Exclusive: Ambulance serious incidents triple

There were 98 patient harm incidents at West Midlands Ambulance Service in June, official data obtained by HSJ suggests, up from 49 in the same month last year.

The figures show that from April-June this year, 262 harm incidents have been logged – a 240 per cent increase on 77 in the same period in 2019 and a 71 per cent increase on 153 last year.

Nursing director Mark Docherty, who previously warned the service was facing a “Titanic moment” and would “all fail” around a specific date of 17 August, said much of the increase can be attributed to worsening hospital handover delays. The service has been on the highest alert level of 25 for delays since October.

More than 700 people at one time waited for ambulances “that were not going to turn up” on Monday, according to Mr Docherty, who described the situation as a “really dangerous place to be”.

Mr Docherty explained how the harm incidents, including deaths, resulted from growing delays: ”You can’t underplay the risk. If you’ve got 750 patients like we did on Monday waiting, none of those patients have been assessed.

“Sadly, amongst them there will have been patients with stroke who won’t be treated because they’ve waited too long.

“There will be some patients that probably die, because that’s the nature of emergency work.”

Response times at WMAS are generally better than some other trusts, indicating that the safety implications consequences may be even worse elsewhere.

Fellow Midlands leaders said Monday into Tuesday was the “worst night ever”, with one crew delayed for 24 hours outside A&E. 

On Tuesday afternoon all eight of the country’s ambulance services were on the highest alert, with concerns arising because of the heatwave, staff sickness rates from covid, as well as “chronic under resourcing versus demand”.

Pressure on WMAS is understood to have eased over the past 48 hours, although HSJ has been told that delays at the start of the week pushed average response times for category one calls to nearly nine minutes (the target is seven), and there are fears the situation will be worse over the weekend and in very hot weather early next week.

Meanwhile, averages for category two – which include suspected heart attacks and strokes – increased to 99 minutes (target is 18), and category three responses rose to a mean of 403 minutes, of which 10 per cent waited over 18-and-a-half hours.

June increase ‘massively significant’

Mr Docherty told HSJ that if every day was like Monday, his service would already be on the brink of failure.

In May, he predicted WMAS could collapse around 17 August, suggesting that by that point, approximately 30 per cent of its resources would be held up at hospitals.

“Back then, we were losing roughly 15 per cent of our resource due to delays,” he added.

“And I was predicting that when we lost 30 per cent that was at the point in which the Titanic effectively was sinking. That was the analogy, but I was also reiterating I really hope we don’t get to that point.” 

He added: “But that’s clearly the direction of travel at the moment… it is going up.

“If it’s not 17 August, unless something dramatic happens, it will be a point in time.”

The number of hours lost to handover delays in April was the highest WMAS had ever experienced at 17,797 until it rose again to 17,845 in June after a dip in May with 13,267. 

As of July 13, 9,038 hours had been lost and Mr Docherty said if the trend continued delays could reach 25,000 hours in August.

“Effectively, by August, we will be losing nearly twice as many hours as we did in May,” he added.

“The increase we’ve seen between June and July is massively significant, because we’re starting to see an upward trend, rather than flatlining.”

Before the pandemic WMAS, which is the country’s only “outstanding” ambulance service, was losing around 100 hours on average per day.

There have been ongoing tensions between WMAS and some local acute trusts over measures to reduce handover delays.

CEO ‘won’t allow service to collapse’

Warnings that WMAS is close to breaking point have led to several MPs raising the issue in Parliament and prompted calls for the Care Quality Commission to investigate harms caused by the delays.

Acknowledging intense pressure on the service, WMAS chief executive Anthony Marsh told Staffordshire’s health and scrutiny committee on Wednesday that it will continue as normal, despite major challenges. He told the meeting: “I will not allow this service to collapse.”

Mr Docherty said patients had been ringing up asking if ambulances would stop responding on 17 August and he was quick to put their minds at ease: “We’re really clear as a service, we’ll never give up on our patients. It doesn’t mean that at all.”

He added: “When people say, ‘what does failure look like’, if you’re a frail elderly patient lying on the floor in this heat and you’ve waited, like 10 per cent of our patients have done this week, 18-and-a-half hours for your ambulance to arrive, I think you’d probably say that’s failure. I would, if that was my mum or dad.

“Equally, if you’re a stroke patient who has waited four hours or more, and you’re now outside any treatment window, I think that’s failure, isn’t it?

“We will constantly try to do our best but what it will mean is that when patients ring up we can’t say to them they’ll get an ambulance quickly, and that feels like failure to me. 

“Sadly, I don’t think we are turning the corner yet.”