Britain’s busiest NHS ambulance service may no longer be able to answer all 999 calls quickly enough because its control rooms are chronically short of call handlers, it has warned.

The London ambulance service (LAS) disclosed this week that its capacity to respond to medical emergencies has been under threat because of a 20% shortfall in its control room staff.

Campaigners for patients have voiced alarm over the findings, saying the risk to the service could lead to people dying of strokes or heart attacks because an ambulance has taken longer than it should to reach them.

In a report presented to its board on Tuesday the LAS identified an acute lack of staff at its two main bases as a key risk to its ability to function. Listing the risks faced by the trust, it said: “The trust may be unable to maintain service levels due to insufficient staff in the emergency operations centre (EOC).”

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The Patients Association said the LAS’s inability to recruit enough staff posed a direct threat to patients.

“The London ambulance service appears to be saying that it is likely that it will be unable to respond properly to medical emergencies due to a lack of staff. This is hugely worrying, but also the logical end point of underfunding the NHS over a sustained period,” said Rachel Power, its chief executive.

“The consequences for someone having a stroke or heart attack, for example, don’t bear thinking about. Lives are being put at risk as a direct result of political choices.”

A separate report to the LAS board noted that a call-handling action plan and a recruitment and retention plan with a focus on the EOC were now in place, and that vacancies within the EOC were currently running at 20% of the agreed establishment, compared with a national average of 15%.

The LAS has two emergency operations centres where up to 5,000 999 calls a day are answered, at its headquarters in Waterloo, central London, and in Bow, east London.

Sources inside the LAS have told the Guardian that both control rooms are so short of call handlers that growing numbers of patients and relatives experience a delay in speaking to one when they dial 999 requesting urgent assistance.

“Things at both EOCs get stretched. That’s become the norm. There’s a lack of staff, and a lot of calls to be taken – a lot of calls coming in aren’t being answered in time,” said one emergency medical dispatcher (EMD).

Each control room should have up to 35 EMDs on duty, who between them answer all 999 calls and send ambulances to incidents. However, many shifts do not have a full rota of EMDs on duty. “LAS are trying to get around the 20% vacancy rate by offering us financial incentives to work more, such as double pay for overtime and even double pay plus £100 if you come in during a peak period,” one dispatcher explained.

Sarah Carpenter, the Unite union’s national officer for health, said: “These documents reveal a truly desperate state of affairs when ambulance staff, not just in London, but across the country are working flat out to answer emergency and other calls in the worst weather conditions for years.”

The LAS’s problems highlight a “massive recruitment and retention crisis in the ambulance services across England”, Carpenter said.

Last year the LAS won widespread praise, including from Theresa May, for its response to the Westminster Bridge and London Bridge terror attacks and the Grenfell Tower fire. It has 5,000 staff and 70 ambulance stations and cares for the capital’s eight million residents.

Its serious lack of call handlers is the latest illustration of the NHS’s deepening staffing crisis. Last week NHS Improvement said that a thorough audit of staffing levels it had conducted had found that the NHS in England was short of 100,000 personnel – equivalent to nearly 10% of its entire workforce.

Under a key NHS target 75% of ambulances in England are meant to respond to 999 calls involving life-threatening emergencies, such as heart attacks or serious breathing problems, within eight minutes. But most ambulance services have not hit that target for several years. The late arrival of vehicles, sometimes many hours after a 999 call, has been blamed for dozens of deaths over the winter.



Q&A What are the financial pressures on the NHS that have built up over the last decade? Show Hide Between 2010-11 and 2016-17, health spending increased by an average of 1.2% above inflation and increases are due to continue in real terms at a similar rate until the end of this parliament. This is far below the annual inflation-proof growth rate that the NHS enjoyed before 2010 of almost 4% stretching back to the 1950s. As budgets tighten, NHS organisations have been struggling to live within their means. In the financial year 2015-16, acute trusts recorded a deficit of £2.6bn. This was reduced to £800m last year, though only after a £1.8bn bung from the Department of Health, which shows the deficit remained the same year on year. Read a full Q&A on the NHS winter crisis

The LAS said that it had decided to recruit an extra 73 call handlers after reviewing its staffing levels. The shortfall has now reduced from 20% to 15.3%, it added.



“We are also running a targeted recruitment campaign and have recruited 137 new staff across our control rooms since March 2017. We also have an additional 22 new call handlers in training and have call-handling courses running each month in order to bring us up to full capacity as quickly as possible,” said Paul Woodrow, the LAS’s director of operations.

But current call handlers claimed that the turnover rate among EMDs was very high, with some new recruits leaving within a year of arrival, sometimes to take similar but better-paid jobs with the London fire brigade or Metropolitan police.