Beds blocked, queuing ambulances, lost patients – West Midlands 999 crisis latest

City and Walsall hospitals are facing an influx of ambulances from across the region after being identified as the quickest places to drop off 999 patients. Dozens of ambulances a week are now being diverted there because nearby hospitals are ‘in distress’ and struggling to cope.

It’s leading to unforeseen consequences – with patients ending up in hospitals miles from home, and sometimes without relatives knowing. One family spent 48 hours not knowing where their sick relative had ended up, a meeting of Sandwell and West Birmingham Hospitals Trust was told.

City and Walsall hospitals have the best turnaround times for ambulances in the area, so inevitably they are getting more ambulances diverted there from places with long queues, the trust board meeting heard. At City and its sister hospital Sandwell, the equivalent of two and a half wards of patients are now from ‘out of area’ as a result.

READ MORE: Staggering 2,300 GP appointments unattended every day in the West Midlands – should they be fined?

The diversions – described as ‘intelligent conveyancing’ – are all part of the attempts to halt a feared collapse in 999 services. “This is the biggest clinical risk facing the West Midlands health services,” said hospitals chief executive Richard Beeken, who revealed it was discussed ‘daily’ at health service Gold command meetings.

The crisis in ambulance response times, reported with increasing levels of alarm by Birmingham Live since last year, has gradually worsened across the West Midlands, despite urgent calls for national action.

READ MORE: Medics fear health service ‘close to collapse’ as hundreds of 999 callers in ambulance queue

READ MORE: ‘Three minutes too late’ – ambulance delayed getting to cardiac arrest teenager

Patients with suspected strokes and chest pains (deemed category 2) are now routinely waiting an hour or more for a crew to turn up. Some patients with broken bones, victims of falls or other incidents, have been left stranded, sometimes overnight.

Latest data shows how the West Midlands service, normally one of the best performing in the country, has seen response times slip drastically. Category 2 patients should ideally be reached within 18 minutes – instead, the response time average in April was a shocking 55 minutes. For 10 per cent of patients, the wait was over two hours.

Frustrated ambulance chiefs say the delayed response is NOT down to increased demand or more callouts but down to delays in getting patients out of ambulances and into hospitals. On Tuesday this week the ambulance service reported hold ups that amounted to a combined 2,100 hours of delays, the worst day on record.



Richard Beeken, CEO at Sandwell and West Birmingham hospitals NHS Trust

Every hospital in the region has now been ordered to make solving the issue a top priority, after senior ambulance service director Mark Docherty warned of an impending meltdown. Docherty, director of nursing for West Midlands Ambulance Service, told Birmingham Live that patients were ‘dying’ because of delays in ambulances getting to them.

He later warned the 999 service could collapse entirely this summer if urgent action was not taken, with August 17th his calculated ‘tipping point’ into chaos.

Meeting this week (Wednesday), Sandwell and West Birmingham’s trust board heard how the two acute hospitals they run were trying to ensure they played their part in stopping that happening. Liam Kennedy, chief operating officer at the trust, said the West Midlands was seeing the highest number ever of ambulances stacked at hospitals, and the number of Category 2 calls not attended in time were “at levels never seen before.”

In City and Sandwell, work to address this had included ensuring patients were rapidly reviewed on the back of the ambulance. Some were taken in as priority cases, others moved into A&E to sit and wait.

A new system had also been introduced to ‘cohort’ patients brought in by ambulance into a designated area of ​​A&E, under the care of a single paramedic, until medical staff could treat them. As a final resort, some patients would also be brought in to wait on beds in a corridor area, with dedicated nurses.

Other measures included streaming patients arriving at A&E and diverting some to assessment units and urgent care centers, or to other parts of the hospital. The opening hours of the urgent treatment center in Sandwell have been extended, and extra GP provision added at City hospital, giving the equivalent of 40 hours extra support.

