- Lynn Eaton, freelance health journalist
Barely a week goes by without headlines about spiralling wait times for NHS ambulatory or emergency care. My father was one of those patients whose wait for an ambulance would be marked as a “missed target.” His experience, and mine in the aftermath of his death, are symptomatic of the wider problems afflicting our health and social care systems and the devastating impact they are having on patients, their families, and staff.
I’ve written about the shortcomings—and successes—of the NHS and social care for decades as a health journalist. So, when my 94 year old father fell last year and waited six hours for an ambulance, I was unlikely to shrug my shoulders and say “these things happen.”
Anyone with frail, older parents will know that gut wrenching feeling when someone calls to say your mother or father has had a fall. I pulled up outside my childhood home and found my father sprawled in the front porch, crying and screaming.
The carer was there. She had called the ambulance an hour earlier, at the same time she’d called me. Neither of us knew when help was going to arrive, or that we had a further five hours to wait. All we were told was not to move the patient. There was no advice on how to reduce his pain. At one point my father became sweaty and his breathing was more laboured. I called 999 a third time but was told there just wasn’t an ambulance available.
We didn’t know it then, but my father had broken his hip and arm in the fall. He had been deemed a category 2 ambulance call. Some older people who fall have a far longer wait. In one case, reported this summer, a man waited 15 hours in his garden, with just a tarpaulin for shelter.1 In another, an 85 year old woman waited 14 hours, according to reports.2
These ambulance wait times are a far cry from the performance targets introduced for England in 2017, which state that, in 90% of cases, a category 2 patient should receive help within 40 minutes.34 Not six hours.
The reasons for these delays are complex. A recent analysis by the BBC showed that by late November more than 11 000 ambulances were spending more than an hour stuck in queues outside hospitals every week.2 But the problem lies only partly with hospitals. As anyone working on a hospital ward knows, discharging an older person home safely often requires an intricate network of home care support. All too often that support just isn’t there. So the patient stays in hospital, long after their medical needs have been met. There is nowhere else they can safely go.
A survey published in November 2022 reported that more than nine in 10 directors of adult social services in England believed there was neither the funding or workforce to meet the care costs of older and disabled people in their area.5 It’s not hard to see how these shortfalls, mainly caused by inadequate funding of social care and minimum wage levels for many care staff, have led us to where we are now. Yet, while social care problems are longstanding and worsening, the government has consistently failed to tackle them.6
Not giving up
Sadly, my father died six weeks after his fall, as a result of complications. When the ambulance trust encouraged me to raise a formal complaint, I said yes and the trust started a thorough investigation.
I was surprised to find, as a result of my complaint, that the 2017 ambulance targets take no account of a person’s age. Amazingly, a 90 year old would be treated in the same way as a 20 year old who had fallen.
I also found out that my third 999 call, when I highlighted my dad’s changed condition, had been accidentally struck off the “stack” (the computer spreadsheet recording all calls) as a “repeat call.” Had it been kept on the system, it should have triggered a clinician’s involvement, potentially offering vital telephone advice. The trust cited human error. It was, admittedly, one of the busiest days the service had experienced. Mistakes happen, I know. But how many other errors like this happen? We’ll never know, not unless people speak up.
I know that many people may prefer not to complain, instead putting delays and errors down to a creaking NHS system. They may not have the time, or the energy—especially when dealing with a bereavement. I certainly hadn’t anticipated how long the process would take, or the emotional impact it would have, all while I was grieving. I frequently doubted the value of making a complaint when the whole system was flawed. What was the point of the proverbial sticking plaster on a wound that was bleeding profusely?
For me, despite the emotional rollercoaster, it was worth it, just to receive the trust’s formal apology and their acknowledgement of shortcomings. Their written apology outlined the ways in which, nationally and at this particular trust, steps were being taken to prevent the same mistakes happening again.
I sincerely hope I helped give the ambulance trust managers the ammunition they needed to improve their service. I know improvements like this don’t even touch the greater problem behind the headlines of ambulance delays: the failure, through lack of funding, to provide appropriate social care. Yet every time we neglect a chance to make a small change for the better or to shine a light on the scale of the challenges facing the NHS, we admit defeat to the steady erosion of what our health service can provide.
The trust’s letter of apology and explanation arrived nearly a year to the day that my father died. On the anniversary of his death, I felt some relief. I’d done all I could. I’m just sorry my father didn’t get to read that letter.