Latest figures show almost a quarter of those had to wait at least an hour before being seen

Up to 100,000 patients this winter have had to wait in the back of an ambulance for at least 30 minutes because of A&E overcrowding, NHS figures have revealed.

In all 104,987 patients brought to hospitals in England have been stuck inside an ambulance, or in parts of hospitals including corridors, for upwards of half an hour.



They have faced long waits because A&E staff, struggling to cope with a surge in demand for care, have been too busy to accept them at the time they arrive.



Q&A Why is the NHS winter crisis so bad in 2017-18? Show Hide A combination of factors are at play. Hospitals have fewer beds than last year, so they are less able to deal with the recent, ongoing surge in illness. Last week, for example, the bed occupancy rate at 17 of England’s 153 acute hospital trusts was 98% or more, with the fullest – Walsall healthcare trust – 99.9% occupied. NHS England admits that the service “has been under sustained pressure [recently because of] high levels of respiratory illness, bed occupancy levels giving limited capacity to deal with demand surges, early indications of increasing flu prevalence and some reports suggesting a rise in the severity of illness among patients arriving at A&Es”. Many NHS bosses and senior doctors say that the pressure the NHS is under now is the heaviest it has ever been. “We are seeing conditions that people have not experienced in their working lives,” says Dr Taj Hassan, the president of the Royal College of Emergency Medicine. The unprecedented nature of the measures that NHS bosses have told hospitals to take – including cancelling tens of thousands of operations and outpatient appointments until at least the end of January – underlines the seriousness of the situation facing NHS services, including ambulance crews and GP surgeries. Read a full Q&A on the NHS winter crisis

Of the patients affected, almost a quarter – 24,624 – have endured a delay of at least an hour.



Labour and health unions have criticised the fact that so many ambulances are getting tied up at hospitals and therefore cannot respond quickly enough to 999 calls.



Last week ambulance crews had to wait outside A&E units with a patient in their vehicle 12,559 times, which meant the total number of such delays since winter began on 21 November breached the 100,000 barrier.



The eight weeks since then have also seen emergency departments forced to temporarily divert patients to another hospital a total of 188 times.



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The largest number of what the NHS calls “A&E diverts” have occurred at Worcestershire acute hospitals NHS trust (39), Gloucestershire hospitals NHS foundation trust (27) and Gateshead health NHS foundation trust (20).



The figures showed that hospitals came under less pressure last week than in the first week of January, when many had patients stuck on trolleys in A&E and were forced to declare an alert as they buckled under intense strain.

Only six A&E diverts occurred, compared with 32 the week before, while the 12,559 patients stuck in ambulances for at least 30 minutes was well down on the 16,690 who faced such a delay in the first week of 2018.

NHS England said hospitals were generally coping with the extra demands of winter, including flu and more people with breathing problems, which have also put added strain on GP and ambulance services.



Q&A Does the UK have enough doctors and nurses? Show Hide The UK has fewer doctors and nurses than many other comparable countries both in Europe and worldwide. According to the Organisation for Economic Co-operation and Development (OECD), Britain comes 24th in a league table of 34 member countries in terms of the number of doctors per capita. Greece, Austria and Norway have the most; the three countries with the fewest are Turkey, Chile and Mexico. Jeremy Hunt, the health secretary, regularly points out that the NHS in England has more doctors and nurses than when the Conservatives came to power in 2010. That is true, although there are now fewer district nurses, mental health nurses and other types of health professionals. NHS unions and health thinktanks point out that rises in NHS staff’s workloads have outstripped the increases in overall staff numbers. Hospital bosses say understaffing is now their number one problem, even ahead of lack of money and pressure to meet exacting NHS-wide performance targets. Hunt has recently acknowledged that, and Health Education England, the NHS’s staffing and training agency, last month published a workforce strategy intended to tackle the problem. Read a full Q&A on the NHS winter crisis

“Raised levels of flu and norovirus continue to put pressure on busy A&Es and other frontline services but today’s figures show pressures abating somewhat compared to the prior week, and with hospitals generally coping too,” a spokeswoman said.



The latest figures came as senior A&E doctors in Wales warned that intense pressures on the NHS meant that patient safety was being put at risk “to an unacceptable degree”.



In a letter to the first minister, Carwyn Jones, the consultants said emergency departments in Wales were “in some ways” in a worse position than those in England.



“We have neither sufficient staff nor sufficient beds (in either acute hospitals or the community) to cope with the needs of an ageing population,” they wrote.



One signatory, Tim Rogerson, an A&E consultant at the Royal Gwent hospital in Newport, told the BBC: “We’re on our knees as far as emergency care [is concerned]. We have patients coming into emergency departments that are already full.”



Nick Scriven, the president of the Society for Acute Medicine, said the NHS winter crisis had left health service staff close to exhaustion.



“We are seeing a sustained period of exceptionally high demand on a service that is only being kept safe by dedicated staff going beyond all normal limits,” he said.



“This is sustainable only for a week or two and we are now entering the third week of this crisis which will not relent for weeks yet, even if admission rates reduce, such is the crowding in our hospitals.



“The NHS and individual trusts must now give thoughts on how they can help their staff cope and not succumb themselves to illness brought on by exhaustion, which is now a real danger.”