'Demoralised' Welsh ambulance workers 'can't do their jobs' amid longest ever handover delays

  • Watch: A special report by ITV Cymru Wales on the crisis facing our ambulance service and the workers that are demoralised, demotivated and burning out.

The sun is barely up and just minutes into a 12 hour shift with an ambulance crew in Swansea we're responding to a red call - the most serious and immediately life-threatening.

Paramedic Mark Tonkin and emergency medical technician Hannah Matthews are in the ambulance ahead. We're following in a rapid response car with operations manager Lucy Seabourne.

Details of the patient come in: A woman in her eighties is now struggling to breathe after calling 999 almost 14 hours ago. She's been on the floor for almost a day after falling.

It's become the norm for families across Wales to contact us on a weekly basis with their accounts of waiting for hours on end for an ambulance.

But seeing it firsthand and in real time, knowing every second counts as they respond to that now critical call, sends shivers down your spine.

At one point, 12 ambulances were waiting to offload their patients to Morriston Hospital - almost all of the fleet on duty.

What is perhaps most disturbing though, is that had that call come in a few minutes later, Mark and Hannah may not have been able to attend.

They were initially due to head straight to Morriston Hospital to relieve a night crew that had spent much of their shift waiting outside A&E with a patient.

Hospital handover delays mean ambulance crews are often spending their entire 12 hour shifts sitting outside hospitals waiting to offload their patients.

While red calls are still being attended, the target time to respond has not been met for more than two years.

Amber calls, which are still serious but not immediately life-threatening, are waiting significantly longer.

Mark Tonkin has been in the service for 22 years, but not being able to respond to calls has made the last few months the toughest.
  • 'Our patient was one of the lucky ones'

When we do arrive at Morriston Hospital at around 9:30am, we're greeted by six ambulances idling outside A&E with patients requiring beds. One of them has been there for more than 17 hours.

"I thought I was going to be sat with the ambulances outside here, but our patient was one of the lucky ones we can get her into the department and get her treated straight away which is good," Mark explains.

But unfortunately, the patient was admitted because she had taken a turn for the worse. These days, only those in most need of urgent care get in that quickly.

By afternoon, one ambulance has been waiting outside Morriston for more than 24 hours.

The waits are often so long that doctors come outside to treat patients on board.

They're under pressure too - unable to make way for new patients because they can't discharge existing ones.

These are patients who no longer require hospital care, but still need care at home. But a huge shortfall in social care workers often makes this impossible. Last year, around 5,500 jobs were unfilled - around 6% of the workforce.

It means ambulances have become an extension of hospitals.

Ambulance workers cannot leave their patient alone while waiting outside hospitals.
  • 'It isn't what we signed up for'

"Times have changed unfortunately," said Mark, who's been in the service for 22 years.

"It's hard, it's demoralising, it's quite saddening to know that we could potentially be coming in on shift, just sitting round listening to the calls going out on the radio when we should be out there actually getting to the calls."

Hannah joined just before the pandemic, but Covid-19 wasn't necessarily the most unexpected part of the job.

She said: "We're witnessing the patients becoming agitated, distressed and frustrated by the hours just passing them by.

"As a crew this is so, so disheartening to see and it's beyond our control. We need these ambulances back on the roads so that we can respond to the public.

"I didn't expect us to be waiting outside hospitals for the length of time that we are. It isn't what we signed up for."

In charge of ambulance response in the Swansea Bay health board area, Lucy is constantly monitoring how many 999 calls are waiting.
  • Thousands of Welsh ambulance hours lost a week to handover delays

In the last three months, ambulances waited outside Morriston Hospital to offload their patients for an average of 137 hours a day.

Swansea Bay University Health Board said it's developing an acute medicine hub where patients who require "urgent but non-999 medical care" will be treated to ease pressure on its emergency departments.

"It will focus on testing and treating many more patients as they arrive, or within 48 hours in an assessment bed, to reduce the numbers being admitted onto wards," a spokesperson added.

But every single major hospital in Wales is facing the same problem. Those with some of the longest handover delays include:

  • Ysbyty Gwynedd, Bangor, where ambulances waited for an average of 75 hours a day

  • University Hospital of Wales, Cardiff, where that daily average was 80 hours

  • Grange Hospital, Cwmbran, where it was 96 hours a day

  • Ysbyty Glan Clwyd in Denbighshire, where ambulances waited an average of 105 hours

Lucy, who oversees ambulance response in her area, explains the consequences of this: "We're not doing our job as far as I'm concerned.

"A crew will bring a patient in, finish their shift, go home, have the 12 hours off and come back to the same patient who's still waiting outside in an ambulance, so they quite often come back to the same patient they took in 15 hours previously.

"The staff are really demotivated, they don't want to come to work anymore because they know they're going to be sitting outside hospital for the whole of the shift."

One ambulance had been waiting for more than a day while we were on shift.
  • Running on resilience

There are now growing fears that new recruits are missing out on building vital medical skills.

"We've also got a real concern over skill decay as well - they're not getting exposure of ill patients anymore which they were a couple of years ago, so we've got to keep an eye on their skill levels making sure they have the skills.

"We hear breaking point every winter, we've heard that for years, but we do question because of the delays at the moment - because they're so significantly more than we've ever seen before - that this year is going to be the breaking point."

What gave me hope during our filming with the Welsh Ambulance Service was the resilience of the crews. They are tired, demotivated and frustrated, but they haven't given up - yet.

But resilience alone won't get ambulances back into the community, and growing numbers of staff are taking sick leave due to burnout.

This is a system-wide issue, and one that's pushing the Welsh NHS to the edge.

Lucy shows Mark how many calls are waiting to be responded to while he waits to handover his patient to the hospital.
  • Unprecedented pressures

The Welsh Government said it has a delivery plan in place to increase ambulance capacity, improve response times and ambulance patient handover.

A spokesperson said: "The Welsh Ambulance Service and wider urgent and emergency care system has been experiencing unprecedented pressures.

"We are driving a 'whole system' health and social care approach to support improvement backed by £25m of recurrent funding to support the transformation of urgent and emergency care services to deliver the right care in the right place, first time.

"This includes a focus on improving the flow of patients through the hospital system to help them return home when they're ready to do so."