Among the procedural messages that paramedic Jason Anderson and his ambulance colleagues receive on their onboard computers as they drive through London, one particular request from hospitals is becoming more and more frequent: Extreme pressure here. Please avoid and use alternative hospital if patient criteria permit.
“This morning I’ve received three or four messages like that,” he says. “It means that if we show up to overstretched hospitals there is a high possibility of extended waits. Therefore we constantly try to ensure we take our patients to the most appropriate emergency department”.
That’s just one, very tangible illustration of the pressures within hospitals that have made the headlines over the past two weeks, with under-resourced staff struggling to cope with increased demand, and patients suffering as a result.
The so-called ‘winter crisis’, exacerbated only in part by the increase in flu sufferers, has seen thousands of patients waiting for hours in hospital corridors, or in ambulances themselves, before being seen by doctors.
The situation is so bad that consultants from A&E units in England and Wales wrote to the prime minister last week expressing their “very serious concerns for the safety of our patients… despite the best efforts of staff”.
They even spoke of patients “dying prematurely” as a result. Spelling out the reasons why, they wrote: “The fact remains.. that the NHS is severely and chronically under-funded. We have insufficient hospitals and community beds and staff of all disciplines, especially at the front door, to cope with our ageing population’s health needs.”
Jason, who has been with the London Ambulance Service for 17 years, couldn’t agree more.
“The news stories are pretty accurate, but this is just an escalation of what’s already been going on in recent years,” he says. “The winter pressures have been highlighted a number of times. But there are periods of pressure all year round that are not reported in the news.
“Although winter was and still is the busiest period, an increase in call rates throughout the year has become the norm.”
As for the winter, the UNISON station rep has his own statistic to add to the debate, namely the call rate for London ambulance crews on New Years’ Eve, which has increased by around 50% in the past decade.
“Every year for at least the past six or seven years it has got busier. Each winter we step up our efforts to deal with it, then get used to the new level of demand, but then it gets worse again and we take it up two more steps.
“We’re dealing with it, working with it, but where do we go from here if the government cuts continue?”
Jason describes how the current problems within the hospital doors impact greatly on ambulance crews, particularly because their involvement with a patient doesn’t end the moment they arrive at an emergency department.
“We make an initial hand-over to a nurse, but until the patient is offered a bed or a chair we have to remain with them, as a duty of care,” he explains.
“If they can walk, we take them to the waiting room, which can be pretty full, but we ensure we find them a seat. If the patient is immobile – they can’t walk or stand – then we wait with them on our trolley bed in the corridor, for however long it takes for a bed to become available.”
He describes those corridors as often overflowing with people: patients, paramedics and the patients’ friends and family – not just the one or two that have come with the ambulance each time, but others who arrive during everyone’s interminable wait.
“We’re used to it. But it can appear chaotic to the public, who think ‘my God, what’s going on here?’ If you keep yourself well and don’t have to go to hospital you won’t necessarily be aware of how bad the situation has become. We do get a lot of patients or their relatives who come in and say, ‘I read about this but can’t believe what I’m seeing.’
“Often the relatives want to know what’s going on, and can become frustrated, with emotions running high at times. We try to put everyone, the patients and their relatives, at ease.
“As ambulance staff, we want to help people and can sympathise with them when they have to experience a long wait. But once we’ve administered our immediate care and brought them to an emergency department, the patient requires hospital intervention – so our hands are tied.
“But we still have to stay with them, until we can hand them over. So we get frustrated too. The longer we’re in a hospital, that’s one less ambulance on the road.”
In some respects, ambulance crews offer the perfect overview of a patient’s A&E experience: they collect a patient from their home, having to administer initial care and witnessing their distress; they bring them to a hospital, which at times can be crowded, and have to wait with them for what can be hours.
Jason paints a picture of a patient who is elderly and frail. “They may have been helpless on the floor in their house, for some time. When they arrive at the emergency department they could be faced with another wait, in a corridor. Then they’re waiting for an x-ray, for example. You find out that they don’t have a carer, or the amount of care time they’ve been allocated has been reduced – all those aspects of social care that are being affected by cuts. Their experience is quite distressing when you add it together.”
In turn, this can become a relentless and heavy burden on the staff themselves. “During your shift and when you leave work you feel their weight on your shoulders,” Jason says. Not surprisingly, some ambulance staff have to take sickness leave because of stress.
Like many UNISON members, Jason has a clear-eyed view of what’s needed to stop the rot. “The government needs to stop the cuts, to improve funding, provide better community services, to put more emphasis on the staff – with more nurses, more doctors, better pay for everyone in the hope that we can retain staff.”
With so much pressure, and so many obstacles, does he still find the job satisfying?
“Maybe once every other day, you walk away from a patient with a smile on your face, because you’ve done something that’s made them better. You feel you’ve made a difference,” he says. “That’s why the staff keep doing what we do.”