OAfter a cold and gray afternoon last week, senior paramedic Glenn Carrington was once again confronted with a familiar but grim situation: waiting four hours in a queue of ambulances outside a city hospital, waiting to transfer a patient.
There was no risk to the patient on this occasion, but for Carrington, who has been a paramedic for almost four decades, the warning signs were clear: the NHS was beginning to slide into another winter crisis.
“The reality is that the wait in the back of the ambulance is starting to increase,” said Carrington, 58, chairman of the Unison branch of the East of England ambulance service. “There is winter flu, a rising number of Covid cases and not enough staff.
“The worst thing is waiting with a patient in an ambulance and watching them deteriorate. It's heartbreaking.”
In January, Prime Minister Rishi Sunak outlined a plan to “de-bottleneck” and reduce waiting times, which was heralded as “one of the fastest and longest-lasting improvements in emergency waiting times in the history of the NHS”.
The plan – which includes 5,000 new beds, faster ambulance response times and shorter waiting times for accidents and emergencies – was intended to help prevent another winter crisis.
But like the Observer This weekend it appears that the main objectives of the plan have not been achieved. The latest figures show that in November, 42,000 patients spent more than 12 hours in A&E waiting for a bed after deciding to be admitted.
Separate figures published by NHS England on Thursday confirmed Carrington's experiences of increasing delays on the frontline. The data published on Thursday showed that 15% of ambulance transfers involving 12,797 patients in England in the week to December 10 were delayed by more than an hour.
This was an increase from 9%, or 8,239 patients, a fortnight earlier, according to analysis by PA Media, although officials warned the figures were not directly comparable.
“We are in a very similar situation to last year, with insufficient capacity and insufficient workforce,” said Dr Tim Cooksley, a consultant in Manchester and former president of the Society for Acute Medicine. “I think the winter will be just as difficult as last year. It will be bad for patients who have to spend very long periods in the corridors and suffer delays, causing harm to them despite the best efforts of staff.
“It is remarkably difficult when you come to work and see patients in the hallway who have been there for a long time. It is harmful to the patient and it is difficult for staff to work under these conditions.”
Cooksley added: “Morale is extremely low. We cannot continue with short-term plans that cannot be achieved within the time frame.”
Sunak has come under fire from Labor and the BMA doctors' union for failing to keep promises he made in January. The BMA said the government has failed to deliver 5,000 new beds based on the latest figures, but NHS England believes it is close to delivering the extra capacity.
Ambulance response times have improved compared to last year, but Sunak's plan target of responding to Category 2 calls within 30 minutes on average by 2023/2024 has not been met. And there are still long waiting times for emergency room trolleys.
Tim Gardner, deputy director of policy at the Health Foundation, said waits of 12 hours or more were rare a decade ago, but in November there were around 1,400 a day in England, similar to November a year earlier.
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“It indicates that hospitals are operating at full capacity and are having difficulty discharging patients,” he said. “On average, around 13,000 hospital beds are occupied every day by patients who no longer require acute care.”
Gardner said these patients were stuck in the hospital due to delays and shortages in the community care needed to support them.
He added that the extent of winter challenges would be influenced by the number of flu and Covid cases, as well as cold weather conditions. The NHS also faced strike action by trainee doctors for three days next week and six days from January 3.
“An annual winter crisis does not have to be inevitable,” he said. “Just because there are no short-term quick fixes doesn't mean there aren't any solutions. But it does require sustainable action in the longer term.”
Jessica Morris, a fellow at the Nuffield Trust, said the latest weekly winter performance figures showed the NHS was under severe pressure. She said: “The last few months have followed a similar trajectory to last year, and we know that A&E waiting times peak in December.”
Professor Philip Banfield, chairman of the BMA council, said: “We are still short of beds, have huge gaps in timetables and patients are not getting the care they need or deserve. The waiting list is still unfathomably long, cancer and emergency services performance targets are not being met and ambulance handover delays are unacceptable. Meanwhile, demand and workload in general practice are unsustainable.”
Banfield said doctors were the solution to the challenges, not the problem. The narrative had to shift from doctors as an expense that the country could 'only afford' to a necessary investment.
Carrington is not criticizing doctors for the delays, but the paramedic says collective action is needed to recruit and retain staff and improve working conditions. “We don't blame the hospitals, nor do we blame the doctors,” he said. “But it will be a terrible winter.”