North West Ambulance Service (NWAS) Director of Operations, Derek Cartwright, said the Trust is facing a huge challenge to meet the eight minute response time after a 25 per cent increase in ‘Red’ calls this year – for those who have a life-threatening or potentially life-threatening conditions.
He also admitted people in pain with minor injuries might have to wait “some time” for an ambulance response, and is relying on volunteer groups to provide support during periods of high activity.
His concerns come as latest data from NHS England showed in September the health service nationally missed its A&E target to see, treat or discharge 95 per cent of patients within four hours.
Lancashire Teaching Hospitals NHS Trust, which runs the Royal Preston and Chorley and South Ribble Hospitals, achieved only 89.7 per cent and its chief executive has warned of further possible delays during busy spells.
Now Lancashire residents are being asked to do their bit in helping the services as the traditionally busiest time of the year approaches.
Mr Cartwright of NWAS said: “In previous years we used to see a peak of calls in the winter and this would then drop in the warmer months before starting to climb again as we approached December.
“This is no longer the case. We consistently see high levels of life-threatening 999 calls throughout the year so instead of dropping in the summer, it stays the same and then increases even further in the following winter.”
The Trust said it can’t explain the change. Mr Cartwright added: “We regularly publish the message asking the public to use us wisely and only in emergency situations and we’re very grateful to those who heed that message, but the non-urgent calls are not rising in the same way as the extremely urgent calls – those that do need an emergency ambulance response.
“This is by no means unique to NWAS , our ambulance colleagues around the country are seeing similar growth and we have to accept that this is unlikely to change and instead, change the way we operate so we can meet this demand.”
NWAS admits a national shortage of paramedics and changes to training of new staff has had an impact on staff resources, but filling vacancies has been one of its priorities during 2015 and since April, 186 road staff and 52 call centre staff have been appointed.
The Trust also recently announced a change to allow easier internal progression for Emergency Medical Technicians to become paramedics.
The Trust has also made changes to the triaging of 999 calls and claims improvements made to the organisation’s clinical structure has meant more people can be either treated at home or can be directed to a more appropriate healthcare service such as a walk-in or GP led centre.
Community Specialist Paramedics are also placed in areas where performance has been challenging, and there is a dedicated Frequent Caller team.
Mr Cartwright added: “The ambulance service has come a long way from the ‘scoop and run’ service it started out as.
“Clinical skills have vastly improved and we work much more closely with other support services, as the more help a person with long term conditions receives, the less likely they are to need an emergency ambulance.
“It is true that some patients, with minor conditions or injuries, while they might be in some degree of pain or discomfort, will have to wait some time for an ambulance response or will be advised on a more appropriate pathway of care, as we must prioritise our resources and send ambulances first to those potentially life-threatening conditions.”
Approximately half of the 999 calls received by NWAS are not classed as immediately or potentially life-threatening, and a proportion of these are referred to other services or can wait up to four hours for an ambulance response.
Mr Cartwright said: “Our priority will always be those in dire, urgent need, due to having only a finite number of resources, it has to be, but we need the public to help us to help them.
“If an ambulance crew attends to someone with a painful ankle injury – it can’t go to someone who in the meantime, has stopped breathing.”
To help with winter pressures, 16 additional ambulances and 19 rapid response vehicles have gone on the road and volunteer groups such as the Red Cross and St John Ambulance are providing support during periods of high activity.
“It is a circular challenge,” said Mr Cartwright.
“Our life-threatening calls rise, so we attend to and take more people to hospital, this results in a busy, pressured emergency department, which means our handover times can take longer and therefore we can’t get back on the road quickly enough to respond to waiting 999 patients.
“We work very closely with our Commissioners and NHS colleagues to tackle this and the introduction of Ambulance Liaison Officers in hospitals goes some way to help alleviate this pressure.”
Karen Partington, chief executive of Lancashire Teaching Hospitals NHS Foundation Trust said: “Our staff are already working hard to make sure we see and treat patients who need urgent care promptly, and that people receive their planned procedures on time.
“Whilst we put additional resources in place in readiness for the winter period, it is likely that patients will experience some delays during exceptionally busy spells.
“Families can support us to make sure we can admit and treat patients with urgent care needs, by working with us to ensure we can discharge people when they no longer need specialist hospital services. We also urge people to stay well this winter by getting their flu jab, taking medicines as prescribed, keeping warm, and making sure repeat prescriptions are organised for the Christmas period.”
Helen Curtis, head of quality and performance at NHS Chorley and South Ribble, and NHS Greater Preston Clinical Commissioning Groups said: “Whilst there are a number of initiatives in place that are helping, we really need the public to help us by using other NHS services. A&E is there to deal with real emergencies and saving lives.”