Consultant Editors Lynda Sibson, Ian Peate, Pete Gregory Editor Aysha Mendes jpp@markallengroup.com Commercial Manager Colin Williams colin.williams@markallengroup.com Classified Executive Colin Williams colin.williams@markallengroup.com Production Manager Kyri Apostolou Production Assistant Jamie Hodgskin Content Development Director Tom Pollard Editorial Director Sophie Gardner Managing Director Anthony Kerr anthony.kerr@markallengroup.com Associate Publisher Mike Shallcross Publisher Colin Williams Chief Executive Officer Ben Allen

Editorial Board Guillaume Alinier Director of Research, Hamad Medical Corporation Ambulance Service, Doha, Qatar; Professor, Simulation in Healthcare Education, University of Hertfordshire, UK Ayesha Bal Paramedic, West Midlands Ambulance Service Trust, UK Aidan Baron Paramedic Researcher, Sydney, Australia; Visiting Researcher in Emergency, Cardiovascular and Critical Care, Kingston University and St George’s, University of London Tony Bleetman Consultant in Emergency Medicine; Honorary Associate Professor, University of Warwick Medical School, Coventry, UK Malcolm Boyle Senior Lecturer, Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia Dr Mike Brooke Doctor and Advanced Paramedic, Tameside Hospital NHS Trust/North West Ambulance Service NHS Trust UK Tanoh Asamoah-Danso Paramedic, East of England Ambulance Service Trust, UK David Davis Clinical Lead, Integrated Urgent Care Workforce Development Programme, NHS England; Fellow and Mental Health Spokesperson, College of Paramedics; Founding Fellow, Faculty of Clinical Informatics, UK Robert Deighton Senior Lecturer in Paramedic Science & Prehospital Care, Edge Hill University, Manchester, UK John Donaghy Senior Lecturer, Paramedic Science, Anglia Ruskin University, UK Georgette Eaton Clinical Practice Development Manager, Advanced Paramedic Practitioners (Urgent Care), London Ambulance Service NHS Trust, UK Kerry Gaskin Principle Lecturer, Advancing Clinical Practice; Academic Lead, CPD and Paramedic Science, Allied Health and Social Sciences Academic Unit, University of Worcester, UK Pete Gregory Head of Allied Health Professions, University of Wolverhampton, Wolverhampton, UK Sigurd Haveland HCPC Paramedic; Resilience and Special Operations Officer, Ambulance Service, Gibraltar Health Authority

Andrew Kirk Associate Head, Allied Health Professions Education, Edge Hill University, UK Joanne Mildenhall Paramedic Team Leader, South Central Ambulance Service NHS Trust, UK Dr Tom Mallinson Prehospital Doctor, BASICS Scotland, UK Ian Mursell Consultant Paramedic, East Midlands Ambulance Service NHS Trust, UK Ian Peate Head of School, School of Health Studies, Gibraltar Health Authority, Gibraltar Nigel Rees Senior Research Lead, Welsh Ambulance Services NHS Trust, UK John Renshaw Senior Lecturer in Paramedic Science, Coventry University, UK Alan Rice Associate Professor, Paramedic Practice, Department of Paramedic Science, Kingston University and St George’s, University of London, UK Lynda Sibson Telemedicine Manager, East of England Stroke Telemedicine Service, Addenbrookes Hospital, Cambridge, UK Ceri Sudron Senior Lecturer and Paramedic Science Course Lead, University of Wolverhampton, UK Kacper Sumera Deputy Head of Education, East Midlands Ambulance Service NHS Trust, Nottingham, UK Sammer Tang Public Health Registrar, Gloucestershire Hospital NHS Foundation Trust, UK James Taylor Locality Manager, Yorkshire Ambulance Service NHS Trust, UK Mark Woolcock Consultant Paramedic; Lead Clinician, Cornwall Health Out-of-Hours Aimee Yarrington FCPara, Clinical Team Mentor and Midwife, West Midlands Ambulance Service NHS University Foundation Trust, Shropshire, UK

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ISSN 1759-1376 Printed by Pensord Press Ltd, Blackwood, NP12 2YA

EditorialEditorial

It isn’t your fault

Diane has suffered a cardiac arrest and has been waiting close to 10 minutes for an ambulance. Tom had a stroke and has been waiting close to an hour. Sally has fallen and been lying on the floor for 4 hours after calling 999. Laura and Paul have been supporting June in their ambulance outside hospital for their entire shift while waiting to admit her to the emergency department, unable to respond to any other calls. Belinda has been on a trolly in the corridor of the emergency department for 2 hours while she awaits a bed. Meanwhile, Phillip remains in hospital despite being well enough to leave because of a lack of local social care.

Stories like these have become increasingly prevalent this year. The health service that has long been a point of national pride is letting down both its patients and its staff. While healthcare staff are doing everything they can for their patients, they are working within a system on the verge of collapse.

Handover delays have led ambulance crews to lose 333 000 hours in the last 12 months until July 2022—this is 18 times higher than in 2019–2020 (Huskisson, 2022). In June 2022, 29 317 patients were delayed for 12 hours or more from the decision to admit to admission—this is the highest on record, being 3.5 times more than the number of 12-hour waits recorded for the whole of 2019 (Royal College of Emergency Medicine (RCEM), 2022). However, the RCEM (2022) warns that the true number of 12-hour waits is much higher when measured from the time of arrival at hospital. Perhaps worst of all, a review by the Association of Ambulance Chief Executives (AACE) (2021) found that in cases where handover from ambulance to hospital is delayed beyond 60 minutes, 80% of patients are assessed as having potentially experienced avoidable harm, with 10% having experienced severe harm.

So where does this leave the clinicians who are working so hard to try and ensure their patients receive appropriate care in a timely fashion? How do we ensure that our paramedics do not become too burnt out and demoralised to continue within the ambulance service when they are perhaps needed most? Paramedics are already leaving the ambulance services in droves, as the number of calls has almost doubled since 2010 (GMB Union, 2022). Every paramedic must surely do what is right for themselves and their families—however, each time one leaves, the load only becomes that much heavier for those who are left behind. The system owes it to them to invest in a long-term plan that’s going to ensure that this crisis is temporary. We often hear of a holistic or whole-person approach to patient care—but what about a whole-systems approach to rescuing the NHS? Why is there no nationally funded and urgently prioritised plan to address the issues that are taking place across every sector of the health service, each affecting the other like a rapidly spreading virus? Every one of you deserves better than the impossible situations you’re being put in on every shift—so do your patients, and it isn’t your fault. JPP

References Association of Ambulance Chief Executives. AACE report published: hospital handover delays potentially causing significant harm to patients. 2021. https://tinyurl.com/2s3skjjc (accessed 25 August 2022) GMB Union. 35% of ambulance workers witnessed deaths due to delays. 2022. https://tinyurl.com/ydtp8tsb

(accessed 25 August 2022) Huskisson R. Ambulance chiefs blasted by Health Secretary over ‘unacceptable’ ambulance handover delays. 2022. https://tinyurl.com/4w86eyx6 (accessed 25 August 2022) Royal College of Emergency Medicine. ‘We are seeing the sharp demise of the health service’, RCEM says as

30,000 patients wait more than 12-hours in A&Es in England in July. 2022. https://tinyurl.com/mrxf59n5 (accessed 25 August 2022)

Aysha Mendes is editor of Journal of Paramedic Practice

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