Ambulance staff stuck in A&E are missing thousands of 999 calls a day in England

Paramedics in England are unable to respond to 100,000 emergency 999 calls every month as they wait outside hospitals to transfer patients, putting thousands of lives at risk, the Guardian can reveal.

As the crisis engulfing the NHS intensified this weekend, figures show ambulance staff are being stuck in A&E for so long that they are unable to respond to a 999 call for help more than 3,500 times a day.

A total of 1,313,218 jobs were lost in the past year as a direct result of ambulance handover delays, an analysis of NHS data by the Guardian and the Association of Ambulance Chief Executives (AACE) has found.

Doctors said the figures were “staggering” and called on ministers to take immediate action to tackle transmission delays.

Patient groups said it was “incredibly frightening” that paramedics could not respond to thousands of emergency calls as they queued outside hospitals.

The revelations follow a Guardian investigation which revealed how more than a thousand patients a day experienced “potential harm” while being left in the back of ambulances outside hospitals.

In total, ambulances waited outside emergency departments to transfer patients for 1,641,522 hours in the year to November 2024.

Anna Parry, the chief executive of AACE, which represents the bosses of England’s ten regional NHS ambulance services, said the data shows how important it is that transfer delays are reduced.

“Lost job cycles are having a profound impact on the resources available to local ambulance services,” she added, with “the most damaging impact” on 999 patients with life-threatening conditions “who need us most.”

Patients who have had a heart attack or stroke have to wait far too long for emergency care, and vulnerable elderly people in some cases spend the entire night on the floor after a fall.

The crisis is caused by rising demand for emergency care, staff shortages and a lack of social care beds, meaning overcrowded hospitals cannot discharge patients who are able to leave, so it is difficult to admit patients who are outside waiting in ambulances.

Dr. Sonya Babu-Narayan, clinical director at the British Heart Foundation, said: “This inevitably has a knock-on effect with ambulance staff caring for patients in hospital unable to get to the next call.

“This desperate situation becomes all the more urgent as the NHS grapples with the enormous challenges it faces this winter.”

Every minute that passes when someone has had a heart attack or stroke risks further damage and even death, she added. “No patient and their family should have to endure dramatic delays, and it is a tragedy to see this happen on such a large scale.”

According to national guidelines, patients arriving at the emergency department by ambulance should be transferred to the care of emergency staff within 15 minutes. However, the target is continually missed, according to the Guardian’s research.

A total of 42.2% of patients arriving at hospitals in England last week waited at least 30 minutes before being transferred to A&E – the highest figure so far this winter.

Over the past two weeks, a crew had to wait eight hours outside a hospital to transfer a patient before they could leave for another 999 call, a paramedic told the Guardian.

Helga Pile, head of health at Unison, Britain’s largest health union, said ministers’ failure to invest properly in the NHS for years has left staff “exhausted” and “frustrated at not being able to do more”.

Dr. Adrian Boyle, president of the Royal College of Emergency Medicine, said the number of 999 calls to which crews were unable to respond because they were stuck in hospitals, as shown by the data analysis, was “staggering”.

“It is demoralizing to my staff that we appear to have gone backwards from where we were last year,” Boyle added.

After Jayne Bolton, 63, from Wiltshire, was admitted to hospital last year with volvulus, a serious condition where the bowel twists and cuts off the blood supply to the organ, she was told to call 999 immediately if she developed symptoms again.

Bolton vomited and experienced severe pain again in September. He called 999 but was told no ambulances were available. She only reached the emergency room when a neighbor agreed to drive her, and subsequently spent almost a week in the hospital. “They need to take the hierarchy to the front lines to see what is really going on,” she said.

Louise Ansari, the chief executive of Healthwatch England, a patient group contacted by Bolton, said ambulance handover delays were “becoming the norm”.

Juliet Bouverie, the chief executive of the Stroke Association, said even stroke patients were “desperately waiting for an ambulance” while crews were “parked outside hospitals due to significant transfer delays”.

The situation was “unacceptable,” she added. “Not only is this incredibly frightening for patients and their families, but it also puts their lives and chances of recovery at risk… we cannot abandon people with suspected stroke in this way.”

NHS England said transfer delays had improved before the winter, but accepted there was “clearly much more to do” to reduce “unacceptably long patient waiting times” in some parts of the country. It was “prioritizing the sickest patients,” a spokesperson added.

The Department of Health and Social Care said its plans to ‘rebuild’ the NHS would allow ambulances to ‘arrive on time again’, but did not specify new measures for emergency care.

A spokesperson added that previously announced social care reforms and a pledge to recruit 1,000 additional GPs would help “relieve pressure on ambulance services”.

However, Patient Association chief executive Rachel Power said immediate solutions were needed to end the emergency room crisis “to ensure patients can get the care they need without unnecessary delays”.

The Guardian investigation has clearly revealed how persistent delays in transfers prevented crews from answering thousands of 999 calls and “continued to put patients’ lives at risk”, she added.

“Every minute counts when it comes to emergency care, and the longer patients remain without help, the greater the risk of harm. The government cannot afford to ignore this issue any longer.”