The Welsh Ambulance Service has recorded its worst set of response times to life-threatening calls in its history, latest figures have revealed. In some parts of Wales more than 60% of the most urgent 'red' calls were not reached within the target time of eight minutes.
Significant delays in response times are most often due to backlogs at overcrowded A&E departments, resulting in patients having to wait in ambulances outside. There have been reports of patients waiting almost two days in a vehicle before being handed over to hospital staff.
The Welsh Ambulance Service's executive director of operations, Lee Brooks, confirmed that in October alone the NHS trust lost almost 29,000 hours to handover delays - this has more than trebled in the past two years. The clock for handover delays starts 15 minutes after an ambulance arrives.
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Mr Brooks added that while ambulance crews reached more patients in eight minutes than in October 2021, demand for red calls has risen substantially.
"Emergency ambulances are to deliver lifesaving immediate care and to take patients promptly to hospital for treatment, so it's as frustrating for us as it is for patients when we can't deliver that part of our service. Hospital handover delays remain the single biggest reason we cannot get to some patients promptly," he admitted.
"Despite record recruitment, including the creation of 400 extra posts in our Emergency Medical Service in the last three years, it is not enough to plug this lost capacity. We continue to do what we can to alleviate pressure by treating and triaging more patients over the telephone and in the community and referring them to other parts of the NHS, beyond the emergency department.
"A new roster system will ensure that our finite resources are better aligned to demand, now and in the future, and we are working hard to see up to 100 additional frontline workers operational from late January. In anticipation of a really difficult winter, the public can help by only calling 999 in a serious or life-threatening emergency - help protect our precious resources for those who need us most."
In October only 48% of red calls - which includes cardiac arrests and choking - were reached within eight minutes which is down on the 50% recorded in September and the 50.7% in August. There were 4,545 red calls in total - the highest number ever - which equates to 12.1% of all calls. To put this into context four years ago in October 2018 there were just 2,044 red calls.
In Hywel Dda University Health Board just 39.3% of red calls were reached within eight minutes last month, and the only health boards to achieve more than 50% were Swansea Bay UHB (50.3%), Cardiff and Vale UHB (56.2%) and Aneurin Bevan UHB (56.4%). In addition, two-thirds (66.7%) of 'amber' call patients - which include strokes - took over an hour to reach, with only 19% arriving within 30 minutes.
Meanwhile the performance in Wales' accident and emergency departments has also deteriorated. In October 66.6% of patients spent four hours or less in A&E - down on the 67.9% in September and 67.1% in August. Eight major hospitals saw fewer than 60% of A&E patients within four hours. At the other end of the scale 11,030 patients spent 12 hours or more in the units which equates to 12.1% - up on last month (11.8%).
Dr Suresh Pillai, vice president of the Royal College of Emergency Medicine Wales, warned there could be many more patients who wait for over 12 hours that are masked by clinical and operational exclusions, classified as breach exemptions.
"We have written to Health Minister Eluned Morgan to ask that these real patients, facing exceptionally long waits, are included in the data. It is vital that the Welsh Government are transparent about the number of patients facing these harmful long waits for the sake of patient safety, and so we can begin tackling the root of the issues facing the system.
"Extremely long waits are distressing for patients; they can affect their condition and their care. Studies show long waits are associated with patient harm and morbidity. Our hardworking emergency medicine staff are doing their utmost to keep patients safe and doing all they can to continue delivering effective care. However, the crisis and the conditions are contributing to widespread staff burnout and exhaustion. Morale remains very low among the workforce."
Dr Pillai said he was "deeply concerned" at the incredibly high levels of bed occupancy, up to nearly 96% in some cases and far exceeding the recommended 85%. He added: "Many patients reside in hospital who are medically fit to be discharged but are unable to be due to a lack of social care support in Wales.
"Staying in hospital once treatment is complete can be uncomfortable and can carry risk for patients. Ultimately, patients staying in hospital beyond their care creates a 'traffic jam' in the system leading to queues of patients waiting to be admitted, waiting in emergency departments, waiting in ambulances outside EDs and waiting in the community for ambulances. The system is not functioning as it should, and we know patients are coming to harm as a result."
It was a similarly bleak picture when it came to NHS waiting lists for planned appointments and procedures. In September a record 754,677 'patient pathways' were awaiting elective treatment. The Welsh Government estimates this is around 590,000 individual patients - an increase of about 2,100 on the previous month.
Some 57,284 patient pathways on the NHS waiting list have been on it for two years or more, falling for the sixth consecutive month but still double the figure a year ago. September saw in excess of 99,000 patient pathways close which is in line with pre-pandemic levels of activity and 6,000 more than the previous month.
Darren Hughes, director of the Welsh NHS Confederation, said: "Despite continuing to operate under huge pressure, the NHS in Wales has made progress in several areas in meeting demand for care. On average across the service, activity is at pre-pandemic levels.
"We know there's a huge amount going on to try and improve patient flow through the health and care system, to in turn reduce ambulance handover delays, emergency department waits and increase capacity for scheduled care.
"However, NHS leaders know there's a long way to go before performance is at the levels that we all want to see. There's no doubt that staff working on the ground are doing all they can to treat patients as quickly and safely as possible, and NHS leaders understand the frustration of staff who feel their efforts can't go far enough.
"To make further progress in tackling the backlog of treatment, further capacity must be created in the system, starting with social care. Without a sustainable, long-term funding strategy for social care to support people stay well at home and enable patients to leave hospital, there is only so far efforts can go.
"We know this is shaping up to be a perilous winter and we need to offer NHS staff hope in the gruelling months ahead. We urge the public to play their part, with those eligible taking up the offer of flu and Covid vaccination and those who aren't in immediately life-threatening situations to consider alternative options to emergency care, such as visiting NHS 111 Wales."
A Welsh Government spokesperson said: "Our NHS continues to face unprecedented demand and is seeing thousands of people every day. In hospitals alone, more than 361,000 consultations were carried out in September. Over 99,000 patient pathways were closed in September, back to pre-pandemic levels and 6% more than August.
"Progress continues to be made on the longest waits. The number of patient pathways waiting more than two years for treatment has fallen for the sixth month in a row and is down by 19% since the peak in March. Waits over 36 weeks also went down in September, by 3% compared to August.
"Primary care, ambulance and emergency department staff remain under intense pressure. As an example, October saw the highest number and proportion of 'red' immediately life threatening calls on record. A further indication of the complexity of patient need is the number of patients admitted to the same or a different hospital following attendance at a major emergency department, which was 27.1% higher than September 2022.
"Whilst we acknowledge ambulance performance is not where we expect it to be, we are driving improvements, including extending same-day emergency care services to open seven days a week, managing calls better to reduce hospital admissions and recruiting more staff. Without all this the pressure on the system would be even greater."
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