Leaders at East Midlands Ambulance Service say an 'unacceptable' pattern of ambulances spending hours waiting outside emergency departments to discharge patients is hampering response times.

The entire Nottinghamshire NHS is currently in a 'critical incident' – meaning hospitals are unable to cope with the rising numbers of patients coming through their emergency departments.

It is the second critical incident declared within the system in three months, after one was announced in July.

The ambulance service covers Nottinghamshire, Derbyshire, Leicestershire, Rutland, Lincolnshire and Northamptonshire.

Chief Executive of East Midlands Ambulance Service (EMAS) Richard Henderson said the service is also anticipating an "extremely challenging winter".

At the service's board meeting yesterday (4 October) senior staff discussed current issues with hospital handover delays which mean paramedics can spend hours waiting to discharge patients into emergency departments.

In September, 14,800 hours were lost due to paramedics waiting outside hospitals to handover patients – which is 4000 more hours than the same period in 2021.

And this cannot be attributed to increased activity as the service is averaging 2,500 incidents a day, which is below what is expected.

Non-executive director Gary Brown asked if there was any "tangible progress" on reducing handover delays.

Ben Holdaway, Director of Operations at EMAS, said: "All we are seeing is things getting worse.

"I would like to say there's a little chink of light but from what we've seen in the last two weeks it's just getting worse."

But the chair of the board Karen Tomlinson emphasised that the issue is "everybody's problem", not just the ambulance service.

The delays are also "inevitably" leading to more serious incidents being declared, the Director of Quality Improvement and Patient Safety added.

Nichola Bramhall said the service is seeing "unprecedented levels" of serious incidents – which can often lead to the death of a patient.

Ten serious incidents were raised in September, six of which were related to a delayed response from an ambulance.

Ms Bramhall said: "Throughout the year we have reported 48 serious incidents with 65 per cent of those relating to delayed response. Over half of those are in Lincolnshire.

"Last year in the same period we reported 28 serious incidents and that was another record year.

"We keep breaking records we really do not wish to break.

"We all have to remember that at the end of those stories is a family who is grieving the loss of a loved one and staff who feel morally injured that they are not able to get there and deliver the levels of care."

Richard Henderson, Chief Executive, added that the pressures are being seen both regionally and nationally.

He said: "This is not only a significant issue for our patients, but for our workforce where people are coming to work and spending many hours with patients in the backs of ambulances outside A&E departments, which is unacceptable.

"Also, our colleagues in control rooms who are having to deal with patients over the phone where we may not have an ambulance immediately available to dispatch and that is extremely stressful and challenging.

"I can't sit here and say we will absolutely improve because at the moment we are not seeing the evidence to support that."

Ben Holdaway, Director of Operations, said delays in hospital handovers are now being seen across most of the region, whereas they were formerly contained within Leicestershire and Lincolnshire.

He said: "For the first 18 days [of September] we were averaging to lose 390 hours a day, which is still an awful lot of hours.

"However from the 18th September onwards, we were losing 710 hours a day on average, it flipped completely.

"Unfortunately, we started the same way and if we continue on the trend we will see just short of 17,000 hours lost this month to hospital delays, which will be the highest in this financial year and second in the calendar year.

"Hospitals are a huge challenge to us.

"Only last week we had Nottinghamshire call a critical incident where we saw delays at Queen's Medical Centre, where we never really had any issues before.

"Under half of what we attend is going to emergency departments yet we have these horrendous delays at all of our sites."

Last week, senior staff at the Queen's Medical Centre apologised to patients who had had planned operations cancelled because of the delays.

But managers also said delays in discharging patients back into the community were causing the backlogs.

A fortnight ago, more than 200 patients across the Queen's Medical Centre and City Hospital were at one point deemed 'medically fit for discharge' – but could not leave the hospitals because there is not enough support for them in the social care sector.