Ambulance ‘meltdown’ is key
Boss of city’s new Integrated Care Board says fixing the handover crisis at region’s A&Es must be the priority
ANEW regional health boss has pledged to work with ambulance, hospital and social care services to avert a feared ‘meltdown’ in urgent care across Birmingham and the West Midlands.
The new Birmingham and Solihull Integrated Care Board (ICB) will go live next month. It is taking over commissioning and overseeing all health services in the area, with a budget rising to £3 billion.
Its boss reacted to recent claims from West Midlands Ambulance Service director Mark Docherty that the 999 service would ‘reach a Titanic tipping point’ this summer without urgent intervention, pushed beyond crisis point by hospital handover delays.
Hold-ups running to thousands of hours a week in getting 999 patients off ambulances and into emergency departments were having catastrophic consequences, the service’s nursing chief had warned.
He repeated warnings that patients are dying because of slow responses.
There have been multiple stories about patients stuck on the floor, in pain, for hours at a time, waiting for an ambulance.
The ICB interim chief executive, David Melbourne, said averting disaster this summer will be a key challenge for the new regional organisation.
“One of our top priorities when our ICB comes into being in July will be urgent and emergency care across the health and care system, with a focus on working collaboratively with all of our health and social care partners. Although we formally go live in July, I am already having conversations with providers and health and care services.”
He said he had spoken to West Midlands Ambulance chiefs and, as a former leader in a hospital trust in the region (Birmingham Women’s and Children’s Hospitals), was aware of the concerns of the handover delays.
“There is a massive challenge for the entire health and care system. For our ambulance services, we have community teams in place to support with some of the emergencies that come in, and we need to make better use of those to allow ambulances to go where they are needed most. Inevitably, if we have 12-hour waits
in A&E we will have ambulances backing up at the front door.
“These hospitals are facing the legacy of the longest waiting lists ever off the back of Covid, which is an enormous challenge the likes of which we have never seen before.
The impact of the pandemic also means there are thousands of people in Birmingham and Solihull who have been waiting for healthcare for more than 72 weeks. “We will work with all of the great health institutions in Birmingham and Solihull, including WMAS, and social care providers, to find solutions and ensure our local NHS can overcome these challenges in order to deliver the best possible care.”
Ambulance Service director Mark Docherty said he had been pressing for a solution for years, but now things were beyond crisis level.
“A delay of over one hour in getting a patient out of an ambulance and into the hospital used to be an unusual and dreadful event”, said Mr Docherty.
“Last year we had 30,000 handovers that took between one and two hours. There were more than 13,000 that took two to three hours, and 7,500 that took from three to four hours. In all more than 60,000.
“There has been a lot of hand wringing and suggestions since, but nothing has changed. Last month, in 148 cases the patient was stuck on the ambulance outside A&E for more than 10 hours.
“That’s an expensive ambulance and crew parked up for an entire shift who should be out getting to more emergencies, including to those at risk of death from strokes, heart attacks and severe injuries.”
He said he had estimated that on the current trajectory the number of held-up ambulances would ‘peak’ on August 17 and cross a tipping point
“When we are losing every day a third of our total resource because ambulances are queueing up outside hospitals then that is past that tipping point.
“I have suggested that point will come on the 17th August, but I may well be wrong - the point is I want to be wrong, I want people to wake up to how urgent this is.”
He said a range of suggestions had been put forward, including creating temporary ‘holding areas’ close to A&Es at the most affected hospitals in Stoke, Birmingham Heartlands and Shrewsbury – described by Mr Docherty as ‘portacabins’ – where ill patients would be offloaded until there was space in the main hospital.
But the priority should instead be on emptying hospitals of ‘bed blockers’ – those well enough to leave, but without the social care in place to do so safely.
He described the large number of medically fit patients occupying hospital beds as “criminal ... when I’ve got teenagers dying on the street from things that are completely reversible”.
An NHS spokesman said: “The NHS has been working hard to reduce ambulance delays and £150 million of additional system funding has been allocated for ambulance service pressures in 2022-23.
“There is no doubt the NHS still faces pressures, and the latest figures are another reminder of the crucial importance of community and social care, in helping people in hospital leave when they are fit to do so, not just because it is better for them but because it helps free up precious NHS bed space.”
Inevitably, if we have 12-hour waits in A&E we will have ambulances backing up at the front door David Melbourne