Paramedics face a "horrendous" dilemma every shift as a "rot" takes over the NHS.
With staff shortages across the NHS, and pressures on the health service rising as we head into the winter months, the Care Quality Commission (CQC) warned the system is "gridlocked". This is evident outside emergency departments where there are hours-long queues of paramedics, who've been unable to respond to 117,000 urgent 999 calls each month because they're stuck outside hospitals looking after patients, according to a CQC report.
Three weeks after the new Royal Liverpool Hospital opened, a queue of "over 26 ambulances" was waiting outside for hours, leaving ambulance crews to continue treating patients onboard until their care was signed over to the hospital. Patients can only be "left safely" if it's clinically appropriate and ambulance crews have followed a handover safety checklist, according to the North West Ambulance Service (NWAS).
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One Merseyside paramedic, who asked not to be named, said delays at A&E have meant they have missed the narrow window in which life-saving drugs can break down clots and prevent disability and death in stroke victims. Although these problems have made headlines in recent months, this NWAS paramedic, who's worked on ambulances for decades, thinks "the rot started well over five years ago", with high demand and long queues at A&E getting "noticeably worse" in the last decade.
They said: "It was a bit of a slow start, and then all of a sudden, in the last five years, it's absolutely exploded. I've never known it to be as bad as it is now. Before covid it was bad, but it never seems to get any better.
"As many ambulances as you put on, you can never fill demand. I feel frustrated. At the end of the day, we've got family out there who need ambulances sometimes, and we're queueing outside at all the hospitals. They're all as bad as each other.
"The controller is shouting out constantly for people to clear if possible to go to these category one calls that are high priority, and you've got this constant guilt of, you know, do you wait in the corridor with a patient who might be really poorly and frail and has got no one there with them, or do you go and say to staff, 'You need to take my patient because I need to go'?
"There have been times when NWAS has told us to leave the patients on the corridors. Some crews have just walked out and left quite vulnerable patients on the corridors. It's a difficult position for us to be in because we know what the risk is outside in the general public, but we're also mindful that the patients in front of us might need us to help them while they're on the trolley."
They added: "It's horrendous. It plays heavily on you because, if that was my family who aren't getting ambulances, I'd be furious. On a regular basis, we're going to people who've been on the floor for 10 hours with broken hips, and because they've been inside, it's not a priority call, it's put way down the list of calls we need to respond to.
"It's infuriating for us, and also we're getting a lot of verbal abuse off the families when we get there because they're, absolutely understandably, upset. But once we've explained to them that there's just not enough of us and it's not that we're standing around on the station doing nothing, we're actually with patients in the corridors - and especially when we take them to hospital and they see the long line of paramedics waiting in the corridors - they can't believe it."
Staff shortages are a major problem across the NHS. There were more than 130,000 vacancies across secondary care in England, according to the British Medical Association (BMA). Roughly 40,000 of these are for nursing roles, with more than one in 10 unfilled, and the shortfall continues to grow. The BMA said: "High vacancies create a vicious cycle. Shortages produce environments of chronic stress, which increases pressure on existing staff, and in turn encourages higher turnover and absence."
The paramedic who spoke to the ECHO said "staff are leaving in droves", with 10 of their colleagues leaving for jobs in the private sector or in GP surgeries in the last 12 months. Those who remain, which is still not enough to run all potentially available response vehicles, are working under additional pressure.
Overstretched ambulance workers can go eight hours of a 12-hour shift without meals, they said, although NWAS claimed the numbers missing breaks entirely are small. But burnout is happening among staff across the NHS. Earlier this year, another Merseyside paramedic told the ECHO ambulance workers were "coming back crying" as 50% report suffering burnout.
Speaking this week, the paramedic told the ECHO: "colleagues are very stressed out, they're hungry and they're tired, and this is when mistakes happen", adding: "I don't know how something awful hasn't happened so far."
NWAS has welfare vehicles providing drinks and snacks to crews outside hospitals, and it plans to make a dent in staff shortages by hiring nearly 400 paramedics and emergency medical technicians this financial year, running from April 2022 to March 2023. In the short-term, they're plugging gaps with overtime and its own staff, which a spokesperson said it looks to do before relying on private ambulance services.
Like other NHS workers, many of whom have been offered a 4% pay rise - a real terms pay cut given high inflation - paramedics are being balloted for strike action after years of stagnant wages. Unions have warned staff shortages and burnout can't be tackled unless pay awards fairly compensate health workers
An NWAS spokesperson said: "The ambulance service remains under extreme pressure. However, our staff work hard every day to ensure everyone who needs an ambulance gets one, and we continue to perform better than other parts of the country. While patients suffering from life-threatening conditions will receive the next available ambulance, some patients are waiting longer than we would like.
"We continue to recruit more call handlers and clinicians into our emergency and non-emergency call centres and more front-line ambulance crews. We also continue working with NHS partners to ease handover delays. We are grateful to patients for considering alternatives for non-urgent health concerns, including NHS 111 online, GP or local pharmacy, which helps us keep our ambulances available for emergencies."
Dr Fiona Lemmens, deputy medical director of NHS Cheshire and Merseyside, said: "As is the case in many parts of the country, we are currently experiencing significant pressures across all services as we deal with the backlog arising from the Covid-19 pandemic along with the growing impact of seasonal flu and continued Covid-19 infections.
"We are entering a challenging winter period and at times this is resulting in longer handover times for ambulance crews at our hospitals. We apologise for the impact this has on patients and their families and want to assure them that patient safety is our top priority.
"Our staff are working in challenging circumstances and we want to thank them for their continued dedication to their patients and the wider community. As well as the challenges for staff and patients in the ambulance service and emergency departments, there is also significant pressure in other areas including social care and because of this we are working collaboratively with partners in all parts of the health and care system to address the delays people are experiencing.
"We would encourage people who are eligible to get their flu vaccination and Covid-19 booster as soon as possible and to help us by doing what they can to stay well, this not only benefits the NHS but everyone across Cheshire and Merseyside. NHS services remain open and available for everyone who needs them this winter and we would encourage those who require urgent medical help to continue to come forward."
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