Paramedics have been told to "drop and go" at hospitals and to pass on certain calls for their help altogether, as the ambulance service struggles with huge demand.

In an internal memo to staff seen by this newspaper, bosses at the East of England Ambulance Service Trust have described it as being "under extreme pressure".

The document chronicles the many difficulties facing the organisation, and especially the problems it has handing over its patients to A&E departments.

It describes how Norfolk paramedics spent a total of 3,500 hours each month waiting on hospital forecourts. The time spent in these queues then has a dramatic impact on the ability of paramedics to respond to other emergencies.

The memo says that on one occasion, the "stack" [backlog] of patients waiting to receive a response from the service exceeded 200.

In the document, officials also lay out the array of measures the Trust has been forced into taking to try and keep ambulances on the road.

These include relying on volunteer 'community first responders' and back-up from firefighters to respond to cardiac arrest 999 calls.

The Trust is also offering incentives for staff to do overtime.

The memo also says the pressures mean "not responding to some calls at all".

It also calls on staff to take a "drop and go" approach, which 'category one' patients - those in life-threatening conditions - are left in emergency department waiting rooms to free up the ambulances for their next tasks.

In these cases, paramedics call ahead to let the hospital know that they will be unable to stay with a patient so will need to forgo the ordinary handover process.

In cases where ambulances are unable to attend at all, call handlers will return calls and suggest alternative ways of accessing care, whether through GPs, the 111 helpline or community health partners.

One paramedic, who did not wish to be named, said the situation had grown so dire that on some shifts they would only care for one patient per day - with their entire working shift taken up waiting to hand them over.

They said: "The pressures aren't the Trust's fault - it's the queueing. There are just so many poorly people.

"People always used to say it's because we are a misused service, but I don't think that's it.

"Most people do genuinely need us, but we're all stuck queueing all shift."

A spokesman for EEAST said: “Demand for our service remains very high, as we are beginning to see rising levels of Covid, staff sickness and handover delays at hospitals.

“We’re working closely with our healthcare partners to keep patients safe and reduce delays wherever we can.

“The public can help us to get to the most urgent cases by using NHS 111 service for healthcare advice in non-urgent cases. Please continue to call 999 if it’s a life-threatening emergency.”

Analysis

The dire situation which is described in this memo is not one that can be pinpointed to one singular cause.

Our healthcare system is one that relies on delicate balances and different organisations being able to work together smoothly.

It is a machine with many, many moving parts, but tragically it only takes one cog to not be turning properly for the whole thing to grind to a sickening halt.

And what we are seeing at the moment is a situation where near enough none of the cogs are able to turn together.

Ambulances can't get to patients because they can't unload the ones they do have at the hospital, so have to wait.

Hospitals can't take in ambulance patients because their emergency departments are full.

The emergency departments can't get people onto wards because the wards are full.

The wards can't discharge people because the care sector can't cope with the volume of people needing its services.

All this during a global pandemic - the greatest health crisis in a generation.

But that fact of the matter is that Covid-19 merely exacerbated the problem, emphasising cracks that have been forming for years.

We have a growing population and an ageing one - yet a health system that has been financed to cope with a fraction of what is needed from it.

The government has pledged to invest billions in the NHS, but the sad feeling is that it is slamming the stable door shut long after this particular horse has bolted.

Clarification

The 'drop and go' system sees ambulance staff call hospitals ahead to allow a bed to be made available for the patient as soon as they arrive.

This allows paramedics to spend as little time on site as possible and swiftly get to the next job.

When patients are 'dropped' they are handed immediately over to hospital staff and placed in a bed.

Non 'drop and go' cases often require paramedics to wait with patients until they can be admitted.