Why it's wrong to blame Scotland's ambulance crisis on Covid cases alone

Yet exhausted and demoralised staff, speaking to the Herald anonymously, describe a "disaster in the making for years" and call centres in "total disarray".

Drew Duffy, GMB representative for frontline paramedics, says the past 18 months has simply "made a bad situation even worse".

The number of incidents attended by the ambulance service is similar to pre-pandemic averages

READ MORE: Anger as Glasgow father of three dies amid 40-hour wait for ambulance

At first glance, the statistics appear confounding.

The total number of incidents the ambulance service is attending - roughly 11,000 to 12,000 per week - is not actually any higher than pre-pandemic, and roughly one in eight callouts in early September involved suspected Covid compared to half of those attended in April 2020.

The majority (95 per cent) of frontline healthcare workers are now fully vaccinated and the number of NHS staff absent due to infection or self-isolation - at just over 3000 - is a third of what it was at the beginning of the pandemic.

Callouts for Covid-suspected incidents peaked in April 2020

So why, nine months into a vaccination programme that was supposed to usher us back to normality, is the NHS facing what many fear could be the worst winter in the history of the health service?

Partly it is because the more transmissible Delta variant pushed herd immunity out of reach, and partly it is because other respiratory viruses such as flu are likely to rebound with lockdown lifted.

But much of it boils down to a problem of patient "flow" which is not wholly related to Covid.

In the five years to December 2020, for example, the number of acute hospital beds available for inpatients and day cases was cut by 700 Scotland.

Delayed discharges, March 2020 to September 2021

But with social care services struggling, too many frail elderly patients who are well enough to be discharged end up occupying the remaining beds because they have nowhere else to go.

Delayed discharges are up 50% since May and by September 15, over 1500 beds were 'blocked'.

That, in addition to physical distancing rules which have cut hospital capacity, causes bottlenecks in A&E where an increasing share of patients are now turning up sick enough to require an urgent admission.

Attendances at A&E have returned to pre-pandemic levels, but a much greater proportion than normal for summer are requiring an urgent admission into hospital

This is strikingly different to a pre-pandemic summer when the vast majority of people presenting at A&E could be treated and discharged, and goes some way to explain why a quarter of patients are spending more than four hours in A&E; they are too ill to go home, but there is no hospital bed to transfer them into either.

Many are not Covid cases, but symptoms of the pandemic nonetheless: late-stage cancers previously undiagnosed, or chronic conditions such as heart disease, COPD or diabetes which have deteriorated during lockdown.

All this leads back to ambulances, which are left to stack outside emergency departments with patients on board and unable to get back on the road until an A&E bed becomes available.

Overall admissions to hospital remain around 7% lower than pre-pandemic averages, but the number of daily admissions for Covid (top) has tripled in the past month at a time when delayed discharge is also increasing and physical distancing limits capacity

READ MORE: Scotland's recovery plan will fail without serious investment in staffing

Meanwhile, call handlers are being flooded with thousands more calls than they were last summer and must prioritise who to dispatch scarce ambulance resources to first.

The end result is patients waiting hours for help and, as the Herald revealed in the tragic case of Gerard Brown, sometimes dying before it arrives.

Nearly 300 extra paramedics and support staff are being trained and recruited, with some due to join the workforce between now and Christmas, and the military is being drafted in to help drive vehicles and man mobile testing units.

But perhaps it is all too little to late?

Ironically, the NHS Louisa Jordan has closed to make way for COP26 just when bed shortages have become critical.

Dr John Montgomery, chair of the Glasgow South GP Committee, told the BBC on Thursday that this "may turn out to be one of the worst decisions that we've made", adding that the venue "would have been a perfect place" for ambulances to drop off patients requiring lower level care.

Nurses at the NHS Louisa Jordan, a field hospital originally established at the SECC to treat Covid 'overspill' patients but later used for outpatient clinics and as a mass vaccination hub. It is now been dismantled in preparation for COP26

READ MORE: Sickness absence for mental health issues rising among paramedics in three years to 2019

However, one Glasgow paramedic with 20 years experience told the Herald that the current pressures date back 15 years.

They said: "We have no more Accident and Emergency ambulances on the road even though the call numbers have been rising year on year.

"The last time we had a shift review that put more A&E ambulances on the road was back about 2005-2006."

The paramedic stressed that ambulance staff were waiting five hours outside the Queen Elizabeth hospital "years before Covid", and that centralisation of some services meant Glasgow crews could find themselves dispatched on lengthy round trips to Lanarkshire to transport patients with broken hips to orthopaedics in Wishaw.

They added that Health Secretary Humza Yousaf had been "quite right" to tell the public to "think twice" before calling 999, adding: "The number of people who could make their own way to hospital but will wait for an ambulance because they think it means they will get seen quicker at A&E is becoming ridiculous."

Meanwhile, control room conditions were described by one senior insider as being "like battery hens", with high staff turnover and shortages of dispatchers to adequately cover shifts.

They said the ambulance service felt like a "dumping ground" for other services.

"GPs and receptionists tell patients to call 111 or 999 often when it’s not required and any buzz word like shortness of breath or chest pain mentioned to 111 gets directed to the ambulance."

They also questioned why patient transport services, which shuttle people who need them to appointments, were primarily used as a 9 to 5 service "when ambulance crews are screaming out for assistance".

"These vehicles could be going to those who just need first aid or a taxi run."

This week has shone a light on a service stretched to breaking point - but much of this crisis is years in the making.