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Ambulance service a ‘deteriorating picture’ with hours lost to hospital handover delays

The number of hours lost by East Midlands Ambulance Service paramedics due to delays in handing over patients to hospitals is again on the rise. Hospital handover delays can lead to ambulance paramedics spending hours waiting to discharge patients into emergency departments.

The regional ambulance service, known as EMAS, covers Lincolnshire, Nottinghamshire, Derbyshire, Leicestershire, Northamptonshire, and Rutland. The problem was discussed at an EMAS board meeting on October 10.

In August, the service reported “significant improvements” in hospital handover delays. But the latest statistics for the first eight days of October show an increase in the number of ‘lost hours’.

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Ben Holdaway, the director of operations, said it was a ‘deteriorating picture’. He said many of the service’s delays are in Lincolnshire, with problems also arising with handing over patients at Nottingham University Hospitals.

The service said 3,180 hours were lost to handover delays in the first eight days of October. This is an average of 398 hours a day.

This is still a year-on-year improvement compared with 5,045 lost hours in the same period for October 2022. The service is also dealing with more incidents – with 639 more attendances in the first eight days of October 2023, than in the same period in October 2022.

Richard Henderson, EMAS chief executive, said the ambulance sector is under ‘significant pressure’. Of 23 safety incidents reported so far this year, eight were down to prolonged waits.

Mr Holdaway said the joint junior doctor and consultants strike from October 2 to 4 was also “difficult” for the service. He said: “We are starting to see hospital delays increase again although compared to last year, the amount of hours lost per day is lower.

“We are seeing a month-on-month increase over the last few months. f you look at last week alone, 50 per cent of all our hospital delays were in Lincolnshire.

“That creates a knock-on effect as we have to drift vehicles from other counties into Lincolnshire.” He added that Nottingham University Hospitals is the “new one on the block” with issues arising with handover delays.

Mr Holdaway said: “NUH is the one that’s causing the most issues which weren’t there last year. They weren’t on our radar at all but the step change was in September last year.

“Flow is the main reason there. They are unable to create as much capacity in A&E because of flow out through the door.”

Mr Henderson added that there were ‘spikes’ in the handover delays. He said: “It’s something we have grappled as an organisation for a long period of time. We did see some significant improvement. Now we are entering the autumn period it is becoming a significant challenge for us, certainly in Lincolnshire.

“My strong view is that activity should be dealt with in the 111 system and not the 999 system.” He added: “What is important is that we are held to account for things within our control, equally, we have to hold to account other parts of the system.”

Perminder Heer, non-executive director, said: “How are we working with the system to educate people on which is the right route to take instead of 999? That’s having a huge bottleneck into A&E.

“We’re firefighting and we will continue to firefight unless we can look at this. Otherwise, it is a cyclical situation we find ourselves in.”

Mr Henderson replied: “This is part of the national communications engagement exercise. What we are seeing is demand in the 999 system and self-presenting in A&E and that does compound the pressure when we arrive.

“There probably are examples of where people are using A&E where clearly they should be treated in other bits of the system.”

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