“If you had 10 paramedics in front of you, whether they are two minutes in or 22 years in, everybody is exhausted. Morale is on the floor. We are literally dragging each other through our shifts. We are that tired.”

The words above are from a North West Ambulance Service (NWAS) paramedic at breaking point - and she is not alone.

Recent weeks have seen a meteoric rise in the number of 999 calls - with NWAS taking more than 155,000 emergency calls in June, 48,000 more than the same period last year and 23,000 more than 2019.

The patients being treated are more seriously ill or injured – with category one (life-threatening) and two (emergency) incidents increasing by 27 per cent and 7 per cent, respectively, in comparison to June 2021 to June 2019.

READ MORE: "We are on our knees": Why it's time for some honesty about the NHS’s summer crisis

In the week commencing July 19 alone, the service says it received 43,000 999 calls, averaging 6,200-a-day - some 24 per cent higher than the same period two years ago, before the pandemic.

Meanwhile, ambulances have been seen queuing upoutside of emergency departments, doctors are claiming that an ‘unprecedented’ number of young patients are showing upunwell enough to warrant a precious hospital bed, and health care leaders are pleading for attention to surging pressure across NHS services.

Now, after more than 18 months of exhaustion, paramedics and ambulance crews say they have had enough.

And as they criss-cross Greater Manchester to deal with hundreds of patients every gruelling shift, their frustration is giving way to thunderous rumblings of institutional problems across the region’s health care system.

Problems that are 'absolutely' costing lives, an NWAS paramedic told us - though this view is denied by NWAS.

Ambulance workers from across the UK have written to their chiefs

North West Ambulance Service, based in Bolton, is among 14 ambulance services who have written, through their union, to the chief executive of the Association of Ambulance Chief Executives (AACE) this month.

The services’ blistering letter tells of ‘widespread’ ‘missed meal breaks, late finishes, queuing outside hospitals and increasing levels of sickness absence’ for paramedics.

‘Capacity issues elsewhere in the NHS mean control room staff are dealing with an unprecedented volume of calls,’ adds the letter.

The demand on ambulance services across the UK has become ‘unsustainable’, they say.

The authors of the letter fear the situation may only worsen.

‘Ambulance staff have been at the forefront of the Covid response, working under levels of pressure never seen before,’ UNISON National Ambulance Officer, Colm Porter, and UNISON National Ambulance Committee Chair, Bryn Webster, write.

‘With the relaxation of the remaining restrictions, we are increasingly concerned about the impact this will have on ambulance services and particularly the welfare of staff.’

A queue of ambulances outside Wythenshawe Hospital's A&E in early July

The words form a grim picture. Speak to a paramedic working on the ground and the descriptions take on a fraught reality - one of a health care system fraying at the edges, even posing a risk to its users.

One paramedic, who has worked for for NWAS 15 years, told the Manchester Evening Newsthat this period is the ‘busiest she has ever seen it’.

“I’ve been here for 15 years now, I’ve never, ever known anything like it,” she says frankly.

“We get reminders sent from our specialist paramedics who send a shift email, which basically tells us if there are delays at hospitals, who you can contact as a senior point of contact.

“In these emails it actually documents how many jobs are currently waiting. We’re looking at anywhere between 150 and 200 jobs per shift that are waiting for an ambulance.”

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The backlogs come from a 'perfect storm' of cases - 'Covid patients' still needing hospital care and adults calling with a mixture of ‘mental and physical’ concerns.

There has also been a rise in children needing urgent medical attention as 'respiratory viruses' make their way through youngsters, according to Northern Care Alliance's chief nursing officer, Libby McManus.

“We are seeing more Covid patients again," says the paramedic, who wishes to remain anonymous.

“When Covid first spiked we were seeing critically ill people. That doesn’t seem to be the case at the moment, but they are nevertheless unwell.

“We are seeing a massive rise of unwell children.

“It has come as a massive shock for us because, normally, children would come in the winter months. Even though it’s not planned, you expect that rise in children because of coughs, colds, viruses. This is an unprecedented demand of children.

“But we’re also seeing a lot of unwell adults. My personal experience of that in the last few months has been a lot of mental health patients, a lot of heart attacks. A mixture of medically unwell and mentally unwell.”

Wythenshawe Hospital, where ambulances were queuing earlier this month

On top of these pressures, frustrations continue around people calling the emergency services with trivial reports.

“I’ve been out to make someone a pizza because they didn’t know how to turn the oven on. We were sent to that on blue lights," the paramedic confesses.

“We were sent to a broken acrylic fingernail that was hurting.

“We’ve been out because people have run out of paracetamol, people who have got shampoo in their eyes.

