With Cumbria’s NHS trust reported to “require improvement” following the latest investigation by a care watchdog, the ambulance service has shared its thoughts.

The Care Quality Commission (CQC) has issued a warning to the North Cumbria Integrated Care NHS Trust (NCIC), instructing it to make immediate improvements to “keep people safe” at both the Cumberland Infirmary and West Cumberland Hospital.

Staff shortages and pressures of Covid-19 are among the struggles faced by the trust, with ambulance handover times also being of major concern to CQC.

In the evaluation report, the group said: “We had concerns about the length of time patients in ambulances waited before being registered in the department.

“National standards state patients should be handed over from ambulance staff to hospital staff within 15 minutes. We spoke with ambulance crews who told us patients often had long waits in ambulances before being handed over.

“This meant patients had not been assessed by a nurse or doctor, nor had any initial tests ordered or carried out and did not have a treatment plan in place.”

They continued: “There was a risk that a seriously ill patient could experience delays to time sensitive treatments such as for stroke, bowel obstruction and sepsis.

“We found evidence of this during our inspection. Delays also meant ambulance crews had to stay with patients and could not go back out on the road to attend to other ambulance calls.”

Dr Rod Harpin, medical director from the trust, said: “The ambulance handover delay was part of the three immediate actions we took after the initial inspection.

"We made improvements in triage and ambulance handover times. I want to emphasize that the numbers of ambulance handover times exceeding 15 minutes have halved since October.

“We have responded to those concerns.

“Underlying this is the flow we need to have through the hospital, so that our ED is not congested.

“That flow includes measures to get patients out of the hospital when they no longer need our acute care.”

From July 20 to August 21 of this year, the North West Ambulance Service recorded 1,624 ambulance attendances relating to Cumberland Infirmary, with 171 of these seeing a turnaround time of longer than an hour.

The longest turnaround time was 246 minutes – longer than four hours.

Of 63 patients who were experiencing signs of a stroke or Cerebrovascular attack, the average ambulance handover time was 34 minutes, with the longest wait time of 84 minutes.

A further 10 patients called an ambulance after having chest pains, with an average handover time of 31 minutes, and the longest time being 45 minutes.

Roger Jones, NWAS head of service for Cumbria and Lancashire, said: “We have worked closely with Cumberland Infirmary to manage the risk to patients, and communicate the broader effects on our response to the wider community as a result of ambulances being held at the emergency department.

“NWAS staff constantly monitor patients who are delayed and the emergency department clinical team are informed of any changes in their condition in order to prioritise them correctly.

"NWAS staff have access to senior clinical advice to support their decision-making and a clear process to escalate any concerns."

He continued: “In addition, we monitor hospital delays throughout the region and have a robust procedure to manage delays and maintain patient safety.

"Since the period mentioned in the report, the situation over handover delays at Cumberland Infirmary has improved and regular discussions are still ongoing.”

Commenting on CQC’s report, Lyn Simpson, who was appointed as chief executive earlier this year, said that it shows trust’s plans are “the right ones”, but the pace of change has been “too slow”.

“We are a relatively new organisation coming together at a time of global pandemic but the bravery and hard work of all our staff, and the efforts and sacrifices of our communities, require that services for patients emerge stronger from Covid-19.

“Importantly, we have already taken swift action to deliver rapid improvements in patient safety.

“The inspection in the summer enabled us to identify immediate actions we needed to take to ensure patients can access appropriate care and treatment in a more timely way.”