Petition Number: P-06-1471 Petition title: Outlaw Ambulances from being used as extra beds for Hospitals. Text of petition: People are dying NEEDLESSLY due to the unavailability of Ambulances because they are being used as extra beds outside A&E Hospitals across Wales. 'It can't continue like this': Paramedics in Wales warn patients are waiting up to 26 hours to get into hospital. Chief executive of the Welsh Ambulance Service, Jason Killens, told Sky News that 38% of his ambulances were unavailable during December due the lengthy delays getting patients into hospitals.

 

 

1.        Background

Ambulances are not officially used as extra beds for hospitals, however the issue of ambulances having to wait outside emergency departments due to delays handing over patients to hospital staff has grown since the Covid-19 pandemic.

Handover delays occur when ambulance crews are unable to respond to new calls while waiting to handover patients to emergency departments. In some cases, this means that the patient is left to wait in the ambulance, whereas in other cases the patient might be moved into the emergency department, but the ambulance crew remain unable to complete the handover process.

NHS Wales guidance[AL1]  says that the handover of care of patients from an ambulance crew to hospital staff for triage or assessment should occur within 15 minutes. The percentage of handovers successfully occurring within 15 minutes of arrival at hospital has been falling since the Covid-19 pandemic. It reached a low in April 2024, when just 14.8% of handovers happened within 15 minutes.

Percentage of notification to handover within 15 minutes of arrival at hospital

 

 

 

 

 

 

 

 

 

Source: Monthly Ambulance Service Indicators, NHS Wales Joint Commissioning Committee

 

Welsh Government statistics[AL2] show that the number of hours of ambulance time lost to handover delays has significantly increased in recent years, with just under five times as many hours lost in 2023-24 compared with 2016-17. There was a substantial increase in the number of hours lost following the Covid-19 pandemic.

Number of lost hours for the ambulance service following notification to handover at emergency departments

 

2.     Welsh Government action

Health boards will be expected to eradicate ambulance patient handover delays of more than four hours and reduce the average ambulance time lost per arrival by 25% (from the October 2021 level) at each hospital site https://www.gov.wales/written-statement-urgent-and-emergency-care-pressures-and-six-goals-programme

 

 

Source: Trends in NHS urgent and emergency care activity: as at March 2024, Welsh Government

A clinical review by the Association of Ambulance Chief Executives, which looked at a sample of handover delays over an hour that occurred in England in January 2021, found that a significant proportion of patients experienced harm as a result. It found that 8/10 experienced some harm, while 1/10 experienced “severe harm.” They describe this finding as “extremely concerning” and say that “it presents a position that is totally unacceptable to all involved in patient care.”

 

3.     Welsh Parliament action

Throughout this Senedd term, the Health and Social Care Committee has been exploring how patient flow through hospitals can be improved[AL3] . A short inquiry focusing on hospital discharge and its impact on patient flow through hospitals was held 2022. The Committee found[AL4] that delayed discharges of patients from hospitals were having an affect on ambulance services, as demonstrated by the large numbers of ambulances seen queueing outside A&E departments across Wales.

Jason Killens, Chief Executive of the Welsh Ambulance Services NHS Trust (WAST), told the Committee:

In December, 25 per cent of our available capacity, our fleet, was lost in delayed handover in emergency departments. Of course, that’s a direct consequence, as colleagues have already said, of pressure across the system and delayed discharge. What that means for us, of course, is that we’ve got patients and our crews waiting at the emergency department to enter the hospital and continue treatment, but, importantly [ ] there are patients in the community that we are unable to respond to as a result of [ ] that capacity, being held at the emergency department.

He said,

I’m clear that the level of service that we’re offering to those patients is unacceptable, and we’re doing everything we can to improve that.

The Health and Social Care Committee held a follow-up general scrutiny session with WAST in May 2024. Jason Killens told Committee that handover delays at emergency departments are the “single biggest challenge” for the ambulance service.

He described the pressures being felt across the system:

what causes the response delays is our inability to hand over patients at the emergency department, and what causes that problem is the fact that there's a problem with flow through the hospital, through the emergency department into the hospital and back out into the community, particularly in adult social care. So, at any one time, there are something in the order of between 1,200 and 1,500 patients in beds in our hospitals across Wales who could be back in our communities. And we can't get those patients safely back into communities because of problems, particularly in adult social care, with capacity, availability and so on.

4.     Welsh Government Action

In response to this petition, the Cabinet Secretary for Health and Social Care, Jeremy Miles MS, said:

The Welsh Government has been explicit with health boards that it is not acceptable for people to be kept waiting long periods in ambulances outside emergency departments.

The response highlights that the Welsh Government are investing more than £180m this year “to support health boards and regional partnership boards to safely manage more people in the community” and claims that this “will help to unlock ambulance capacity and improve responsiveness.”

In 2021, in recognition of the “ongoing and exacerbated pressure on the urgent and emergency care system and the associated risk of harm to patients and staff,” the Welsh Government developed the six goals for urgent and emergency care[AL5]  and announced £25m recurring national funding to support Health Boards and NHS Trusts to deliver them.

An accompanying policy handbook[AL6]  was published in February 2022 and includes the target:

Improving ambulance patient handover, ensuring no one arriving by ambulance at an Emergency Department waits more than 60 minutes from arrival to handover to a clinician – by the end of April 2025. The number of people waiting over this period for ambulance patient handover will reduce on an annual basis until that point.

The Quality Statement for Care in Emergency Departments[AL7]  was published by the Welsh Government in March 2024.

There has been some improvement reducing handover delays. The 2023/24 six goals programme update[AL8]  highlights that Cardiff and Vale University Health Board has significantly improved ambulance handover performance over the past 18 months; eliminating 4-hour ambulance delays and reducing the number of 2-hour delays to less than 1 per cent of arrivals through a new onboarding process and Rapid Assessment Treatment Zone.

The then Cabinet Secretary for Health and Social Care, Eluned Morgan MS, in a statement on the update, said:

However, there is unwarranted variation in performance across Wales, with issues intrinsically linked to challenges in supporting timely discharge of patients from hospital to home.

Every effort is made to ensure that the information contained in this briefing is correct at the time of publication. Readers should be aware that these briefings are not necessarily updated or otherwise amended to reflect subsequent changes.