“It will be reported as something entirely different. When you get there, you find out what has happened.

“I think for any member of the public who hasn’t got an understanding of it, who is relaxed thinking ‘Covid doesn’t exist’, ‘Covid ended on Monday’ - they need to wake up.

“It’s a long way from ‘clap for the NHS’. It’s horrific.”

NWAS bosses are sharing that there has been an ‘unprecedented’ spike in 999 calls.

Earlier this month, the demand was such that the service urged people ‘not to call the service back'amid ‘a rise in category one calls’ - the grade given to the life-threatening calls.

The Manchester Evening Newsput the paramedic's claims to NWAS - asking for a response to the mounting pressure on the service and its staff.

Chris Grant, Medical Director for North West Ambulance Service (NWAS), told the M.E.N.: “Our dedicated teams are working hard to answer calls and care for our patients and we are prioritising those that are most sick and severely injured.

“The health and wellbeing of our staff is also extremely important to us, especially given the current pressures; we have measures in place to support them, including trust-supported counselling and links into to other NHS services.

“While we remain very busy, we would urge the public to consider other options if it is not a life-threatening emergency, including NHS 111 online for urgent advice, or your GP or pharmacy.”

In spite of these pleas from the NWAS top brass, this paramedic says the delays patients face in getting care are already ‘dangerous’.

The paramedic continued: “Only two, three weeks ago, we went to an elderly lady who had been on the floor for 22 hours after a fall. She was 93. It’s dangerous.

“We don’t find out about things like that until they come up on our screens. Jobs get passed to us by the call handlers and the dispatchers.

“That job had been waiting 22 hours. The family had eventually called us back to update us on the patient and it had been re-categorised as a category one.

“You’re met with an obviously upset family, an obviously distressed patient. Before you can even get to your patient to deliver care to them, you have to appease a family.

“You’re apologising on behalf of the trust and then, on top of that, you’ve got to provide care for that patient.

“Some people are quite volatile with us, they’re not happy. But, if that was my relative, I wouldn’t be happy either.”

Covid-19 has put the NHS under unprecedented strain

Is this extreme pressure on the service costing lives? “Absolutely,” the paramedic replies.

“We went to a gentleman in his 60s with chest pains about five weeks ago. He’d been waiting an hour already, we travelled around 50 minutes to get to him. He went into cardiac arrest while we were there.

“He’d basically sat and waited nearly two hours by the time we got there.

“As a person, that does take its toll on our mental health, I don’t think it’s good for us.

“It’s quite distressing, what we’re seeing. It’s nothing like we have ever seen.”

However, NWAS bosses have disputed the paramedic's claims that lives are on the line.

Despite the high rate of calls, there has been no increase in 'serious incidents' following category one and two 999 calls, such as unexpected or avoidable death, unexpected or avoidable injury, says the service.

Paramedics are seeing more and more mental health cases, says one NWAS worker, just as their own mental health is plummeting

The trouble is, there does not appear to be just one root cause for the chaos.

Instead, this paramedic claims that other NHS services, designed to leave NWAS room to deal solely with emergencies, are actually bursting at the seams themselves.

Mental health teams and GP surgerieshave had limited capacity due to pandemic restrictions, causing patients to be left until they are at the ‘point of crisis’, she says.

Patients, too, have had reservations about seeking help while Covid-19 was at its height during 2020, meaning their illnesses have progressed to critical stages.

And now concerns about catching the virus in hospital are being allayed by the vaccine rollout, people are more likely to call 999, in the paramedic's view.

“I think people are wary of going to hospital because of the risk you’ll catch Covid, but I don’t think they’re as wary as they once were,” continued the paramedic.

“Again, the demand we’re seeing with the children.

“It’s a multitude of things that have all piled up at once, not helped by this nonsense system."

The ‘nonsense system’ in question, the paramedic claims, puts oldest cases first, as opposed to sending ambulances to jobs closer geographically.

This results in paramedics ‘driving past’ serious incidents, she says.

“We have been working to a different kind of system,” explains the paramedic. “If you’re the next available ambulance, you travel the distance to wherever the next oldest job is.

“It’s been in the background for about 18 months but it started being used around three months ago

“That’s putting pressure on us as a service because we are driving past incidents.

“Say I went from Oldham to Tameside, I might have driven past two jobs. I’ll deal with the job in Tameside, then I’ll have to go back on myself and deal with the jobs I’ve already driven past.

“We are seeing less people because we’re driving so much further.”

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The M.E.N. asked NWAS about the system, named the EOC001 protocol.

