NHS in crisis: 12 hours on ambulance frontline with ‘the one service which cannot say no’

Pulling out of a busy south London A&E in the middle of a 12-hour day shift in mid-August, paramedics Harriet Walton and John Chilvers are one of the only free crews in London.

With July’s ambulance response times for the most urgent 999 calls the worst on record and 152,000 ambulance crew hours lost to delays in June, this summer has exposed the extent of the problems facing the ambulance service, with all 10 trusts put on “black alert” in what is traditionally a quieter season.

Response times have collapsed – with some patients waiting several hours following a 999 call and 4,000 patients estimated to have come to severe harm due to handover delays in June – prompting health leaders to warn that the delays are the “biggest” safety risk facing the NHS.

As news of the crisis dominates headlines, The Independent was given exclusive access to join two London Ambulance Services senior paramedics.

Grappling with the consequences of a broken social care system and a backed-up NHS, they say they the pressure is mounting because they are “the one service which cannot say no”.

The start of the shift is eerily quiet and the pair from Brixton Ambulance Station begin their day with an unusual silence from the dispatch team. 

But the 20 minutes of stillness is just the calm before the storm as the first Category Two alert comes in – a man with a severe mental health condition in crisis.

Blue lights turned on, and we soon arrive at the door of the patient.

Ms Walton, who is aged just 21, and Mr Chilvers 27, speak calmly to the man who is agitated, incoherent and delusional, but the pair work quickly to assess the risk he poses to himself. 

As his behaviour escalates, they are reluctantly forced to call for police assistance and an advanced paramedic to help take the man to hospital.

The differing priorities of the police force and paramedics are clear as the officers question whether it’s possible to leave the man.

A mixture of drugs and his worsening mental health means he must be assessed at hospital but without access to a number for his community mental health team, A&E is the only option.

The decision to call the police to restrain the man is not taken lightly but he ticks all the markers on his own care plan for needing hospital assessment. 

It is a difficult situation to watch, as he is eventually restrained by six officers and taken with his head down into a caged police van.

The paramedics are able to calm him and he is taken to King’s College Hospital A&E which is near The Maudsley mental health hospital. 

Lewisham Hospital A&E Unit (Lewis Whyld/PA)

A dissonance of beeps, alarms, shouting and scurrying clinicians meet the team at an ambulance bay at the hospital, which is already full with three ambulances waiting to hand over patients. 

While he waits, the patient deteriorates again.

Three hours have passed between the first dispatch call to when he is eventually handed over to A&E teams – and these calls can happen at least once a day.

Upon leaving King’s College emergency department, a hospital announcement warns that one ambulance has already been waiting for four hours to hand over a patient and another has waited for two.

Paramedics transfering a patient to a London A&E

Admission rates are falling for all age groups, though they remain highest among the most elderly (Dominic Lipinski/PA)

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