Paramedics last year spent 500,000 hours outside hospitals with a patient in the back of their ambulance because A&E staff were too busy to accept them, an official inquiry has revealed.

That was the equivalent of 41,000 12-hour ambulance shifts being taken up with waiting instead of crews being able to attend to other emergencies, according to a report by the National Audit Office.

Ambulance crews are meant to take no more than 15 minutes to hand over a patient to A&E staff and another 15 minutes to prepare their vehicle to get back on the road. “Each failure to meet this standard results in a poor experience for the patient and a delay in an ambulance crew being available for a new emergency call,” the report says.

Last year just 58% of ambulances transferred their patient within 15 minutes and 65% were ready to leave a quarter of an hour later.

All but one of the 10 NHS regional ambulance trusts are breaching 999 call response targets, services are desperately short of paramedics and funding has not kept pace with a surge in the number of patients who need an ambulance.

The NAO report says: “Ambulance services are finding it increasingly difficult to cope with rising demand for urgent and emergency services. Introducing new models of care has helped but there are signs of stress, including worsening performance against response time targets.”

Ambulances are meant to arrive at the scene of 75% of Red 1 and Red 2 calls within eight minutes. Red 1 calls involve life-threatening emergencies such as patients who have suffered a cardiac arrest, are not breathing and do not have a pulse. Red 2 calls are less immediately time-critical but involve events such as a heart attack or stroke. Green 1 calls have a target of 20 minutes.

In 2015-16 the West Midlands ambulance service was the only one of the 10 trusts in England to meet the three main targets, the NAO found.

The NAO flags up a 10% vacancy rate for paramedics, and ambulance trusts’ difficulties in retaining staff, as obstacles to tackling what it describes as “significant challenges”.

It says the ageing population, growing number of patients with alcohol or mental health problems and lack of health services outside hospitals all help to explain the rapidly growing demand for care. The number of calls to ambulance services and transfers from the NHS 111 telephone advice service rose from 7.9m in 2009-10 to 10.7m in 2015-16 – an average year-on-year increase of 5.2%.

Phil McCarvill, deputy director of analysis at the NHS Confederation, which represents NHS trusts including ambulance services, said underfunding elsewhere in the health and care system was a key reason ambulance trusts were under pressure.

“Our highly skilled and dedicated ambulance personnel are working incredibly hard to make sure people get the right care where and when they need it, but they are having to respond to unprecedented demand for health and care services,” he said.



“If we are to relieve the current pressures on ambulance services, we also need to see the right balance of resources going into community, primary care and social care.”

Norman Lamb, the Liberal Democrats’ health spokesman, said: “The health secretary says he wants to make the NHS the safest healthcare system in the world, but these figures show patient care and safety is being severely compromised.

“When thousands of patients are stuck outside A&E departments, ambulances can’t get to other emergencies on time. People suffering from serious conditions such as a stroke will be left with serious disabilities and other life-long problems, and there is a serious risk of lives being lost because emergency calls are delayed.”

Case studies

Rachel, Newcastle upon Tyne: “I was ordered an ambulance by NHS Direct due to a suspected brain haemorrhage. My boyfriend offered immediately to drive me to A&E but they insisted on sending an ambulance, and he was told to wait outside ready to receive the paramedics. Forty-five minutes later we were still waiting, and when we were able to speak to someone we were told that it was in the system but hadn’t been dispatched yet.

“We drove to hospital and were seen immediately. Given that we offered to drive from the outset, it was an unnecessary delay and, had the ambulance arrived, would have been an unnecessary journey.”

Paul Baggaley, Newark: “I came across a pedal cyclist lying in the road after falling off his bike on a slippery surface. A young carer stopped with us and called for an ambulance after five minutes of convincing him that he needed to be seen by hospital. He had injuries and a broken helmet after cracking his head on the road. After coming back to his senses he informed us of two spinal operations he had suffered so we didn’t move him. We kept him warm with blanket and kept him talking.

“After 20 to 30 minutes I rang 101 for police assistance to help with traffic. They arrived in 15 to 20 minutes. We stayed 20 minutes then had to leave. After we had done what we had to do, we came back past that way and still no ambulance. He was lying on the cold ground for over an hour.

“The East Midlands ambulance service is the poorest performing service in the country and things seem to be worst where we are because we are 23 miles from the nearest A&E and so ambulance service is continually stretched.”