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Written on 16th June 2022 by Susan Brown

Healthcare watchdog, HSIB, has called for immediate action by the Department of Health and Social Care (DHSC) to reduce the risk of harm to patients from delayed ambulance handovers to emergency care.

HSIB’s interim report, Harm caused by delays in transferring patients to the right place of care, sets out concerns identified during its ongoing investigation into patient safety risks caused by unacceptable delays in transferring patients from ambulances to hospital emergency care (A&E and ED). 

The interim report highlights the harm suffered by patients from deterioration in their condition or delays in access to necessary treatment during long waits in ambulances for emergency hospital admission. It points out that EDs (A&Es) are routinely at or above maximum capacity and this is affecting their ability to provide safe care.

The impact of delays caused by backlogs in the flow of patients through the healthcare systems not only affects patients awaiting admission to accident and emergency departments (A&E/ED) but also results in:

  • delayed responses to 999 emergency calls;
  • delayed responses to NHS 111 calls that require an ambulance response;
  • cancellation of planned surgery;
  • people staying in hospital longer than they need to.

The pressure on ED and ambulance services is also affected by problems with patient flow at all stages of the healthcare system, including delays in discharging people who no longer need inpatient treatment from hospital to community and social care.

HSIB referred to reports by The Association of Ambulance Chief Executives (AACE) which suggest that patient harm from these problems in hospital settings may include:  

  • delayed responses by ambulances which may have resulted in the patient’s death
  • extended waits for people in ambulances at EDs resulting in harm ranging from a deterioration in their condition to the development of new clinical symptoms, such as pressure sores;
  • people developing hospital acquired infections or becoming institutionalised due to unnecessary extended stays in hospital.

HISB’s findings so far

HSIB’s investigation is still continuing but it has published some early findings, based on its observational visits to ambulance services and acute hospitals, and conversations with national organisations and senior NHS healthcare staff.

In keeping with other reports, HSIB found that demand on services, the availability of beds and patient flow through acute hospitals to discharge to social and community care have affected the ability of ambulances to hand over patients to emergency care. 

HSIB acknowledged that work is being carried out by NHS organisations to relieve the emergency handover delays, such as:

  • the ambulance sector has worked on taking only those patients who need emergency care to an ED:
  • hospitals have tried to increase beds and capacity in A&Es/EDs to cope with growing demand.

However, HSIB point out that these organisations can only increase efficiency and make small changes within the area of the healthcare system which they directly control, with limited impact overall on patient safety.  Acute hospitals and ambulance trusts are unable to influence the problems affecting how patients are discharged to community and social care. The whole system must work together if patients are to be moved effectively from ambulances to EDs, through hospitals and out into the community and social care. Reducing harm to patients from delays in patient flow requires a nationally led, strategic and structured approach which recognises that the whole system includes healthcare and social care.

HSIB is also concerned that the impact on healthcare staff from delays in patient flow, including handover to emergency care, is not being measured. It is likely that working at or beyond their personal capacity with long-term exposure to highly challenging work environments may affect their ability to make safe decisions.

What happens next?

HSIB’s investigation continues. In the meantime it has called on DHSC to carry out an integrated review of the health and social care system to identify risks to patient safety from challenges in constraints, demand, capacity and flow of patients in and out of hospital and provide an immediate, strategic, national response to prevent further patient harm.

If you have suffered severe injury or the loss of a loved one as a result of delayed or negligent medical care, and would like to find out more about making a claim for compensation, you can talk to one of our solicitors, free and confidentially, by contacting us here.