Ambulance staff ‘dead on their feet’, says manager
STAFF in the Welsh Ambulance Service are “dead on their feet” from the pressures of Covid-19 and soaring numbers of 999 calls, two of its most senior bosses have warned.
Director of operations Lee Brooks and director of paramedicine Andy Swinburn say that while the performance of the NHS trust is nowhere near where they want it to be, many problems with the day-to-day running of the service are being caused by factors out of their control.
Latest figures from the Welsh Government show that ambulance staff reached barely half (51.1%) of ‘red’ calls, those deemed immediately life-threatening, in the target time of eight minutes in March, the second worst on record.
Wales’s poorest-performing health board was Hywel Dda UHB, which covers Pembrokeshire, Carmarthenshire and Ceredigion, where just 43.2% of ambulances arrived within the eight-minute target. The target of 65% has not been reached in more than 18 months.
“There are still large numbers of patients, not just in the red category but in the amber category as well, who are waiting longer than any of us would want for an ambulance response,” admitted Mr Brooks.
“At the start of March we had some very positive signs from a pandemic perspective. The volumes [of calls] were on their way down, staff were coming back to work, and we had actually removed our pandemic protocol for triaging 999 calls. But then, of course, the BA2 variant [of Omicron] came along. It meant that we began to see an increase in Covid-related absenteeism that peaked right at the back end of March.”
Mr Brooks confirmed that by the end of March more than 220 staff were off in one go, which equates to around 7% of the operational workforce. While he said this was “very much felt” by the service, it was still significantly lower than the peak of sickness absence in January 2021 when 411 (13%) were off. To help during the winter months the military were drafted in to drive some vehicles, but they were withdrawn at the end of March.
“It was not an easy decision to use the military for a third time and that cannot be the long-term option,” he added. “But we saw reductions in community waits during that period, so it was the right thing to do. Now we’re in a position where we no longer have them and have to absorb more pressure. It means some patients are being told that ambulances are not available to them and have to find other means of getting to hospital, and that’s regrettable.”
One of the things that has most concerned Mr Brooks in recent weeks is the sharp rise in the proportion of calls being classified as ‘red’, which has doubled from around 5% to 10% in recent months. Many of these have been related to severe breathing problems caused, in part, by Covid.
In March, almost 39,000 emergency calls were made to the Welsh Ambulance Service, an average of 1,256 calls per day. Mr Brooks said his biggest concern was an increase in repeat calling which can be attributed, in the main, to longer waits in the community for ambulances to arrive.
He added: “The volume has felt relentless. It’s key that members of the public are only calling us back if there is a change to the patient’s condition or if they are going to make alternative arrangements.
“What you could be doing is preventing somebody else who may have a life-threatening need from actually getting that contact with a call handler.”
Andy Swinburn, director of paramedicine based in North Wales, said the workforce were “exhausted” and had gone “above and beyond” over the last two years to keep communities safe.
“Without wishing to be too melodramatic, they’re dead on their feet,” he said. “However all the parts of the health economy are feeling the same pressures we’re feeling.
“For instance, people have not been able to get an appointment with their GP and they’ve put it off and put if off until eventually their low-level complaint becomes a much higher level of complaint, which then trips into 999.”
Mr Swinburn said the current pressures on the Welsh Ambulance Service were the most challenging he’d experienced in his three decades in the career.
In the first quarter of 2022 a staggering 70,171 hours were lost due to handover delays from ambulances to A&E, more than three times the amount recorded in the same period in 2021 (21,598), 2020 (25,929) and 2019 (21,250).
Mr Brooks said this was down to patients being unable to “flow” through the NHS system due to a shortage of available hospital staff and beds, and hold-ups in discharging patients when they’re medically fit and ready to go home.
“We have seen some of our staff suffer trauma because they’ve seen the consequence of the delays to the patient they’re with, and because they are hearing of the calls that are waiting in the community that they’ve been unable to respond to,” he added.
Despite these problems, both men agreed that Wales was one of the best in the UK at managing patients in their communities and preventing them from needing an unnecessary trip to hospital. But they said emptying hospitals for only those who need to be there is “really, really key”.
They added that the national rollout of the NHS 111 service would also help to direct people to the most suitable care to meet their needs.
The Welsh Ambulance Service has also been busy recruiting, doubling the size of its clinical support desk team, diverting its staff to do more clinical work remotely, and enlisting more support from St John Ambulance.
“There’s no doubt that our reputation has taken a knock,” Mr Swinburn added. “We are doing as much as we can to absorb as much of the pressure as possible, but the levers that are available to us are not plentiful.
“If Covid behaves for us and we don’t see new variants, if we see an improvement in attendance by our existing staff as a consequence, and if we see our new EMTS coming in next month, that will improve the picture.
“However the single greatest area we’ll see in terms of improvement is the reduction of lost hours at the emergency department – that is the reality. There do need to be meaningful and effective plans to start to bring those figures down before I can speak with confidence that there will be a turnaround in these response times.”