Earlier this week West Midlands Ambulance Service (WMAS) revealed its frustrations with patients being put at "catastrophic risk" as a result of handover delays at hospitals in the region – some more than 10 hours for a single patient.
In recent days the severity of the situation was illustrated with two patients tragically dying in the back of ambulances while waiting to be seen at hospitals, while the service has warned the situation means other patients may die before they get to them.
Now, a call handler for the service has spoken out on the dangers facing patients, the 'devastating strain' on staff, and their fears for what will happen as winter takes its grip.
The experienced worker, whose identity is being kept secret, said the situation as worsening, describing Wednesday this week as the worst shift since they started with the trust.
They explained that the level of demand meant that 'category two' calls – life-threatening incidents where people may have severe breathing difficulties, have had a heart attack, stroke or major blood loss – were waiting up to six hours for an ambulance.
'Category three' calls – involving broken bones and patients who have fallen, were facing waits of up to 20 hours.
The ambulance service itself confirmed the strain facing its staff – and the risk to patients – as it revealed that on Wednesday it had 'lost' 1,179 hours across the West Midlands due to delayed hospital handovers.
The service had around 405 ambulances on at the time, meaning effectively 100 ambulances – a quarter of its workforce – was out of action.
The longest handover experienced was nine hours and 56 minutes, at Queen Elizabeth Hospital in Birmingham.
With ambulance staff working a 12-hour shift – with a 45-minute break – one nine -our delay almost wipes out the entire shift on one call.
The situation is so stark that earlier this week NHS England wrote to hospital trusts ordering them to "eliminate" handover delays.
The call handler has called on the government to declare a 'major incident' and bring the army in to help at hospitals.
They warned that staff have been left 'broken' by the daily decisions they face trying to get help to people who need it.
They said: "I have never seen anything like it. It has been worse than any New Year's Eve shift – and New Year's Eve is the busiest night of the year.
"It is not just the call volume although the volume is massive. Our call answering times are very good, it is just the frustration of it. The fact that people who don't normally call ambulances – they call because their husband is having breathing difficulties – they are people who don't normally call ambulances and they expect to get one. These are high-priority calls and they are waiting up to six hours for us to get to them."
They added: "We are in despair. We just do not know where to turn. You just want to bang your head against the wall. You just feel completely and utterly helpless.
"For the despatchers, it is like Russian roulette for them when they have 50 calls at category two outstanding.
"When they get a free crew they have to decide 'do I send it to the next in the queue or to a baby struggling for breath', they are horrendous decisions to have to make.
"I have never known anything like it and I have never known the staff feeling so helpless."
The delays mean many people call back repeatedly wondering when help will come, with handlers left having to apologise.
They said: "A lot of these are elderly people who have fallen, and they are in distress and these are the real heart-breakers because they are on the floor for hours. People are calling back in to see where the ambulance is and we just have to say we are extremely busy, we will get to you as soon as we can."
They added: "Emotionally it is devastating. A lot of people are calling the ambulance because they feel it is the only way they can see a healthcare professional – they can't get a GP or go to A&E.
"It is broken, it is absolutely broken and so are the staff."
The worker called on the government to step in before it is too late.
They said: "Normally an ambulance on a 12-hour shift would attend six to eight jobs. At the moment some of them are only doing one or two because they are spending all the time sitting outside a hospital.
"It is on its knees.
"We do not understand why it is being kept so quiet. It is not to do with Covid, we don't understand why there is no major incident declared, why have the army not been brought in? Why have the fire service not been asked to help?
They added: "The really frustrating thing is when the winter pressures hit, more people are falling over outside, people will be left out in the snow or the cold with broken hips for ten, 12, 14 hours at a time.
"The hospital side of this has to be fixed. there has to be somewhere to take these patients and free up ambulances for emergencies.
"It is like you have your hands tied behind your back. You cannot do anything, it is frustrating, soul destroying and heart breaking at points. Where does it go now? Something needs to be done and it needs to be done fast because it will be a catastrophe in winter."
WMAS last week moved to its highest risk rating for hospital handovers, with Mark Docherty, director of nursing and clinical commissioning, warning that worse could be to come.
He said: “Despite everything we are doing by way of mitigation, we know that patients are coming to harm as a result of delays.
“We know that there are patients that are having significant harm and indeed, through our review of learning from deaths, we know that sadly some patients are dying before we get to them.”
A spokesman for NHS England/Improvement in the Midlands said they are working to address the challenges.
He said: “All local healthcare services are working closely to help reduce ambulance handover delays and improve flow through hospitals using better assessment and discharge processes, despite the extreme pressures on NHS services.
“This year we have invested more than ever in transformation projects as well as providing support for rapid recruitment and additional capacity, but we would urge the public to help us help them by using NHS 111 online to get advice on the most appropriate service before attending A&E, and to only use 999 in an emergency.”