February 8, 2023

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A day with an ambulance in the UK: Long waits, mounting frustration

WREXHAM, Wales — Rachel Parry and Wayne Jones, two paramedics with the Wrexham Ambulance Service, arrived at a hospital in north Wales with a patient just after 10am early December morning.

Then her waiting began.

It would be 4:30pm before her patient, a 47-year-old woman with excruciating back pain and numbness in both legs, would be admitted to the emergency room at Wrexham Maelor Hospital. It had been more than 12 hours since she first called 999, the UK equivalent of 911.

The delays had gotten so bad — and so frequent — the two paramedics said their first interaction with patients was no longer an introduction.

“We’re starting with an apology now,” Ms Parry said. “Every job, they open the front door and say, ‘Hi, we’re so sorry we’re late.’ That has become the norm.”

The sight of ambulances queuing for hours outside hospitals has become frighteningly familiar in Wales, which has recorded the worst wait times for life-threatening emergency calls over the past month. But the problem is far from isolated. Ambulance services in England, Scotland and Northern Ireland are also experiencing record waiting times.

It’s a near-crisis situation that experts say is signaling a collapse in the pact between Britain and its revered National Health Service: that the government will provide responsible, efficient and mostly free health services for all income levels.

The problem becomes clear on Wednesday when ambulance drivers in England and Wales stage the first of two strikes over low wages and deteriorating working conditions. They are supposed to get out again next week.

It will be the latest in a period of intense industrial action in the UK, with a series of strikes planned across the country over the holiday. Nurses are conducting their second one-day strike on Tuesday, and rail workers and airport border control workers will begin several days of strikes later in the week.

A New York Times photographer and I spent a day with the Wrexham service earlier this month, watching as the paramedics gently carried patients down stairs, navigated narrow alleys, and attempted to comfort people during the excruciatingly long waits in the hospital parking lot. Frustration built as the hours passed.

One challenge cited by health experts was evident that day: there is an acute shortage of beds in the Accident and Emergency Department, or A&E as emergency departments are called in the UK, which are overcrowded due to a lack of patient space elsewhere in hospitals. That’s because patients who are ready to be discharged from the hospital often have nowhere to go due to dwindling social care services — hampered by a lack of government funding and severe staffing shortages.

That leaves ambulances outside waiting for beds to become available.

Frontline workers reach a breaking point.

While Ms Parry and Mr Jones waited in hospital with their second patient, there were at least 21 calls in their area that they and other paramedics who were also stuck in the hospital could not be called on. During their 12-hour shift, they picked up only three patients.

“It’s frustrating,” said Mr. Jones. “These people are out in the community and they’re desperate.”

Sometimes good Samaritans step in and drive people in need to the hospitals themselves. While Ms. Parry and Mr. Jones waited with their patients, two cars with patients pulled up at the ambulance drop-off point. In both cases – one in which an elderly woman fell and broke her wrists, and another in which a woman collapsed in a supermarket – the driver had called emergency services, only to be told it would be hours before an ambulance could come.

“Bystanders do more jobs than me these days,” Ms Parry said, frustrated after helping both arrivals to the hospital.

Analysis of the latest data from the Association of Ambulance Chief Executives found that response times across the country had increased and delays in patient handovers reached unprecedented levels through November.

Ms Parry and Mr Jones say their biggest fear is picking up a patient after a long delay, only to find they were late.

“I know people have died,” Ms Parry said. “I know a crew who said, ‘We just got to someone who’s been waiting for us for four hours, and they’re dead on the sofa.'”

Emergency services across the country, almost all part of the National Health Service and managed by an area’s local health foundation, have described a rising number of deaths related to long waits. An English ambulance service found its crew had increased from just one in 2020 to at least 37 in 2022.

A spokesman for the government’s Department of Health and Social Care, which oversees the National Health Service, said in a statement that it recognizes the pressure emergency workers are under “and is taking urgent action to support emergency services and staff”.

“No one should have to wait longer than necessary for emergency care,” the statement said, adding that the government is investing a further £6.6 billion, or about $8 billion, in the service over the next two years “to ensure this is possible Act quickly to improve wait times.”

Right now, ambulance workers like Doug Green, 48, a paramedic and operations manager at Wrexham Ambulance, are doing their best to manage.

As the ambulance bay at Wrexham Maelor Hospital became a car park with stalled fluorescent yellow ambulances that afternoon, Mr Green went in and began helping clean the rooms to speed up the process of admitting ambulance patients. The most serious cases, known as “red” calls, are always prioritized and caregivers find ways to make room for these patients.

“As soon as you free a bed, it’s already full,” said Mr. Green. “It’s like a chess game where your pieces keep getting stolen.”

Emergency room workers often visit patients waiting in the back of ambulances to assess their condition and make sure they aren’t getting worse.

For the patients who face these long delays, the wait can be excruciating.

Just after 7:00 am, Mr. Jones and Ms. Parry responded to their first call of the day, received at 3:42 am

The dispatcher gave them details of the patient and Ms. Parry turned on the blue lights and siren and drove quickly to a terraced house on the outskirts of Wrexham. One woman, Gill Foulkes, had excruciating back pain and her husband had called 999.

Paramedics found her upstairs in bed writhing in pain and hooked her up to a machine to monitor her vital signs. They gave her morphine, stabilized her, and offered her words of reassurance while carefully loading her stretcher into the back of the ambulance.

“I was at the point where I thought I was going to die from the pain and then these angels came,” she said of the paramedics.

Ms Foulkes was grateful to paramedics but said she was distressed and frustrated. She added that she also felt sorry for the emergency call handlers.

“I was about to beg for an ambulance and they were distraught listening to me devastating,” Ms Foulkes said. “Our government is failing us, I’m afraid.”

Families also find the long wait times excruciating as they watch their loved ones suffer. Frank Taylor waited three hours for an ambulance with his wife Ann Taylor, 79, and said it was hard for him to see her in so much pain.

When paramedics arrived, he was relieved to see them quickly hook her up to oxygen before gently carrying her, wrapped in a blue knit blanket, down the stairs to the ambulance.

But when they reached the hospital, it was another two hours before Ms. Taylor was finally brought inside.

At around 8:30 p.m., Ms Taylor was transferred from the emergency room to the intensive care unit, the final ward after a long day of uncertainty.

Last year Ms Taylor was transferred to a care home after her health deteriorated – she has end-stage lung disease – and Mr Taylor visits her daily. The ambulance picked her up from there.

The next morning, in the living room of their home, Mr. Taylor, also 79, displayed the dozens of spoons his wife had collected during their five-decade marriage, which were displayed in a cabinet he had built. “There are a lot of good memories here,” he said of the home where they raised their five children.

While praising the diligence of the paramedics, Mr Taylor said the wait was frustrating. He worried about his wife’s dignity in this last phase of her life.

He said he supports the forthcoming ambulance strike. Emergency calls have become an overly tense waiting game.

“It’s not like it was years ago,” said Mr. Taylor. “Years ago they came right away.”