People having a heart attack or stroke in some parts of England are being asked to get themselves to hospital when dialling 999 due to the current NHS winter crisis, it has been reported.
According to The Times, West Midlands Ambulance Service has changed the script used by its 999 call handlers to suggest that patients should make their own way to hospital during periods of high demand.
It comes amid concerns over a potential “quad-demic” of illness putting the NHS under more pressure than ever.
The number of people in hospital with flu has more than quadrupled compared with last year, and health leaders said rising cases of COVID, respiratory syncytial virus (RSV), and norovirus are also putting the health service under strain, leading to a record number of people occupying hospital beds for the time of year.
An average of 96,587 hospital beds in England were occupied each day last week, more than have been recorded at this point in any other year. It also means about 95% of hospital beds in England are full.
The Times reported that a leaked internal memo sent to staff at West Midlands Ambulance Service said category three and four 999 calls – including patients with urgent abdominal pain or who have fallen or are vomiting – will be told that the service is under “significant pressure” which means it could take several hours before an ambulance could attend, adding: “Is there any way you can arrange to safely make your own way to a hospital emergency department?”
The memo also reportedly says that in particularly pressured periods, the same request would be made of category two 999 calls – patients who may be having a stroke or heart attack or have suffered major burns and who should be seen normally within 18 minutes.
When should you call 999?
Advice from ambulance services such as North West Ambulance Service says to always call 999 in a medical emergency – when someone is seriously ill or injured and their life is at risk.
Examples can include:
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cardiac arrest
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loss of consciousness
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confused state
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fits that aren’t stopping
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chest pain
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breathing difficulties
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severe bleeding
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severe allergic reactions
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burns and scalds
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suspected stroke
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suspected heart attack
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fall from height
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serious head injury
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stabbing
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shooting
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serious road traffic incidents
However, the NHS website advises that calling 999 does not always mean an ambulance will be sent, adding: “You might be told it’s safe for you to make your own way to A&E, or to be seen elsewhere.”
NHS England explains that in 2017, following the largest clinical ambulance trials in the world, it implemented new ambulance standards across the country to “ensure the sickest patients get the fastest response and that all patients get the right response first time”.
This resulted in four categories of call, based on questions asked to the person by a call handler:
Category 1 – Calls from people with life-threatening illnesses or injuries, with examples given as cardiac arrest or serious allergic reaction.
Category 2 – Emergency calls, with examples including burns, epilepsy and strokes.
Category 3 – Urgent calls, for patients with conditions such as late stages of labour, non-severe burns and diabetes. For these calls, patients may be treated by ambulance staff in their own home.
Category 4 – Less urgent calls, for conditions such as diarrhoea and vomiting and urine infections. In some instances, people might be given advice over the phone or referred to a GP or pharmacist, the website says.
But despite these categories, the memo from West Midlands Ambulance service to staff reported by The Times suggests that even patients in category 2 could be asked to get themselves to hospital.
What else can you do if you’re unwell?
If you’re unwell or injured, but may not need an ambulance, there are other options to dialling 999.
Yorkshire Ambulance Service advises that when you need urgent medical help but it is not a 999 emergency, you can call 111, who will then give you self-care advice, connect you to a nurse, emergency dentist or GP, book you a face-to-face appointment, send an ambulance if necessary or direct you to a local service.
You can also take yourself to A&E, it advises, saying: “Calling 999 and arriving by ambulance doesn’t necessarily mean you will be seen sooner than if you had found your own way to A&E. If you are not in a serious or life-threatening condition, you will be prioritised by the A&E hospital team along with the other patients waiting to be seen.”
Other options include going to an NHS urgent care centre such as a walk-in centre or minor injuries unit, as well as visiting your GP surgery or a pharmacy.
Why is the NHS in crisis?
The NHS always faces pressure in winter due to illnesses like flu, norovirus and also respiratory syncytial virus (RSV) and COVID.
Concerns had initially been raised over a “triple-demic” of flu, RSV and COVID-19 heaping additional pressure on the health service. But last week, after an 86% rise in norovirus cases in hospital compared with the same week last year, the NHS’s top doctor told the service to brace for a “quad-demic”.
NHS national medical director Professor Sir Stephen Powis said: “The NHS is busier than it has ever been before heading into winter, with flu and norovirus numbers in hospital rising sharply – and we are still only at the start of December, so we expect pressure to increase and there is a long winter ahead of us.
“For a while there have been warnings of a ‘triple-demic’ of COVID, flu and RSV this winter, but with rising cases of norovirus this could fast become a ‘quad-demic’, so it’s important that if you haven’t had your COVID or flu jab to follow the lead of millions of others and come forward and get protected as soon as possible.”
Figures for the NHS in England showed that an average of 1,099 flu patients were in hospital beds each day last week, including 39 in critical care – prompting health bosses to urge people to take up the offer of free flu jabs.
NHS staff have also been urged to take up the offer as figures showed that uptake among staff is lower than in recent years.
Figures also showed that 36% of patients arriving by ambulance at hospitals in England last week waited at least 30 minutes to handed over to A&E teams – up from 27% in the equivalent week last year and 31% in 2022.
Some 16% of ambulance handovers, or 14,805 patients, were delayed by more than an hour, compared with 10% at the same point in 2023 and 15% in 2022.
