One Day With an Ambulance in Britain: Long Waits, Rising Frustration

WREXHAM, Wales — Rachel Parry and Wayne Jones, two paramedics with the Wrexham Ambulance Service, pulled up to a hospital in northern Wales with a patient just after 10 a.m. one early December morning.

That’s when their wait began.

It would be 4:30 p.m. before their patient, a 47-year-old woman with agonizing back pain and numbness in both of her legs, would be handed over to the emergency department of Wrexham Maelor Hospital. It was more than 12 hours since she had first called 999, the British equivalent of 911.

The delays have grown so bad — and so common — the two paramedics said, that their first interaction with patients is no longer an introduction.

“We start with an apology now,” Ms. Parry said. “Every job is, like, they open the front door, ‘Hi, we are so sorry we are late.’ That has become the norm.”

A medical emergency vehicle responds to a 999 call.Credit…Andrew Testa for The New York Times

The sight of ambulances lined up for hours outside hospitals has become distressingly familiar in Wales, which last month recorded its worst wait times ever for life-threatening emergency calls. But the problem is far from isolated. Ambulances services in England, Scotland and Northern Ireland are also experiencing record-high waits.

It’s a near-crisis situation that experts say signals a breakdown of the compact between Britons and their revered National Health Service: That the government will provide responsible, efficient health care services, mostly free, across all income levels.

The issue will be cast into sharp relief on Wednesday when ambulance drivers in England and Wales stage the first of two strikes over low wages and deteriorating work conditions They are scheduled to walk out again next week.

It will be the latest walkout in a period of intense labor strife in Britain, with a series of strikes planned across the country during the holidays. Nurses are staging their second one-day strike on Tuesday, and rail workers and border control workers at airports will begin several days of strikes later in the week.

Countless harrowing incidents have called attention to the ambulance problem in Britain, including that of an elderly man whose family covered him with a tarp as he waited seven hours after falling outdoors, and a 17-year-old soccer player who waited for four hours lying on a rainy field after suffering a neck injury.

Ambulance workers wheeling a patient suffering a suspected heroin overdose into the Wrexham Maelor Hospital. The most serious cases, known as “red” calls, are always prioritized, and nurses find ways to make space.Credit…Andrew Testa for The New York Times

A New York Times photographer and I spent a day with the Wrexham service earlier this month, witnessing the paramedics gently carrying patients down staircases, navigating narrow streets and trying to comfort people during excruciatingly long waits in the hospital parking lot. Frustration built as the hours ticked away.

One challenge cited by health care experts was evidently clear on this day: There is an acute lack of beds in the accident and emergency department, or A&E as emergency rooms are called in Britain, which are overcrowded because of an inability to find room for patients elsewhere in hospitals. That is because patients ready to be discharged from the hospital often have nowhere to go as a result of dwindling social care services — which have been hobbled by a lack of government funding and huge staffing shortages.

That leaves ambulances lined up outside waiting for beds to open up.

Doctors, ambulance crew members and nurses conferring in the busy accident and emergency department at Wrexham Maelor Hospital in Wales.Credit…Andrew Testa for The New York Times

Frontline staff are reaching a breaking point.

While Ms. Parry and Mr. Jones waited at the hospital with their second patient, there were at least 21 calls in their response area that they and other paramedics also stuck at the hospital could not be deployed to. During their 12-hour shift, they only picked up three patients.

“It’s frustrating,” Mr. Jones said. “These people are out in the community and they are desperate.”

Good Samaritans sometimes step in and drive people in distress to the hospitals themselves. While Ms. Parry and Mr. Jones were waiting with their patients, two cars pulled into the ambulance drop-off point with patients. In both cases — one in which an elderly woman fell and broke her wrists and another in which a woman collapsed in a supermarket — the driver had called the emergency services only to be told it would be hours before an ambulance could come.

“Bystanders are doing more jobs than me today,” Ms. Parry said in frustration, after helping both arrivals into the hospital.

Analysis of the latest data by the Association of Ambulance Chief executives found that response times had increased across the country, with patient handover delays reaching unprecedented levels by November.

Ambulance crews waiting outside the Wrexham Maelor Hospital. Once the beds in the hospital are filled, ambulances have to wait with their patients outside until more beds become available.Credit…Andrew Testa for The New York Times

Ms. Parry and Mr. Jones say their biggest fear is arriving to pick up a patient after a long delay only to find they have arrived too late.

“I know people have died,” Ms. Parry said. “I know of a crew that has said, ‘We’ve just been to someone who was waiting four hours for us and they are dead on the sofa.’”

