NHS call handlers have told patient safety investigators of their distress at hearing people deteriorate while waiting for ambulances, with staff saying they often worry: "How many people are we going to kill today?"
Officials from the Healthcare Safety Investigation Branch (HSIB) asked staff working in urgent and emergency care (including in A&E, NHS 111 call handling centres and ambulance services) for their experiences as part of wider research into NHS care.
They concluded there is a strong link between patient safety and staff wellbeing, adding: "The investigation heard that while staff are trying their very best to ensure safe care, harm is happening, and this is affecting patient outcomes and staff wellbeing."
Investigators said staff "at all levels" told the HSIB team about the challenges they face each working day.
"Many staff cried or displayed other extreme emotions as they described their working environment, their personal feelings on their own decision-making and that of others in relation to patient care, and the burden of moral distress," their report said.
Emergency (999) call handlers told how they received repeated calls from patients waiting for an ambulance.
"In some cases, the patient was heard to be deteriorating and staff were unable to respond, other than offering telephone advice," the study said.
'Frustration' at 'Not being Able to Send Ambulances to Patients'
On some occasions, more than 100 category 2 calls (relating to conditions including heart attack and stroke) were waiting, "with no ambulances available to respond".
The study added: "Dispatchers told the investigation that it was common to worry about 'How many people are we going to kill today?' due to their frustration and sadness at not being able to send ambulances to patients."
In A&E departments, staff described making "challenging decisions" on which patients in queuing ambulances to take in for treatment. They described this as often being "the most unwell, unwell patient", and said they felt distressed when they were unable to do the right thing by all patients. Other staff told how delays to discharging people from hospital to social care increased their risk of acquiring more infections.
As a result of these pressures, a whole range of staff said they found it hard to switch off from work, while some "spoke of isolation and despair at going home to an empty house after a difficult and challenging day at work, without support structures in place".
Data shows that anxiety, stress, depression, and other psychiatric illnesses are consistently the most reported reason for NHS staff sickness absence, accounting for more than 476,900 full-time equivalent days lost and 23.2% of all sickness absence in June 2022.
The HSIB said it had initially begun a project "focusing on what is working rather than what is not working" but this quickly changed "as the investigation saw, felt and heard the significant distress" of staff.
Investment in Mental Health Support for Staff 'Key'
An NHS spokesperson said: "There is no doubt that NHS staff have faced significant challenges this winter with record demand for urgent and emergency care, high levels of bed occupancy, difficulties discharging patients, and the combined impact of COVID and flu making this the busiest winter ever.
"The safety of both patients and staff is vital, and the NHS takes staff health and wellbeing incredibly seriously with a range of support, including dedicated helplines, wellbeing apps and coaching, as well as the option of flexible working – and we will shortly publish an update to our Patient Safety Strategy which will include detail on staff safety."
Responding to the HSIB report, Sir Julian Hartley, chief executive at NHS Providers said: "This report reflects the mounting pressure on ambulance workers. Long shifts, often on the road and away from the support of colleagues or managing high stress situations, can lead to feelings of isolation, which can make managing an already-challenging job even more emotionally taxing.
"At the heart of this problem lie systemic issues, including high demand, low capacity, delayed discharges, and vast workforce shortages. This feeds into a deeply challenging work environment right across the system, which leaves staff feeling they can't provide the care they want to – leading to a sense of moral injury, further exacerbating a difficult situation.
"Trust leaders are working extremely hard to recover urgent and emergency care services, but this can't be done overnight and not without action on a national level. Growing capacity and investing in mental health support for staff is a key short-term solution.
"On top of that, the NHS' long-term workforce plan, which needs to be funded by the government, should go a long way to shore up vital resources. We also hope the decision to withdraw national funding for NHS staff wellbeing hubs is reversed, as they provide invaluable mental health support."
This article contains information from PA Media