An NWAS spokesperson said that that while the system is being used, the service still prioritises patients in the most urgent need, with ambulances being dispatched directly to them so they receive the fastest response, adding 'we are not leaving people in most urgent need'.

Paramedics may feel as though they are driving past jobs, but they may not be aware that there is another available ambulance being directed to an incident, explained the spokesperson.

The AACE has been approached for comment, but did not respond.

The Department for Health and Social Care did not directly address the experiences of the paramedic nor the recent pressures admitted by NWAS, put to it by the M.E.N.

Instead, the department's spokesperson responded: "We have backed the NHS at every turn of this pandemic and the government is committed to supporting the NHS and its staff through COVID-19 and beyond.

“This year we have seen record numbers of doctors and nurses in the NHS, including an increase of 883 ambulance staff. There are now over 1.19 million NHS staff and we plan to deliver an extra 50 million appointments in general practice by growing and diversifying the workforce.

“This will mean improved access for patients and more support for staff to provide a wider range of care options outside of hospital.”

Greater Manchester Mayor Andy Burnham said on Wednesday, July 28, that the NHS crisis was a lot worse than he first thought

But the paramedic says that while there may be more ambulances, many staff are 'stuck waiting on corridors' with patients - unable to hand them over to hospital staff who are at capacity, preventing paramedics from being out on the road.

One hospital in NWAS' roster was so busy that it 'needed a divert', says the paramedic.

A diversion means a hospital asks for ambulances to be sent elsewhere because beds are full.

To deliver safe care, occupancy rates should not exceed 85 per cent, according to the British Medical Journal.

“It might look great on paper that we’ve got so many ambulances per day. But 25 per cent may actually be stood on a corridor," said the paramedic.

"There’s hospital delays meaning we can’t turn around at hospitals, we’re being held on corridors. We can’t get out to people.

“Hospital staff can’t turn us round, there’s no beds.

“We had a hospital, last week, telling us that it was holding ambulances because it needed a divert because it didn’t have staff for their department.

The undisputed weight piling up on paramedics and NWAS staff is having profound effects as paramedics try everything to ease the towering 'stack' of 999 calls that are being logged for them to attend.

“It does impact on your family time,” added this mum-of-three.

“When I walk in at 8pm after being out since half six in the morning, it’s literally shower, uniform, eat your tea, go to bed.

“We have an 11-hour break between our shifts. That’s the minimum we have to have before going back to work.

“There’s no time for a rest break. We should be getting a 20 minute break in the afternoon where we are out of the system for a rest, but instead we’ll take another job.

“It eases the stack by only one job, but it does take another job out of another team’s stack.

“We have access to counselling services, but you would need to do it on your day off - and they are the days you don’t want to be thinking about work.

“If you had 10 paramedics in front of you, whether they are two minutes in or 22 years in, everybody is exhausted. Morale is on the floor. We are literally dragging each other through our shifts. We are that tired.”

'There is no end in sight', says one paramedic

But just how to untangle the seemingly mammoth web of issues?

“It’s difficult,” says the paramedic, before reeling off a list of ideas - anything to slow the race to the cliff edge.

“We need to be put back to our normal working practice, where a dispatcher would allocate us to a job within an area.

“What we hear from the managers is that we need to turn around at hospitals quicker.

“Wear a mask. Stay as safe as you can. Only ring us if you absolutely need us. We should be the last port of call."

The paramedic’s powerful warning gives way to a wavering tone of resignation.

“In the last three months, we’ve had a massive spike - which is only going to get worse because everything is getting back to normal.

“There’s no end in sight. This is kind of becoming the new normal. You know you’re going to be exhausted by the time you’re going home, there’s no reprieve from it.”

NWAS did not have a direct response about the claims of pressure from managers for ambulances to 'turn around' more quickly from hospitals. Rather, a spokesperson said pressure remained high due to the influx of 999 calls.

A spokesperson for the NHS in the North West said: "We are working with partners across the North West to respond to rising demand for urgent and emergency care, and we are grateful to ambulance service colleagues for their work in ensuring people continue to get the care they need.

“Whilst ambulance services have plans in place to ensure everyone who needs an ambulance gets one, they are incredibly busy so we’d urge anyone who needs urgent care to go to NHS 111 online or call 111 so that you can be signposted to the best option for your needs.”

Still, in the face of an apparently spiralling crisis, the quiet courage of a service that has fought valiantly for the last 18 months shines through - a vital sign that those at the centre of the pandemic remain committed to their calling.

The radio buzzes, this paramedic’s break is over, she starts back to work.

“We’re falling to bits. But no matter what, we come in, put our bravest faces on, we get on with it.”

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