen running out, she called a nurse to accompany her while taking the child to hospital in a taxi herself. She was not equipped to treat a patient in transit. It had been five and half hours of waiting before they reached the hospital. “Luckily she didn’t deteriorate, but it was a tricky decision.”

“If we’re put in this position, people are going to die”

Having been a doctor for 12 years, she calls this situation “way worse than anything we’ve experienced” before.

“If we’ve got very unwell patients deteriorating in our care, then people are going to die. We’ll see deaths of people at home waiting for an ambulance, people in GP surgeries, and people in ambulances outside A&E.”

Ambulance waiting times are now above the pre-pandemic average in every English region.

Ambulances are queuing outside two-thirds of emergency departments before handing over patients, according to a new study by the Royal College of Emergency Medicine. Handovers should be completed within 15 minutes, as per NHS guidance – but the majority are failing to meet that standard.

Eve*, a paramedic for the South Western Ambulance Service, tells the New Statesman she saw just one patient in an entire 14.5-hour overnight shift on 15 November.

“It can be extremely stressful for both the crew and patient,” she says, describing how she uses blankets to try and make stretchers more comfortable.

“I can’t get to patients who have no one else coming – it has a psychological impact”

“Stretchers have very little padding and aren’t designed for patients to lie on them for long periods. Imagine an elderly patient who has broken their hip.”

While waiting, her radio was going off, asking crews to attend life-threatening emergencies. “To not be able to respond is causing moral injury among staff.”

Paramedics end up as “glorified nurses” waiting with patients for hours, according to Jade, who spent eight and a half hours with a Covid-19 patient in January.

“I am a front-line, emergency, pre-hospital clinician, and I can’t get to patients who have no one else coming. The psychological impact of that is emotionally hard.”

Ambulance queues are stopping patients who need emergency treatment reaching hospitals.

Retired investigative journalist Manfred Roxon, 71, in Ashburton in Devon, died of an abdominal aortic aneurysm earlier this month. Paramedics had told him the ambulance queue was too long at Torbay Hospital.

Lu La Buzz and Manfred Roxon (photo: provided by family)

The day before he died, his blood pressure had been so high that an out-of-hours doctor warned he was “sitting on a time bomb”, recalls his wife, Lu La Buzz, 51. “He should’ve been in hospital.”

She called an ambulance the following day when he was in immense pain.

“This was a priority, a life-and-death situation, and we weren’t looked after”

“The paramedics said there would be no beds and he’d be stuck in the car park for hours – he couldn’t bear the thought of that, it would’ve been awful.”

After the paramedics left, Roxon died. “This was a priority, life-and-death situation, and we weren’t looked after,” says his wife. “It’s inhumane.”

“It has left us reeling,” says his sister, Yolanda Bentham, 68. “He was a very fit man in every other way, but his blood pressure had gone sky high. He walked his dog regularly, kept his weight down. He shouldn’t have gone like that.”

The situation is gravest in the south-west, where Scarlett, Ursula Ann Martin and Roxon’s family live.

Where in England and Wales are ambulance waiting times rising?
Ambulance waiting times above pre-Covid average.
Ambulance waiting times below pre-Covid average.
Source: NHS England and Wales. September figures used for Wales

(Equivalent data is not available for Scotland, Wales and Northern Ireland, though ambulances are delayed throughout the UK. Every nation has requested military assistance for the escalating situation.)

Calls to 999 are surging after a drop during the pandemic, when people were reluctant to use the NHS. The New Statesman has heard one ambulance service is receiving 20,000 more 999 calls a month than in 2019.

“There was this lull in between the [Covid-19] peaks because people were absolutely terrified of going to hospital; they didn’t ring us unless it was an absolute dire emergency,” says Jade.

“It used to be ambulances waiting for calls, and now calls are waiting for ambulances. It’s even worse than before the pandemic.”

Hospitals had already reached peak winter bed occupancy at the beginning of November in England, according to Chris Hopson, head of NHS Providers.

Some of this is down to lockdowns. Patients who would otherwise have sought help earlier are now sicker, and older people who have been out less are falling more due to muscle wastage. Yet the main factor is limited social care provision, which means patients who should be discharged from hospital are left waiting for community or domestic care.

“The flow through the hospital is very, very sticky,” said Caroline Clarke, head of the Royal Free London hospital trust, when we spoke earlier this month.

“Lots of our patients rely on either a nursing home or residential place or home-care package… [and] end up staying in our hospitals: it backs up, so you can’t admit people, so patients wait.”

There is also a perception that GPs are inaccessible. While a 6,000 GP shortage is preventing some surgeries from holding all appointments in person, criticism in the press and from the Health Secretary Sajid Javid has led to people going straight to 111 or 999.

“Quite a lot of patients are not that unwell, and they’re coming into emergency departments because they don’t know where else to go,” said Clarke.

“For the first time ever after I finished my shift, I was in tears”

A running joke among ambulance workers is to nickname themselves “the Big Yellow Taxi”, one tells me. “We’re at absolute dire straits right now, we need to stop people calling us for things they can get in a taxi for.”

If primary care was better resourced, argues Pocock, then there would be less of a crunch at the doors of A&E. “Our focus needs to be elsewhere: in the community. Can we stop people being admitted to hospital?”

Until a solution is found, however, health workers and patients alike face a traumatic winter.

“For the first time ever, after a long shift, I came home and cried,” says Pocock. “The hardest thing is that this isn’t the care we want to give people.”

“It’s terrifying,” says Jade the paramedic, who had the morning we speak been to see a patient at 10am who had called 999 at 8pm the night before. “It all falls back on our shoulders, and we have to pick up the pieces.”

*Names have been changed and some ambulance service names omitted on request of anonymity.

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