NHS Managers accused of leaving patients in ambulances to hit A&E targets
Don’t leave patients in ambulances to hit A&E targets, hospitals told
Hospital bosses have been ordered to stop putting lives at risk by making ambulances queue outside casualty wards to rig waiting time targets.
Hospital bosses have been ordered to stop putting lives at risk by making ambulances queue outside casualty wards to rig waiting time targets, a practice known as “stacking” Photo: ALAMY
By Robert Watts, and Laura Donnelly
9:15PM BST 27 Oct 2012
NHS managers are accused of leaving patients in the vehicles so they can meet the target to treat everyone within four hours of being admitted to accident and emergency.
They were warned they face tough action by the NHS regulator, Monitor, which said that hospitals that carried out the practice – known as “stacking” – were risking “serious implications” for the patients they are supposed to treat.
The message was disclosed amid mounting concern over the way some hospitals are meeting the four-hour target. By keeping the patients in the ambulances, hospital managers can attempt to delay the point at which the clock starts ticking.
The regulator – which has the power to sack NHS boards or issue fines – warns that where evidence is found that hospitals are carrying out the practice, the matter will be taken “very seriously”.
Figures obtained by The Sunday Telegraph show that the number of emergency patients who have had to wait more than half an hour to be transferred from an ambulance has risen by almost a third in just two years.
Although the practice developed under the last government, the number of these cases has risen by 20 per cent in the past year, according to statistics from more than half of Britain’s ambulance trusts.
The disclosures emerged as hospitals and ambulance crews prepare for winter pressures, with the flu season and worsening weather increasing the demand on services.
Monitor, the regulator of NHS foundation trusts, has now specifically warned hospitals against “gaming to meet health care targets”.
“Keeping any patient who requires hospital care in an ambulance for an extended period of time is clearly poor patient care and could have serious implications for patients with certain medical conditions,” it wrote in a letter sent to every foundation hospital.
Monitor said that the practice also stops ambulances responding to other patients “in need of urgent medical attention”.
“We would encourage all trusts to ensure that such practices are not taking place at your hospitals. Evidence of foundation trusts carrying out these practices would be taken very seriously by Monitor,” the letter warns.
It reminds trusts that the “clock” is supposed to start within 15 minutes of the ambulance arriving on site, even if the patient is not in A&E – meaning that attempts to dodge the target could backfire.
Making patients wait in ambulances is already described as “not acceptable” in Department of Health (DoH) guidance.
Figures obtained from six of Britain’s 11 regional ambulance trusts showed that there were 444,158 instances when an emergency patient was obliged to wait in an ambulance more than half an hour before being transferred to A&E last year – up from 340,355 in the final year of the Labour government.
David Flory, the deputy director of the DoH, wrote to senior NHS executives four months ago calling for a “zero tolerance” to delays in handovers from ambulances to hospitals.
“The unacceptably long handover times in a number of places is sufficient to warrant our focused attention,” Mr Flory wrote. “There should be no doubt that the delays have an adverse impact on patients’ experience of the service and may increase risk to patient safety.”
Andy Burnham, the shadow Heath Secretary, last night said the regulator’s warning was further evidence that the health service is in “increasing distress”.
“The sight of ambulance queuing outside A&E takes us back to the bad old days of the Tory NHS,” Mr Burnham said. “They are putting people at risk so they can tick Government boxes.”
Earlier this month the South Tees Hospitals NHS Foundation Trust, which includes the James Cook university hospital, announced an investigation following the death of a patient from cardiac arrest, after waiting two hours and 20 minutes with paramedics before being seen by A&E staff.
Mr Burnham said: “A&E isn’t coping because of the job cuts and now it’s being felt by the ambulance services. People in parts of the country are being left without adequate cover as ambulances are tied up at A&E.”
Katherine Murphy, chief executive of the Patients Association, called for “urgent action” to stamp out the practice.
“We do not see any place in the health service for targets to be used as an excuse for gaming or falsifying information,” Mrs Murphy said. “This is not safe for patients. There is no justification for patients being left in ambulances outside hospitals for any period of time whatsoever.”
Three years ago an investigation by The Sunday Telegraph revealed that thousands of 999 patients were being held in hospital car parks or diverted to other sites before they could even join the queue for urgent treatment. In some cases the delays were found to have lasted for as much as five hours.
Documents obtained under the Freedom of Information Act showed that Sir Graham Meldrum, chairman of West Midlands Ambulance Service, warned that patients are “being put at risk on a daily basis” by this practice.
They also revealed an investigation into the death of a patient who waited three hours to be seen by A&E staff after being taken by ambulance to The Royal Wolverhampton Hospitals Trust.
Meanwhile, DoH figures show that the number of patients who waited more than four hours in A&E has more than doubled between 2009/10 and 2011/12, from 353,617 to 724,938.
A spokesman for the DoH said it was “completely unacceptable” for sick and injured patients to be left waiting in ambulances.
He said: “This isn’t a widespread problem across the NHS, but those hospitals where there are long delays in getting patients into A&E need to take action to ensure that patients get the prompt treatment they deserve.