Public told to think harder before making 999 calls, with three out of 10 ambulance trusts in England at ‘critical’ over Christmas

Ambulance services in England are stretched close to breaking point with three of the country’s 10 ambulance trusts declaring themselves under intense pressure over the Christmas period.

High levels of demand forced the three ambulance services to rate themselves as reaching a “critical” state, just one short of the “potential service failure” ranking on a six-point scale measuring the pressures they face.

London and Yorkshire have been at critical status for more than two weeks. South Western moved to critical for a brief period from Saturday afternoon to Sunday night, calling in an extra 45 volunteer staff to help cope with demand.

Other trusts are at “severe pressure” status – the next level down – but even on this level, East of England said that weekend calls to the service were up by 25% on last year.

The staffing pressures are emerging as the ambulance service braces itself for the fallout of New Year’s Eve celebrations, which traditionally give the NHS’s emergency services their busiest night of the year.

The head of the British Medical Association said patients were suffering as the NHS’s emergency and urgent care system struggled to cope.

Mark Porter, council chair of the doctors’ body, said: “It’s clear to see the whole system is now under immense pressure. GP services are struggling to keep up with the number of patients coming through the door, ambulance services are stretched close to breaking point and hospitals are so full that patients don’t always receive appropriate treatment in an appropriate place within them.”

Porter added:“These figures show that the system is operating in a constant state of crisis, running just to stand still – there is no spare capacity to deal with a seasonal spike in demand and patients are suffering.” The grim picture suggests next week’s update on emergency admissions to hospitals and on A&E visits, taking in the Christmas and New Year period, will offer little respite for ministers over the NHS’s financial troubles as May’s general election looms. Before Christmas, the government indicated it had put on hold proposals from ambulance chiefs to change some response times to emergency calls relating to serious, but not the most life-threatening, conditions.

Yorkshire ambulance service said there had been an almost 30% rise in incidents involving the most seriously ill or injured over the weekend compared with last year. In south-west England incidents involving the ambulance service on Saturday were 38% up on the same weekend last year and 22% up on Sunday.

London ambulance service said the number of patients attended in a serious or life-threatening condition had so far this month increased by 12% on 2013.

The service said it was planning big increases to its 3,056 staff to cope with the rise in demand. “Every year demand increases and, in addition to this, we’re facing a shortage of paramedics in the UK which makes recruitment challenging,” a spokesperson said.

“We will continue to prioritise our response to our seriously ill and injured patients but other people, with less serious injuries and illnesses, should use NHS 111 or make their own way to hospital.”

David Macklin, executive director of operations at Yorkshire ambulance service, said staff and volunteers had worked beyond their normal hours, often without breaks, in order to cope.

“We have had to strictly prioritise our calls to ensure that the people who most needed our help received it,” he said. “This has meant that some people have not got the response they expected or wanted but I am sure they will understand that patients with life-threatening illnesses and serious injuries should be cared for first,

“While we do not want to deter people from calling 999 in serious cases such as heart attack, breathing difficulties or stroke, we do need people to think very carefully about their options and consider whether they really need an ambulance or whether there is another option available to them.”

Clifford Mann, president of the College of Emergency Medicine, said the NHS 111 telephone advice service was sending an ambulance to take a patient to hospital too often because local out-of-hospital medical services, such as visits from a GP or district nurse, were too often inadequate.

Mann, a senior emergency care consultant at Musgrove Park hospital in Taunton, Somerset, said the South Western ambulance service had introduced over the weekend “a policy which means that they now won’t wait with the patient [in the back of an ambulance outside an A&E unit] after 30 minutes – that is, the ambulance crew will leave the patient with the hospital staff and go to attend another call. That was the first time that policy has been used at my hospital and it was triggered by the pressure of demand.”

NHS England insisted that it was “pulling out all the stops” to ensure that patients received care when and where they needed it.