Local hospitals turning away ambulances because they are at full capacity, research shows

SMP Healthcare

The Pennine Acute Hospitals Trust, which runs Rochdale Infirmary, Royal Oldham Hospital, Fairfield General and North Manchester General, were one of five organisations accounting for approximately half of all the reported diversions during the winter, a report by Nuffield Trust found.

The other four trusts were Northumbria Healthcare, County Durham and Darlington, South Tyneside, and Worcestershire Acute Hospitals.

Pennine Acute is one of the largest Acute NHS Trusts in the country running three category one A&E departments in North Manchester, Oldham and Bury, and an Urgent Care Centre in Rochdale.

According to reports published by NHS England each year during winter, 478 diversions for last winter (2016/17) took place: 80 percent more than the previous year’s figure of 265 diverts. In comparison, only 225 were diverted in 2013/14.

For Pennine Acute, 89 diversions took place between 1 December 2016 and 28 February 2017. 85 of these were diverted internally between the Trust’s four hospitals, with only four patients being diverted outside the organisation to another NHS Trust.

Nuffield Trust say this is ‘an indication of mounting pressure on emergency departments and an added difficulty for the ambulance service in transporting patients’.

A spokesperson for The Pennine Acute Hospitals NHS Trust said: “On occasions when one of our A&E departments is too busy to take more ambulances, we routinely agree with ambulance crews to take a patient to one of our other local hospital sites as an ambulance ‘internal divert’ to ensure patients are seen by our doctors as quickly as possible.

“This approach means that we can use our staff and internal operational arrangements flexibly and is best use of resources. These are not classed as diverts in the true sense that may be the case in the rest of the data presented in this report. An internal divert is usually for an hour or two.

“During the 13-week winter period between 1st December and 28th February, we only diverted four patients outside of the organisation to another NHS Trust.

“Under arrangements agreed with the ambulance service and all NHS Trusts across the region, the most serious cases, including patients for example who are having a heart attack, are not diverted at all and are brought by ambulance to any A&E.

“Sometimes diverts are activated by the ambulance service as it may be more appropriate to take a patient to an alternative hospital site where the ambulance would be able to handover their patient in a timely manner; not undertaking such a system-wide approach could lead to longer delays for patients and staff with ambulances unnecessarily queuing at an already busy unit.

“Unlike many rural areas in the North of England, within a conurbation such as Greater Manchester the distances between hospitals may not represent the time element that would affect a more rural setting so any direct comparisons can be misleading.

“Our A&E departments have continued to face real pressures throughout the year and we know demand on our services further increases over winter. This report reflects the day to day pressures and challenges staff in our emergency departments and ambulance crews are facing.

“We continue to work closely with our colleagues in primary care, community care and social services to improve patient flow in and out of our hospitals and to speed up treatment and discharge for our patients which in turn takes off the pressure in A&E.

“We are also investing in our frontline services including in our A&Es and are actively recruiting more nurses and doctors as part of our improvement journey. Our priority continues to ensure patient safety and our staff always prioritise those who require urgent attention.”

Professor John Appleby, who lead the Nuffield Trust research, also found there was low morale amongst ambulance staff, with many feeling there are not enough staff to enable them to do their job properly.

Ambulance staff also felt they found it hard to meet conflicting demands on time.

The National Audit Office found ambulance services are finding it ‘increasingly difficult to cope with rising demand for urgent and emergency services’.

Around 500,000 ambulance hours were lost in 2015/16 due to turnaround at A&E departments taking longer than 30 minutes. This equated to 41,000 ambulance shifts of twelve hours.

Patient transfer from ambulance to the department is expected to take no longer than 15 minutes, with a further 15 minutes to prepare the ambulance for the next call.

Between 2009/10 and 2015/16, the number of ambulance calls and NHS 111 transfers increased from 7.9 million to 10.7 million. Increased funding for these services has not matched rising demand, and future settlements are likely to be tougher.

The NAO report also found ‘a general consensus placed too much focus on response times’ from commissioners, regulators and providers.

Currently there are three main response time targets, based on the urgency of the calls received- Category A, Red 1 and Red 2.

Category A calls are split by urgency into Red 1 (the most time critical, including cardiac arrest patients who are not breathing and do not have a pulse) and Red 2 (urgent, but less serious incidents).

95 percent of all Category A calls must receive a response with an ambulance at the scene of the incident within 19 minutes.

75 percent of Red 1 and 2 calls must receive a response with an ambulance at the scene of an incident within eight minutes.

In January 2017, only 88 percent of Category A calls met the standard. Red 1 and Red 2 also fell short of the 75 percent target with 67 percent and 58 percent, respectively.

All three targets were only met six times since January 2013: in April, May, June and August of 2013, and again in January and March of 2014.

No response time target has been met since May 2015.

Original article 7th April 2017: