I doubt many, including those of us who work in Ambulance Services, really understand the issues at play but I have a few observations:
1: Demand has increased, though I suspect that staffing numbers have increased too. I don't think it's fair to blame users of the service for the problems. At least not exclusively.
2: Ambulance Services are under greater pressure than ever to treat at scene. When I started over 11 years ago the main focus was on safely transporting patients to hospital. If you were a diabetic having a hypo you quite possibly went to hospital. Now you'll quite likely be treated at home. This is usually great for those patients, and should be recognised as good patient care but it does mean crews spend longer on scene than they used to and may mean that additional staff attend to facilitate treatment the first crew on scene recognise is likely to allow the patient to be left at home but can't administer themselves, thus reducing the nu!bet of available resources.
3: As mentioned turn around times at A/E are longer than they have been. If there are no beds in A/E for patients arriving by ambulance and they're too unwell or vulnerable to wait in the waiting room crews can't free up. There's no space in A/E because there's no beds for the patients in A/E to be moved into and those beds aren't free, in part, because social care is a mess and those requiring it spend longer than clinically necessary in hospitals while it is arranged.
4: Demand and (at least perceived) disinterest and unacceptable delays accessing primary health care either from NHS111/NHS24 or GPs is 'forcing' some to call 999 for things they perhaps wouldn't otherwise call for. This could also be said for social problems too. While these calls don't always generate an ambulance response they do take up service time and resources regardless. This is partly down to a lack of GPS and other primary health care practitioners.
5: A higher percentage of patients are more ill than they perhaps need to be. Whether that's because chronic condition management and routine testing stopped during the early Covid pandemic and therefore problems went unnoticed until they became emergencies or for other reasons I don't know.
6: Staff sickness and retention is a problem. I make roughly the living wage and I have delivered babies, I have talked people through CPR more times than I can count, including on babies and children and in a variety of horrific circumstances. Working overnight at Tesco stacking shelves would be a lot less responsibility and stress for not really that much less money. I know of many people in my service who have left or are actively looking to leave. Vocation or not, there comes a point when enough is enough. I
7: Poverty with its associated poor mental, substance misuse, crime, poor diet and low exercise levels, is also a factor I think. Poor people are really struggling and that affects their health.
I'm not sure how you fix things. Addressing some of these things, or all of them would help I think. It takes money but it also takes a longer term, joined up approach - something government's are poor at. You can't look at any one part of our social matrix in isolation. You can't fix the ambulance service with improving social care, without improving social equality, without improving education etc. It's all connected
