Exclusive: NHSE crackdown on 10-hour ambulance delays

Local leaders were told today that emergency patients were being kept waiting in ambulances for 10 hours in some areas.

They were also told the CEOs of the five worst-performing trusts for ambulance handovers were called into a meeting with health and social care secretary Victoria Atkins earlier today. This appears to have been instigated by Ms Atkins.

HSJ has spoken to multiple sources who were on the call with NHSE’s chief executive Amanda Pritchard and emergency care boss Sarah-Jane Marsh, in which they outlined new protocols for long handover delays.

This will involve a new national escalation process being triggered when a patient has been waiting in an ambulance outside an emergency department for eight hours. They said national teams should be contacted at this point, so they can step in to help resolve the situation and avoid 10-hour delays. This would be a “backstop” – to stop 10-hour waits ever occurring – rather than a “target”, it was stressed.

Official data has shown a steep rise in ambulance handover delays this month, reaching similar levels to last December, when delays were far worse than previous years, drawing widespread media coverage and political pressure. There are serious concerns about the NHS’s ability to cope with the high demand which normally comes from patients in early January, particularly as junior doctors are due to strike over this period, and flu infections have not yet peaked.

Ms Marsh said the majority of integrated care systems were handling ambulance handovers relatively well given current circumstances and may be shocked to hear of 10-hour delays.

But she stressed this was happening in some parts of the country, where trusts were using this as a strategy to manage pressures within the hospital. She said this was inappropriate “no matter what the circumstances”.

She said systems must also work effectively with council partners while admitting this would be “exceptionally challenging” in some areas. She said local leaders should escalate problems that cannot be solved locally with local authority partners and NHSE would work with the government to resolve matters.

Also on the call, sources said Ms Pritchard urged systems to open as much capacity as possible, as quickly as possible, due to concerns about handovers and overcrowding when junior doctors go on strike.

This prompted several questions about whether financial targets would be relaxed if escalation wards were opened, to which the answer according to one source, was that it is for systems to determine. Some systems are relying on maintaining enough planned-care activity through winter to trigger elective recovery funding to balance their books.

NHSE was approached for comment.

The five worst performing trusts called to meet Ms Atkins were University Hospitals Plymouth, Royal Cornwall Hospitals, Gloucestershire Hospitals, Shrewsbury and Telford Hospitals and Worcestershire Acute Hospitals.