Delays handing over ambulance patients to A&E departments are growing, a report has warned - both increasing the risk to those needing emergency care, and increasing the strain on 999 crews.
A report due to go before the West Midlands Ambulance Service (WMAS) board tomorrow reveals "more patients than ever [are] being delayed in handover to the hospitals", with the number waiting more than an hour doubling in December.
This poses a "risk to effective care of patients", it states, as well as keeping paramedic crews out of action for long periods of time, which could impact 999 responses.
Figures for December - spanning the end of the second national lockdown to shortly before the third came into force - show that the Royal Shrewsbury Hospital in Shropshire recorded the highest rate of patient transfer delays, with 13.9 per cent taking longer than 60 minutes.
That amounts to 237 of 1,505 handovers - and was the highest rate out of the 16 emergency hospitals covered by WMAS.
Heartlands Hospital, which is run by the University of Birmingham Hospital Trust, was in second place with a rate of 13.6 per cent, or 557 of 3,846 handovers.
Meanwhile, the number of people waiting even longer was worryingly high too.
Worcestershire Royal Hospital saw 29 patients wait more than four hours - more than double the next two highest hospitals, Heartlands and the Royal Stoke, which had 12 and 11 respectively.
Matthew Hopkins, chief executive of Worcestershire Acute Hospitals NHS Trust, said: “Teams across our two emergency departments are working incredibly hard to ensure patients receive appropriate and safe care through one of the most challenging periods in the history of the NHS.
"Additional seasonal pressures also mean more patients are attending our A&E departments each day - in addition to the significant challenges posed by coronavirus."
He said that they had seen a reduction in waiting times since the beginning of January.
The Royal Shrewsbury Hospital did not record anyone having to wait more than four hours, though chief operating officer Nigel Lee echoed observations that it was an increase in winter pressures - as well as Covid patients - driving delays.
“Our hospitals are seeing a significant level of urgent care activity, both in terms of the number of patients with COVID-19 that we are treating and the number of emergency patients more generally we are seeing at our A&Es," he said.
“Patients arriving by ambulance, whose admission is delayed, are assessed by a senior member of the medical staff."
University Hospital Birmingham NHS Trust has also been approached for comment.
Hour-plus ambulance waiting times across West Midlands Hospitals:
Royal Shrewsbury - 13.9%
Heartlands - 13.6%
Worcestershire Royal - 12.7%
Burton - 11.7%
New Cross - 11%
Queen Elizabeth Hospital - 8.4%
Good Hope - 8.3%
Princess Royal - 6.7%
Royal Stoke University Hospital - 6.3%
Russells Hall - 4.1%
University Hospital Coventry & Warwickshire - 3.4%
Hereford County - 2.2%
Warwick - 1.7%
City (Birmingham) - 1.6%
Sandwell - 0.8%
Alexandra - 0.6%
Report author Craig Cooke, the Strategic Operations Director for the ambulance service, reported that the number had "doubled" for the third quarter of 2020 across the region.
"Hospital handover difficulties started to rise in June, and this situation has worsened each month thereafter," he wrote.
The increasing pressure that NHS staff are facing was also highlighted by a social media post that Dr Punith Kempegowda from the Queen Elizabeth Hospital (QEH) tweeted in December 30 2020.
He tweeted a picture showing a row of ambulances waiting outside of QEH, saying patients waited for more than three hours in ambulances due to a lack of space.
In the report, Mr Cooke went on to say that WMAS had been working closely with NHS England to try to tackle what he called the "worsening situation", to highlight "both the patient risks and operational difficulties this presents."
The board of directors will discuss his report on January 27.