A £ 1 million support package to help fund further improvements had also been mooted, though details were yet to be confirmed, the meeting heard.

But while their efforts were working, other hospitals in the area were still facing huge problems, he said. “In April there were around 830 conveyances (in the local area) – of those 350 went into City or Sandwell, or 41%,” he said. This was because ambulance controllers, aware crews were already struggling to offload patients at other hospitals, were choosing to send them a longer distance knowing they would get hospital care sooner.

Mr Beeken, as well as trust Chief Executive, is also the urgent care senior responsible officer for the Black Country. He said the role had “opened my eyes to the reality of this very concerning problem through the lens of individual patient stories.” The impact particularly on Category 2 patients was profound, “waiting multiple hours without being responded to.”

He added: “In the West Midlands area we have the lowest ambulance conveyance rates to hospital in the entire country (meaning the proportion of 999 patients who end up being taken to hospital). We have only seen a 1% increase in 999 call activity to the ambulance service overall and not had a significant increase in ED attendances or emergency admissions. And yet performance continues to deteriorate. “

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When asked why this was, he said: “In general terms in the West Midlands and the Black Country it is a result of exit block from the hospital, particularly, but not exclusively, for those on complex discharge pathways.” But he said there was also felt to be a general increase in the level of patient illness and dependence when they get to hospital, often meaning they stay longer.

“We try to mitigate that … but there is no magic bullet here.”

Hospitals say difficulties in getting some patients discharged once they are well enough – known as bed blocking – is causing lengthy delays at the front door. Recent figures back that up. At the end of April, there were more than 260 patients who were deemed ‘fit to discharge’ stuck in hospital beds at University Hospitals Birmingham. Across Birmingham and the Black Country, the total number of ‘bed blockers’ was close to 600.

Mr Kennedy highlighted the situation at neighboring Russells Hall in Dudley, where there were “over 100 patients that should not be in the acute setting, but they can not get them out; they then get backed up in ED, the ambulances are diverted towards us and we end up with Russells Hall patients. ”

He said the impact on City and Sandwell hospitals was beginning to tell. “Add two or three ambulances a day and it has an impact, add 12-20 a day, as we are now, and it’s a miracle we are still providing that turnaround.”

The Trust’s chief integration officer Darren Fradgley, a former paramedic, said the issue was “keeping everyone awake at night” in the ambulance service.

“Having been unfortunate enough to dial 999 a few months ago for a relative and agonisingly waiting, when you expect someone to turn up quickly and take control, the trauma on the patient and relatives is unbelievable, never mind staff. If ever there was a case for places to work together to disrupt flow and do things differently this was it. “

He said it was vital that all hospitals across the region battled to tackle the issue with the same ‘concern and pressure’ being shown at Sandwell and City.

Among the hospitals where handover delays are still high is Heartlands, part of University Hospitals Birmingham NHS Foundation Trust. Today a spokesperson said: “The Trust has been working hard on several initiatives to reduce handover delays. We have teams working to create new patient pathways, to decongest emergency departments and improve flow throughout our hospitals.

“Additional wards have opened, or are due to open, across our hospital sites to enable us to treat more patients. We are also working with our local health and care partners to develop out-of-hospital services, which will also help reduce delays . ”

Birmingham City Council, which provides social care provision, including post hospital support, said it was working closely with the ambulance service and health providers to prevent a collapse.

In a letter to West Midlands Ambulance Service chief Anthony Marsh, new cabinet member for health and social care, Cllr Mariam Khan, pledged to act swiftly to address the issue. She wrote: “Clearly the system is experiencing unprecedented challenges at the present time.

“We will individually and collectively have to challenge ourselves and our established ways of working… (to find solutions.) We recognize there is still more to do especially… taking earlier action to prevent people being unnecessarily taken to and then admitted to hospital care. ”

She has requested an urgent meeting to help ensure that the social care system in Birmingham is doing all it can to ease the burden on hospitals and the 999 service.

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