NHS ambulance strikes will put patients at risk – but delays already at record high | NHS

At any other time in the 74-year history of the National Health Servicethousands of nurses staging their first strike would pose the greatest threat to patient care.

Last Thursday’s walkout by nurses resulted in the cancellation of 16,000 appointments, procedures and surgeries in England, with more to be postponed this Tuesday.

However, these are unprecedented times, and this week, striking nurses will not be the biggest problem. Nine ambulance trusts in England and Wales are expected to be affected by industrial action on Wednesday, coordinated by the GMB, Unison and Unite unions.

Ambulance strikes will involve paramedics as well as control room staff and support workers. The threat to patient safety on Wednesday will be exceptional.

According to trade union laws, vital care must be provided during strikes. But there remains a lack of clarity about what will be offered. Even at this late stage, NHS leaders say negotiations are continuing between unions and ambulance services to agree which incidents will be exempted from the strike.

All Category 1 calls, the most life-threatening cases, will be answered, while some ambulance trusts have agreed waivers with unions for specific incidents within Category 2 calls.

However, in some cases, older people who fall during strikes cannot be helped until they have spent several hours on the ground. Patients with heart attacks and strokes can get an ambulance only if the treatment is considered “critical”.

There is no doubt that many of those patients making calls to 999 on Wednesday will not receive the care they need. Some will probably die as a result.

The government says anyone in an emergency should still call 999, with military personnel to be recruited to cover, but the complex nature of urgent and emergency care is such that there will be no substitute for ambulance workers.

NHS leaders believe Wednesday’s strike will present an entirely different magnitude of risk. Quite simply, patients who do not receive emergency treatment quickly enough can mean the difference between life and death.

Some hospitals are set up for many more patients arriving at emergency departments in taxis, adding to the chaos. Even if ambulances can’t drop patients off quickly, they can contact hospital staff before they arrive so emergency departments know what’s coming.

But a sudden increase in seriously ill patients arriving by taxi or private vehicle will leave hospital staff with less time to prepare or plan to triage patients.

Hospitals have been ordered to implement measures by Wednesday to ensure that ambulance patient transfers are kept to no more than 15 minutes, in order to maximize capacity in urgent and emergency care.

However, NHS data from last Thursday showed ambulance delivery delays to hospitals in England were already at a new high, a week before the ambulance strike, with one in six patients waiting for more than one time to move on to the emergency department crews. One in three waited at least 30 minutes.

Ambulance crews were unable to respond to nearly one in four 999 calls in October, the most ever, because many were tied up outside A&E waiting to deliver patients.

An estimated 5,000 patients in England, also the highest number on record, potentially suffered “serious harm” by waiting so long to be admitted to A&E or simply for an ambulance to show up to help them.

The alarming data underscores what many in the NHS have been saying for months. The strike action will likely be deadly this week and beyond, but parts of the system have been broken for some time.

Paramedics are on strike because they are being asked to do more and more, at extreme and unsafe levels, and for less and less. Patient safety is already being put at risk, they add, because the government has failed to retain or recruit staff for many years.

Immediate action by ministers is needed to fix the health service, and first on the agenda must be a workforce plan that ensures more staff are retained and recruited. If no action is taken, more staff will resign, fewer will remain on the front lines, strikes will continue, and harm to patients will become a daily reality.