Hospital chiefs aim to cut ambulance waiting times

On some days there can be as many as 10 ambulances waiting at the Stevenage hospital at once.

National NHS officials have now stepped in to instruct hospital chiefs across the country to review and address delays in handing over the care of patients, from ambulances to emergency departments.

On Wednesday the ongoing review at the Lister was highlighted to a meeting of the East and North Hertfordshire NHS Trust.

According to national policy ‘ambulance handovers’ should take no more than 15 minutes – ensuring patients receive necessary care and ambulances get back on the road.

But data presented to the board shows that in September just seven per cent of handovers were completed within the 15 minutes target.

On 783 occasions it took in excess of 30 minutes – and on 336 occasions it took more than an hour.

Meanwhile average handover times reported to the board ranged between 24 and 78 minutes – with maximum handover times ranging between 54 and 321 minutes.

In a letter sent to the Trust, senior national and regional officials from the NHS have acknowledged that staff are already "working incredibly hard to resolve this problem".

They stress that action must be taken to ensure ambulances are not used as additional emergency department cubicles – and that crews can safely offload patients to the care of emergency departments.

And to address delays they highlight initiatives such as ‘surge capacity’ and ‘fit to sit’ for patients that do not require a trolley – as well as measures to enable earlier discharge.

They also highlight the potential use of GP streaming, community and mental health service capacity to reduce the number of patients taken to hospital emergency departments.

Chief operating officer Julie Smith acknowledged it is “a very challenging ask” – and, pointing to partners in the hospital and the community, she stressed the need for "a collective response".

“It is important that it is regarded not only as a ENHT issue to resolve but one that system partners need to work together to address.

“Every part of the pathway from the community, to the hospital and back to the community can cause delays and bottlenecks and so a collective response is required.”

One of the Trust’s preferred options is for ‘additional temporary capacity’ – such as a porta cabin – in the car park for the ED at the Lister.

And it was reported that they already plan to have an additional ‘decision-maker’ available in ED after 5pm during the winter months – that would ‘support flow out’ and increase capacity for those coming in.

According to the report, the Trust is also looking at whether it could create an admissions unit in the existing ‘discharge lounge’ at the Lister, where ED patients could wait until a bed was available, and they are looking at initiatives that could increase capacity in the hospital for new patients by enabling earlier discharge.

That could be, for example, moving patients who are waiting for transport home to move to the ‘discharge lounge’ or exploring additional community capacity.

The report also highlights the possibility of discussions to increase additional support for mental health patients – diverting mental health patients away from the ED ‘to a more appropriate alternative setting’.

Trust chief exec Nick Carver acknowledged the letter from officials – but stressed that this was an issue the Trust was already aware of and takes “extremely seriously”.

“For the absolute avoidance of doubt, whilst I am very happy to receive a letter – we do not need a letter to remind us of the importance,” he told the board.

“We know that if we have any delays here, it delays the time that an ambulance takes to get to a patient at home.

“So we fully understand this – we haven’t suddenly started to become focused upon this.

“We think we do better than many other place. We think frankly our facilities help us but we do – again for the avoidance of doubt – recognise there’s more we can do individually and as a system to reduce the delays still further.”