UK Scandal: patients in ambulance 'holding patterns'

[Guest guest]

Scandal of patients left for hours outside A & E

· Ambulances delayed to meet targets

· Emergency care at risk, say doctors

Denis , health correspondent The Observer, February 17 2008

Hospitals were last night accused of keeping thousands of seriously

ill patients in ambulance 'holding patterns' outside accident and

emergency units to meet a government pledge that all patients are

treated within four hours of admission.

Those affected by 'patient stacking' include people with broken limbs

or those suffering fits or breathing problems. An Observer

investigation has also found that some wait for up to five hours in

ambulances because A & E units have refused to admit them until they can

guarantee to treat them within the time limit. Apart from the danger

posed to patients, the detaining of ambulances means vehicles and

trained crew are not available to answer new 999 calls because they

are being kept on hospital sites.

Last night the practice was condemned by doctors and ambulance union

leaders and was described as a 'scandalous distortion of practice' by

one MP. Dr Steve Field, chairman of the Royal College of GPs, called

it 'absurd, entirely inappropriate and unacceptable'.

They were backed by Sam Oestreicher of the union Unison. 'A fully

equipped ambulance and a fully trained ambulance crew are effectively

babysitting patients when they should be out there dealing with

emergencies. Ambulances should not be used as mobile waiting rooms.

They should be freed up to do their job.'

Evidence of patient stacking is revealed in the official 'turnaround

time' data from seven of England's 11 regional ambulance services who

responded when asked for the figures last week. These show that delays

of at least an hour are widespread in the NHS. Figures relating to the

past 15 months show that a total of at least 44,000 delays were

reported by the seven ambulance services.

In London, there were 14,700 occasions last year when an ambulance

took at least an hour from its arrival at one of the capital's 35

hospitals to hand over a patient and be ready to respond to the next

emergency. This figure includes 332 that took more than two hours.

The Department of Health says an ambulance should arrive in 15 minutes

and, although it includes time taken to clean and restock a vehicle

after a patient has been handed over, ambulance staff say that takes

only five or 10 minutes.

'These figures show there's a terrible and colossal waste of ambulance

resources going on in many parts of the country,' added Oestreicher,

whose union represents about half the 30,000 ambulance personnel in

England. 'The...#8239;problem is that A & E units aren't admitting

patients who are in the back of ambulances if at all possible if it's

going to compromise the four-hour target that they are set by the

government to treat all patients in A & E. They are deliberately keeping

patients outside waiting in ambulances.'

The London Ambulance Service admitted last month that 'long turnaround

times at hospital did have a clinical impact as it meant patients were

waiting for an ambulance'. It has recently held a series of 'handover

summits' across the city, involving crews and A & E medical personnel,

to try to reduce turnaround times by five minutes each and thus boost

the service's availability of vehicles.

Norman Lamb, the Liberal Democrats' health spokesman, said the

accusations represented 'a scandalous distortion of practice to meet a

target that is meant to improve the service'. Lamb said that he would

be writing to Alan , the Health Secretary, to demand an urgent

investigation.

Dr Fielden, the chairman of the consultants' committee at the

British Medical Association, said: 'Undoubtedly some patients' care

will have suffered as a result of these delays. The vast majority of

patients coming into hospital by ambulance are in critical need of

urgent care in hospital and therefore delay in getting to that

critical care can worsen their outcome. That could include patients

with heart attacks, certain types of strokes, breathing difficulties

or trauma.'

The BMA claims A & E units are under pressure because of cutbacks in

the number of hospital beds.

A Department of Health spokeswoman said last night that 'these

statistics are based on only seven out of 11 trusts and measure the

time taken to turn around an ambulance for its next emergency,

including cleaning and restocking the ambulance ready to go back out

on the road. They do not reflect time spent by patients in the

ambulance before being admitted to accident and emergency. These

figures must be seen in the wider context of the 4.3 million patient

journeys undertaken by emergency vehicles in 2006-07.

'But it is clearly important that patients are handed over to A & E as

soon as possible after the ambulance arrives.'

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