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East Midlands Ambulance Service paramedics suffering ‘moral injury’ as more than 18,000 hours lost to hospital handover delays in February, with Nottingham’s Queens Medical Centre the main culprit

East Midlands Ambulance Service (EMAS) lost more than 18,000 hours to hospital handover delays in February, causing some staff ‘moral injury’.

The ambulance service covers Nottinghamshire, Lincolnshire, Rutland, Derbyshire, Leicestershire, and Northamptonshire.

In February, EMAS lost a total of 18,216 hours due to handover delays over 15 minutes, which equated to an average of 628 hours a day.

EMAS paramedics are suffering ‘moral injury’ due to handover delays.
EMAS paramedics are suffering ‘moral injury’ due to handover delays.

Ben Holdaway, director of operations, raised concerns for the service’s staff at a board meeting on March 5.

He said that Queen’s Medical Centre, run by Nottingham University Hospitals (NUH) was contributing to 28% of the lost hours.

A lack of available beds has meant that ambulances must wait to hand over patients.

This is largely due to patient flow problems through hospitals, where there are often hundreds of patients who are medically fit for discharge but cannot leave because there is no space for them in the social care system.

At NUH, paramedics can cohort patients so colleagues can be released to respond to calls while those in hospital stay to watch over a group of patients.

Chief executive Richard Henderson said it is a “deep-rooted” problem.

Mr Holdaway said: “What compounds the 18,000 lost hours is that 28% of those were lost at NUH, our busiest hospital, and 18% at Leicester Royal Infirmary, our second busiest.

EMAS headquarters in Nottinghamshire.
EMAS headquarters in Nottinghamshire.

“46% of our hours were lost in those hospitals which adds pressure elsewhere as we have to move resources around.

“We have been working to highlight the risk we are facing through NUH, not just through lost hours but also the moral injuries through staff having to cohort patients and waiting with patients for a long period of time.

“We’ve been raising these concerns with the Integrated Care Board (ICB) and hospital. Lots of escalation meetings are taking place until we are more assured we will see improvement.”

Mr Henderson added: “I am confident we will see further change and improvement but it would be wrong to say the improvements have been sustained.

“It would be unfair to say the meetings aren’t having any impact. This is not just a hospital issue.

“It is clear to say, we would deliver all the trajectories if the handover delays weren’t present.

“That’s not to say we haven’t got our own internal inefficiencies but there is a clear correlation between handover delays and our inability to respond.

“That scrutiny of handover is well and truly understood, addressing it is a different challenge as it is deep-rooted.

“Almost 50 per cent of our lost hours are being experienced by our biggest acutes [hospitals] in the region. That has a profound impact.

“This is not just a Nottingham or a Leicester issue, it is something which impacts the whole region.”

In February 2024, EMAS board papers show there were 317 breaches in Minimum Care Standards during the transition from ambulance to hospital.

Of these, 33 patients were taken for a scan or X-ray before being returned to the hospital to wait for handover.

Board chairman Karen Tomlinson said it was “unacceptable”.

She said: “If somebody is that ill, they should not be returned to the ambulance. From a patient perspective it is abysmal.

“For the paramedics, it is not part of what they came into the job to do.

“That worries me more than a lot of other stuff. It’s not acceptable and we need to keep a tight focus on it.”

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