Ambulance services across the country, which are part of the National Health Service and managed by an area’s local health trust, have described a rising number of deaths linked to long waits. One English ambulance service noted that the number for its crews had risen from just one in 2020 to at least 37 in 2022.

A spokesperson for the government’s Department of Health and Social Care, which oversees the National Health Service, said in a statement that it recognized the pressure the emergency crews are under “and are taking urgent action to support the ambulance service and staff.”

Ambulance workers arriving to take care of Ms. Taylor, who suffers from complications of COPD, or chronic obstructive pulmonary disease.Credit…Andrew Testa for The New York Times

“No one should have to wait longer than necessary for emergency care,” the statement said, adding that the government is investing an additional 6.6 billion pounds, or about $8 billion, in the service over the next two years “to ensure it can take rapid action to improve waiting times.”

For now, ambulance staff members like Doug Green, 48, a paramedic and operations manager with Wrexham Ambulance, are doing the best they can to manage.

As the ambulance bay at the Wrexham Maelor Hospital became a parking lot of stalled florescent yellow emergency vehicles in the afternoon, Mr. Green went inside and began helping to clean rooms to expedite the process of admitting ambulance patients. The most serious cases, known as “red” calls, are always prioritized, and nurses find ways to make space for those patients.

Frank Taylor at home on the morning after his wife was taken into the hospital.Credit…Andrew Testa for The New York Times

“I see all of these ambulances stuck out there and of course there is an urgency,” Mr. Green said. “As soon as you free up a bed, its already full,” he added. “It’s like a game of chess where people keep stealing the pieces from you.”

Emergency room staff members often visit patients waiting in the back of the ambulances to assess their conditions and make sure they are not deteriorating further.

For the patients who encounter these long delays, that wait can be a torment.

Just after 7 a.m., Mr. Jones and Ms. Parry responded to their first call of the day, which had come in at 3:42 a.m.

The dispatcher gave them details about the patient, and Ms. Parry switched on the blue light and siren and quickly drove to a terraced house on the outskirts of Wrexham. A woman, Gill Foulkes, was in excruciating back pain and her husband had called 999.

The paramedics found her upstairs in bed, writhing in pain, and hooked her up to a machine to monitor her vital signs. They gave her morphine, stabilized her and offered reassuring words as they carefully loaded her stretcher into the back of the ambulance.

Doug Green, 48, operations manager for Wrexham Ambulance and a paramedic, following an ambulance crew on an emergency call.Credit…Andrew Testa for The New York Times

“I was at the point where I thought I would die from the pain, and then these angels came,” she said of the paramedics.

Ms. Foulkes was grateful to the paramedics but said she was distressed and frustrated. She added that she felt sorry for the emergency call handlers as well.

“I was at the point of just begging for an ambulance, and they were distressed listening to me be distressed,” Ms. Foulkes said. “Our government is letting us down, I am afraid.”

Families also find the long waits excruciating as they watch their loved ones suffer. Frank Taylor waited three hours with his wife Ann Taylor, 79, for an ambulance, saying it was hard for him to see her in so much pain.

When the paramedics arrived, he was relieved to see them swiftly hook her up to oxygen before gently carrying her, wrapped in a blue knit blanket, down the stairs to the ambulance.

But when they reached the hospital, it was another two hour wait before Ms. Taylor was finally taken inside. At one point, she was transferred from the back of one ambulance to another to allow a new team of paramedics to take over.

A patient being tended to at Wrexham Maelor Hospital.Credit…Andrew Testa for The New York Times

Around 8:30 p.m., Ms. Taylor was transferred from the emergency room to the intensive care unit, the final stop after a long day of uncertainty.

Last year, Ms. Taylor was moved to a care home after her health declined — she has end-stage lung disease — and Mr. Taylor visits her daily. It was there that the ambulance picked her up.

In their living room of their home the next morning, Mr. Taylor, also 79, pointed out the dozens of spoons his wife had collected over their five decades-long marriage, displayed in a cabinet he built. “There are lots of good memories here,” he said of the home where they had raised their five children.

While he praised the care of the paramedics, Mr. Taylor said the wait time was frustrating. He worried about his wife’s dignity during this final stage of her life.

He said he supports the upcoming ambulance strike. Calls for emergency care have become too tense a waiting game.

“It’s not like it was years ago,” Mr. Taylor said. “Years ago, they would come straight away.”

Wayne Jones and Rachel Parry responding to a 999 call in Wrexham.Credit…Andrew Testa for The New York Times
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