London’s ambulance service – from super to special measures
London’s Ambulance Service has been put into special measure following a disappointing review by the Care Quality Commission. It is the first Ambulance Trust to be placed in such a position.
The London Trust, which was ranked as the best performing Ambulance Trust in the country in 2014, has plummeted from the top to the bottom of the table, with failing in response times, staff shortages and concerns regarding the workplace environment all being cited as reasons to place the Trust in special measures.
Just a few of the conclusions reached in the report were:
- “The trust was operating with a shortage of trained paramedics in the light of a national shortage and due to paramedics leaving its service for a number of reasons including better pay elsewhere”;
- Concerns regarding the use and handling of medication;
- “Significant concerns about a reported culture of bullying and harassment in parts of the Trust”;
- Need to improve response and waiting times.
Whilst the level of care provided is not necessarily being criticised, it is the response times to category A calls that is letting the Trust down. Only 25% of such calls were attended in the mandatory 8 minutes. Depending on the length of the delay, that could ultimately boil down to an issue of life and death.
Whilst the failures of the service will no doubt be the main focus of those involved in turning the Trust around, a number of positives were also highlighted, including: Highly dedicated, open and honest staff; good levels of clinical advice provided to frontline staff; higher than average number of cardiac patients receiving angioplasty and good multi-disciplinary working.
Dr Fiona Moore, Chief Executive for London Ambulance Service, said
“We would like to apologise to Londoners and say how sorry we are that we haven’t come up to the standards they should expect of us and we are working really hard to address those issues”.
She highlighted the fact that staff were lost due to the high cost of living in London and accommodation shortage. Recruitment has had to span as far as Australia and New Zealand in order to bring in recruits to fill outstanding vacancies.
When discussing the issue of staff shortages, a spokesman for the GMB Union has said
“We are pleased the CQC identified this and perhaps now it can be addressed in full … as a result of staff shortages, existing staff have had to shoulder more responsibility”.
Whilst a downgrading to “special measures“ status is a blot on the Trusts reputation, the added supported and guidance that comes alongside will no doubt be of benefit to the Trust. This year is estimated to be its busiest in terms of call numbers; 1.9 million. That’s 5,000 every day. It will certainly be relying on the additional support and guidance provided as part of the special measures process to tackle that demand as best it can.
The announcement is a typical example of the challenges faced not only by Ambulance Trusts, but NHS services generally across the country. Lack of funding, increased demand, demoralised staff, and difficulty recruiting are increasingly commonly cited as reasons for falling standards. It also highlights the downward spiral that can develop when just one or two of those crises take hold.
Unfortunately, whilst the report will no doubt have an impact on those working within the Trust, it is the patients who suffer most. Errors or delay in critical care can have an irreparable effect on a patient’s overall result.
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