Catastrophic state of the ambulance service: what's behind it?

[tulips27]

Seeing the shocking and upsetting thread where the OP has been waiting for over 24 hours for an ambulance for her relative who has a broken hip I want to ask what has cause this state of affairs? How can this be possible in our country? Can anyone offer any insight?

(Link to the thread for those who have not seen it: www.mumsnet.com/talk/am_i_being_unreasonable/4701431-i-know-iabu-blatantly-using-this-for-traffic-emergency-situation-no-ambulance-still-and-need-advice )

How can it not be possible? Underfunding, overuse. Treating ambulances like taxis, fear of litigation for making the wrong call by not sending one. It's not a sustainable model anymore and the lack of investment and the abuse of the system mean it is, essentially, buggered.

Flow in hospitals, no carers so noones being discharged so no one can get in, so ambulances can't off load and they are stuck waiting to do so and can't go out and do more jobs.

The Tories have created this shit show, that's how.

And what @Everydaywheniwakeup says too sadly.

Tories.

People call ambulances for non-emergencies/an entitled society/no common sense
poor triaging and a risk averse society
an ever ageing/growing population but no infrastructure to support it
111 - poor triaging, risk averse
lack of GPs

twenty/thirty years ago ambulances were only ever called for life and death or serious injury emergencies ! Today we get sent to mainly urgent care jobs

Lack of social care for the elderly is a massive factor as I understand it.

and if you draw an arrow from that I imagine a big problem is the outrage about people paying for their own old age care by selling their properties that they can no longer live in.

and if you draw an arrow from that - it’s adult children wanting their inheritance.

there are a lot of factors obviously. But paying for old age care is a big one

and the tories philosophy of not believing in investing in public service

I should have added: and what's the solution?

This.

Exactly this. Our local hospitals each have dozens possibly even 100 patients waiting for nursing home or care packages to be discharged to, so the beds are stuck and nowhere to put the new sick / new fractures etc as they happen. Start paying carers double the wage and in a few weeks this could be dramatically improved. Problem is they’d have to increase nursing / AHP / junior medical
pay at the same time to stop them
all leaving!

Make caring an attractive job.

Really? Where have you been? Social care is broken which means we can't get patients out of hospital. If we can't get patients out of hospital we can't get patients into hospital either. If we can't get patients in to hospital they are stacked in ambulances not being off loaded. If ambulances can't offload their patients they can't get new ones.

That is without the staff shortages throughout the NHS - again if there are no ambulance drivers then patients will have to wait. People (Drs and nurses) are leaving faster than they are joining the profession.

What has caused it? Massive underfunding. Reducing the numbers of acute hospital beds in the NHS. Not paying nursing homes properly. The devaluing pound so no one wants to work here anymore. Brexit. Not paying carers and NHS staff properly. Not valuing NHS staff.

What else do you want to know?

No overall investment. Not enough social care, poor mental health services, overworked paramedics leaving the profession. Miss use of the service and poor/no effective rehab programmes. I believe its a social problem brought on by years of neglect and no forward thinking.

It was like this before the tories! This was happening when my dad first qualified as a paramedic over 30 years ago.

Meant to say: it didn’t change when labour came into government. It has been like this for decades but people either didn’t care as much because they didn’t have Boris / Sunak to blame or because they were unaware or because it didn’t affect them.
One of the above.

@Auntieobem Make caring an attractive job.

That's a very tough ask, isn't it? The way I see it as an outsider is that it is emotionally and physically demanding labour, long shifts and antisocial hours and all for minimum wage. Hats off to anyone who chooses it.

A lot of bed blocking. Adult social care on its knees. Covid causing a huge backlog of patients. An inability for people to get a doctors appnt so they’re heading to A&E. Then add strikes. What is the solution? God only knows. Probably wide scale euthanasia.

People living longer and living at home (rather than in care/ nursing homes) will mean there are more cases of elderly people having falls or otherwise requiring transport to hospitals. It’s difficult for many people to get to their GP so they ignore symptoms until they become serious enough to require hospital treatment or they are using ambulances and A&E in place of a taxi to the GP. Local hospitals have been closed or seriously downsized so that ambulances are having to transport people further distances and therefore can answer fewer calls and, with the cancellation of rural public transport services and the cost of living crisis, somebody on the poverty who lives 40+ miles from their nearest hospital will likely call an ambulance over a costly taxi even if in theory they could cope in a taxi. A&E departments are overworked and underfunded and can’t quickly or easily offload patients into hospital so are stuck in hospital car parks unable to move onto their next call. High levels of staff sickness due to staff burnout and difficulties in the nhs with retention mean fewer paramedics to drive the ambulances. The tories have underfunded and privatised vast amounts of the nhs so that now parts of it are in or near to crisis.

I had a 32 minute seizure this morning.
It took my husband 24 minutes to get through to an operator. Ambulance came luckily in 20 minutes. I got to hospital at just after 1.30PM.

I'm in a trolley in the hallway along with 16 other trolleys, that's not counting the ones outside and I haven't even seen the waiting room. And it's now 17.45PM. Once the paramedics have done handover they tend to leave. But we are stacked here like a cattle market.

It is awful.

Should relatives be made to collect elderly patients who are ready to be discharged but who cannot be sent home alone?

Absolutely, is possible.

Made to how?

It’s not a problem with the ambulance service really it’s with getting people out of hospital after treatment. So social care really.

without social care in the community for an aging population more likely to live alone than in previous generations you can’t discharge
so you can’t admit new patients to wards
so you can’t get people out of a&e
plus more walk-ins at a&e because of gp shortages
so you can’t get people into a&e
so ambulances are queuing for hours to offload patients at hospitals
so they’re not available for new patients

I have a friend who drives ambulances. Our local hospitals are not at critical quite yet but she still wastes hours and hours of each shift waiting at a&e.

she also says she spends most of each shift dealing with acute mental health problems due to lack of mental health care.

Bed blocking as no socail care? It's a complex eco system not a stand alone service and every teir of it is currently failing.

Can't see a gp
Can't get timely cronic care
Can't discharge to community
No carers in community
Can't off load ambulance outside of A&E as no beds, bays free
No bursary or funding to get your nursing degree
Can be paid more stacking shelves than being a carer.

welcome to capitalism!

once you see your own loved one inna ambulance for 5 hours outside of a major A&E in Kent after 17 hours on the floor then driven to another hospital, you have no idea how bad it is. You presume if you have a heart attack help will come? Your wrong. Some people are waiting to be answered by 999 doing cpr. Its shit. Money wont help you either as the nhs is a great leveler. We all die the same way waiting for that ambulance parked up for 5 hours outside of A&E. Don't get ill. Don't get old.

Surely there can be no other outcome?

Yes.