Daily Insight: Ambulance pressures move to the next level

Worsening pressure piling on ambulance services has led to a major trust declaring it is causing “catastrophic” harm to patients – entering its highest ever alert level over deteriorating hospital handover delays.

For the first time in its history, West Midlands Ambulance Service’s board yesterday agreed to go into an “unprecedented” level 25 risk category, with senior medics expressing fears its paramedics are reaching patients too late.

As winter approaches, nursing director Mark Docherty’s stark warning – where he admitted some patients were “dying before we get to them” – is likely to ring agonisingly in the ears of board members up and down the country.

Not least because of NHS England and Improvement’s controversial intervention on Tuesday – where trusts and integrated care systems were instructed to take urgent action to “immediately stop all delays to ambulance handovers”.

As reported by HSJ, the national bodies warned of “difficult choices” and said leaders should discuss the issue of ambulance handovers at every board meeting they hold.

In a letter sent to all local chief executives and chairs, trusts were told “corridor care” is “unacceptable as a solution”, adding that ambulances should not be used as “additional ED cubicles”.

If that article’s comments section is anything to go by, the move has jarred with medics who have been warning of mounting pressure for months.

‘Out of touch’ and out of the picture

The Care Quality Commission has spelt out the problems which have prompted it to rate leadership at a newly merged acute trust “inadequate”.

The CQC, which has now published its full report after a July inspection, said Liverpool University Hospitals Foundation Trust was “much worse” than comparators for whistleblowing alerts, with 15 reported over an eight-month period.

Senior leaders were seen as “out of touch” with what was happening on the front line and as being unable to understand the risks or issues described by staff. 

There were also found to be serious failings around patients’ safety in the emergency services, which was rated “requires improvement” overall.

As previously reported, the trust received a warning notice for these issues in the summer, after which chief executive Steve Warburton announced his sudden departure. Medical director Tristan Cope and chief nurse Dianne Brown have also since stepped down from their roles. Sir David Dalton, the former group chief executive of the Northern Care Alliance, has recently taken over the trust on an interim basis. Read our full story about the CQC report here.