More than 500 seriously ill patients died last year before they could get treatment in hospital after the ambulance they called for took up to 15 hours to reach them, an investigation by the Guardian reveals. The fatalities included people who had had a stroke or heart attack or whose breathing had suddenly collapsed, or who had been involved in a road traffic collision. In every case, an ambulance crew took much longer to arrive than the NHS target times for responding to an emergency. At least 511 people died in England in such circumstances after a 999 call during 2022, according to figures supplied by NHS ambulance trusts and the outcome of coroners’ inquests. Such tragedies are happening more regularly, as large numbers of ambulances become tied up outside hospitals, unable to offload their patients to the staff of overcrowded A&E units. The figure of 511 deaths was more than double the 220 known comparable deaths that occurred in 2021. Bereaved relatives have spoken of how the pain of losing a loved one has been compounded by the ambulance crew having taken so long to arrive and start treatment. Coroners, senior doctors and ambulance staff say the scale of the loss of life illustrates the growing dangers to patients from the implosion of NHS urgent and emergency care services. “These 500-plus deaths a year when an ambulance hasn’t got there in time are tragic and avoidable,” said Dr Adrian Boyle, the president of the Royal College of Emergency Medicine, which represents A&E doctors. “These numbers are deeply concerning. This is the equivalent of multiple airliners crashing.” Rita Taylor, who was 84, died at home in Milton Keynes last October after falling at home, banging her head and developing bleeding in her brain. The inquest into her death heard that an ambulance was called at 10.28am and “due to lack of resources it did not arrive until 17.17” – almost seven hours later. Tom Osborne, the coroner for Milton Keynes, concluded: “The delays in sending an ambulance resulted in a number of lost opportunities to admit her to hospital and begin her treatment.” He was so concerned by the ambulance delay that he issued a prevention of future deaths (PFD) report – a legal warning notice – to the NHS minister, Will Quince, and the South Central ambulance service. The 511 deaths that the Guardian has established occurred last year after a delayed ambulance response are likely to be an underestimate of the true number. Only three of England’s 10 regional ambulance services provided full-year figures for the last two years as requested. We obtained figures for four others in their board papers. Three others – the London, East Midlands and East of England ambulance services – did not provide and do not publish any data on such deaths, even though all 10 trusts are obliged to do so quarterly as a way of improving care. The North East ambulance service (NEAS) recorded 248 deaths last year in cases where its crews could not respond in time to patients deemed to be a category 1 or category 2 emergency. That was more than double the 122 “delayed ambulance response” deaths it had in 2021. Ambulances are meant to respond to category 1 calls within seven minutes and category 2 calls in 18 minutes. When 31-year-old Aaron Morris was involved in a crash while riding his motorbike in County Durham last July, the NEAS took 49 minutes and 49 seconds to respond, despite six different calls asking for urgent help. NEAS’s investigation found that an ambulance was not allocated until 25 minutes after the first call, and there was a 95% chance that he would have survived if delays that impeded his care had not happened. Stephen Segasby, NEAS’s chief operating officer, offered Morris’s widow, Sam, and family his “sincere and heartfelt condolences”. The West Midlands ambulance service (WMAS) and Yorkshire ambulance service each recorded 70 such deaths last year. In WMAS’s case, that was more than treble the 22 it had in 2021. Andrew Cox, the senior coroner for Cornwall, recently issued a PFD to Steve Barclay, the health secretary, after hearing at separate inquests that three patients who died did so after ambulances took, respectively, two and a half, nine and 19 hours to arrive, in 2021 and 2022. Laurence Turner, the GMB union’s head of policy and research, said: “These new figures expose the brutal reality in ambulance services. The horrific scale of this loss of life is placing an unbearable strain on staff and patients’ loved ones. This is a hidden scandal and sadly we know that the true number of deaths will be much higher. More than half of GMB ambulance members have witnessed a fatality due to delays.” Mark Docherty, WMAS’s executive director of nursing, recently told the Birmingham and Solihull joint scrutiny committee that ambulance crews being stuck outside A&E units was the key reason patients were dying because of delayed responses. “This isn’t a staffing issue or a money issue,” he told councillors. “We don’t want to be spending every day going around meeting families and apologising for their relative or loved one dying when they shouldn’t have done. It’s entirely preventable in my view.” The London ambulance service said it did not keep figures on such deaths, despite one of its officials, Helen Woodford, telling the service’s board last September that it was encountering “a high number of incidents reported as death which can be attributed to delays occurring due to the high levels of demand”. NHS leaders, staff groups and thinktanks all blame increased demand for care, years of underfunding and lack of staff for hospitals being so overloaded that they have to force patients to stay in ambulances outside for many hours, leaving paramedics unable to respond to other 999 calls. NHS England did not respond directly to the figures. A spokesperson said: “NHS staff have worked exceptionally hard, particularly throughout winter, to continue to provide patients with care despite record levels of demand, industrial action, a ‘twindemic’ of Covid and flu, and limited capacity due to thousands of beds taken up by patients who are medically fit for discharge every day. “Despite this incredible pressure on services, which has continued into this year, the NHS has delivered significant improvements in ambulance performance in the last two months with response times for category 2 calls an hour faster in January and February than in December. “We know there is more to do, which is why last month the NHS launched its urgent and emergency care recovery plan, which sets out how we plan to reduce waiting times and boost capacity, with hundreds more ambulances, thousands more beds, and increased use of measures like urgent community response teams.” The Department of Health and Social Care said: “Our sympathies are with the family and friends of those who have lost loved ones. No one should be waiting longer than necessary for emergency care and we are taking urgent action to reduce waiting times. We have set out a plan to deliver one of the fastest and longest-sustained improvements in emergency waiting times in the NHS’s history, backed by record funding.”