Surge in A&E demand forces rise in private ambulances

A Channel 4 News and Firecrest Films investigation has found that there has been a surge in the use of private ambulances in parts of the country crewed by staff who may have as little as five days’ medical training, writes Victoria Macdonald. And in both private and NHS ambulances, they are turning up at 999 calls without a paramedic on board.

We have been told of occasions when patients in agony have been left without morphine because the crew who had attended the 999 call were not qualified to administer the drug. In another instance, we learned of an ambulance travelling without a paramedic that had to stop and wait for help after a patient’s heart rate dropped to a dangerous level.

The most tragic case, however, was that of Carole Stevens. Mrs Stevens, who had multiple sclerosis, had been visiting her family in Kent last October when she fell out of her wheelchair.

My dad said there was nothing they could do for her, that she was going to die soon. Joe Stevens

Because of her condition, an ambulance was called. Her daughter Joe Stevens said: “As far as she told me they said: ‘We think you have pulled your tendon because you are not used to your legs being bent that way and you probably do not need to go to hospital.'”

So, believing there was nothing concerning to worry about, Mrs Stevens and her husband drove back to their home in Spain. But eight days after the accident she still had pains in her legs and was taken to hospital.

“My dad rang me and said they had taken mum into hospital and they had discovered she had two broken legs,” Joe Stevens said. “The doctors in Spain were absolutely horrified that they had been missed.”

Joe Stevens flew out to be with her mother but just one day after she had returned her father called to say Carole’s condition had deteriorated. She had developed an inflammation of the colon and had other complications.

“My dad said there was nothing they could do for her, that she was going to die soon,” Joe said. “I just… when I spoke to my dad I said, look, just let her know that it is OK to go. I didn’t want her to hang on and wait for me if she was suffering.”

Sixteen days after her fall, Carole Stevens died.

Private ambulance crew

Yet it was only when her daughter complained to the South East Coast Ambulance Trust that she discovered it was a private ambulance which had answered the call and there was no paramedic on board. The crew instead were made up of an emergency medical technician and an emergency care assistant. Techinicans can typically have up to 12 weeks’ training compared with the two years of a paramedic.

In the NHS, care assistants receive about nine weeks learning the job but in the private sector that can be just four weeks’ training – three of those spent on driving with a blue light.

The crew who attended Joe’s mum came from ERS Medical, owned by an American company better known for their clinical waste facilities but now with NHS frontline ambulance contracts. An investigation into Carole Steven’s case said that the crew had recommended that she go to hospital, but this is something her family dispute.

Joe said: “I felt quite insulted I think because it did feel like they had shifted the blame to mum and however much they apologised they were ultimately saying that she refused to go to hospital and we don’t believe that.”

In response, ERS Medical told us they had engaged fully and transparently with the investigation from the outset. They added: “The clinical assessment was undertaken by an NHS trained and qualified ambulance technician, who has over ten years frontline ambulance experience both in the NHS and private sector.”

Using the freedom of information act, we discovered that the use of private and voluntary ambulances has soared. Between 2010 and 2013, in the east of England the number of responses more than doubled, and in the south east and Yorkshire it more than tripled. In London, just 45 emergency responses came from private ambulance services in 2010, but by March this year that had risen to nearly 35,000 – although some of that is likely to be because of the Olympics and the Jubilee.

But it is not just private ambulances who are sending out crews without paramedics. It is also happening in the NHS and this can mean a delay in treating the patient while the technician and assistant waits for back up.

Mark Thompson had broken his leg in two places and dislocated his ankle while playing football near Hull. It took the ambulance 30 minutes to arrive and then when they did they could not give him any pain relief apart from oxygen.

“It wasn’t making any difference whatsoever and then they told me they could not give me anything until the paramedic arrived. I was more confused than anything else,” he said.

They told me they could not give me anything until the paramedic arrived. Mark Thompson

And indeed it was a technician and a care assistant. A paramedic had to be called which took another 20 minutes.

In response, Yorkshire ambulance service said: “We would like to reassure the public that we are committed to providing responsive and high-quality care to people in Yorkshire and patient care and safety remains our highest priority.

“As with all emergency incidents, the nearest available crew was dispatched to Mark Thompson. As part of our A&E workforce plans we intend to employ an extra 450 paramedics at the trust over the next five years.”

In both Mrs Stevens’ case and that of Mr Thompson, the expectation had been that it was a paramedic who had come through the door. They were, after all, wearing the familiar green uniform. But as our investigation has shown, that does not always mean what it used to.