Ambulance crews queued outside Norfolk hospitals for more than 2,000 hours last month
More than 2,000 hours when ambulance crews could have been responding to other calls in Norfolk were lost due to delays in handing patients over at A&E last month.
New East of England Ambulance Trust (EEAST) figures seen by this newspaper showed crews lost 1,224 hours queuing at the county’s busiest hospital, Norfolk and Norwich University Hospital (NNUH), in January.
And an extra 634 and 194 hours were lost at the Queen Elizabeth Hospital (QEH) in King’s Lynn and James Paget University Hospital (JPUH) respectively.
The NNUH had the most hours lost across the six counties covered by EEAST.
The second worst-performing trust for hours lost was Watford General Hospital, with 660 hours.
But NNUH also had the most ambulance arrivals in January with 30,328 turning up at the front door, a decrease of just 0.3pc on 2016/17.
A spokesman for NNUH said this meant an average of one ambulance arrived at the hospital every eight minutes. He said: “This puts considerable pressure on the hospital and our staff have done, and continue to do, a fantastic job.”
Both the JPUH and QEH saw a rise in arrivals on the year before - 15,884 ambulances arrived at JPUH in January, a rise of 3.7pc, while 14,868 arrived at QEH, a 3.4pc increase.
Chief operating officer at JPUH Graham Wilde said: “We continue to be extremely busy at our hospital and are constantly working closely with all our health and social care partners, with the aim of ensuring that our patients continue to receive safe care.”
QEH chief operating officer Ciara Moore added: “The more patients conveyed to hospital by ambulance the greater the pressure on our A&E department. We are working with our partners across the healthcare system to ensure patients are treated in the most appropriate setting while reducing pressure on A&E.”
Handover delays have been attributed as a major factor in causing delays in responding to patients who call 999 and hospitals were ordered to accept prompt handover at a risk summit held by NHS officials last month.
The target is for ambulance crews to be able to hand patients over to A&E within 15 minutes, but if the department is full or staff are too busy this cannot be done.
EEAST have now introduced a new procedure, starting next week, to get ambulances back out on the road as soon as possible.
A spokesman said: “It sets out clear escalation procedure if ambulance crews have to wait longer than 15 minutes to handover a patient at hospital. If the patient is waiting for more than 30 minutes, hospitals and ambulance crews are to work in partnership to ensure safe transfer.
“We have also agreed with our commissioners a significant increase in funding, to invest in more staff and vehicles, and we have already increased the number of ambulances by eight across the region daily.
“As a system we are continuing to work with our partners to improve how we respond appropriately to emergency calls across our communities.”
And the NNUH has become the first hospital in the region to agree an immediate handover policy.
A spokesman said: “The average length of time an ambulance spends at our hospital is much shorter than at other hospitals not yet employing this protocol. In addition, we have taken steps to find alternative routes for patients to be transported to hospital. For urgent GP referrals to our emergency services, we have arranged transport through an alternative provider. Since January, this project has delivered a two-thirds reduction in the numbers of these patients utilising an ambulance, helping to free up crews and vehicles to attend emergency calls in the community.”
Before the implementation of the immediate handover policy last month, just 18.4pc of handovers at NNUH were done within 15 minutes and there were reports of hours of waits outside all three hospitals.
At QEH 14.4pc of patients were handed over within the target time and at the JPUH the number was 50.8pc.
At all three trusts data showed patients waited longer, on average, than they did in 2016/17.
Patients at NNUH waited an average of 28 minutes to be handed over last year, compared to 41 minutes this year.
At the JPUH it was an average of 20 for 2016/17 against 21 for 2017/18.
While at the QEH the average jumped for 31 minutes last year to 38 this year.
The data also showed that in December the percentage of patients waiting in ambulances for more than an hour was at the highest level since 2014.
Improvements to be made at QEH
Last year the QEH was given a number of recommendations by NHS Improvement, the body tasked with overseeing trusts.
Clinical experts visited the A&E and found it “works at a different pace to the rest of the organisation” and that “inpatient areas do not respond as swiftly as they could to pressures” in A&E.
They felt crowding in A&E was unsafe, and there were not enough consultants to allow one to manage each area of A&E.
And they were also told access to cleaning was an issue, with one cubicle on October 22 being out of action for six hours while waiting to be cleaned - and another could not be used for an hour and half during their visit.
On the visit they also found nurses were not allowed to request x-rays, and patients who were well enough to be brought into the department by wheelchair were instead brought in using an ambulance trolley, as crews were told the hospital’s wheelchairs were not safe to use outside.
There was also not a “consistent focus” to keep patients off trolleys and sit if appropriate.
They made a number of recommendations, which the trust’s chief operating Ciara Moore said were being implemented in full.