Ambulance service rated ‘inadequate’ as report suggests long delay contributed to death of patient

An ambulance trust has been rated as “inadequate” by inspectors as a report suggested that a long delay had contributed to the death of an elderly patient.

A damning report from the Care Quality Commission (CQC) said that elderly patients faced long waits after falling – with one waiting for 14 hours for assistance from South Central Ambulance Service.

In another tragic case, a long delay contributed to the death of a patient who had fallen and was trapped under their bed.

“Delays in reaching people who had requested emergency assistance were frequent and prolonged,” the report authors said.

Staff felt that “control lacked empathy”, inspectors were told.

Similar to other ambulance trusts around the country, trust data showed “deteriorating” response times to ambulance call-outs, with ambulance queues at A&E, high vacancy rates and staff sickness to blame.

Inspectors highlighted concerns about triaging, including a case where a patient with a “catastrophic” brain haemorrhage experienced delays.

“Staff told us there were issues with scheduling and they felt that ‘control lacked empathy’,” the authors wrote.

“They said it was very hectic with elderly patients waiting long periods following a fall. Staff told us about the day before our inspection when a patient had been on the floor for up to 14 hours, following a fall, before the crew arrived.

“One incident report showed that the medical examiner at the hospital had identified that a long delay where an elderly person had been trapped under their bed had contributed to their death.”

Meanwhile, emergency ambulances were not always staffed with crews who had the skills to give emergency care.

And staff were “discouraged” from reporting safety incidents by local managers as “it created too much work”.

“Incidents that should have been reported as serious incidents by ambulance crews were not, this included where patients had died or suffered significant harm,” the authors wrote.

When things went wrong, staff did not always apologise.

And when written apologies were sent, they “tended to be for the distress felt by the patient or relatives and not for the care shortcomings”, the CQC added.

Trust leaders were “dismissive” of people raising concerns and when some staff raised concerns they were “treated badly”.

One person told inspectors they were “concerned about the culture of problems being swept under the rug, in particular within the management team.”

The CQC also said that a pigeon infestation at one resource centre in Portsmouth led to droppings covering vehicles and contaminating personal protective equipment for staff.

The service is responsible for emergency care for seven million people who live in Berkshire, Buckinghamshire, Hampshire and Oxfordshire.

The latest inspection, in April and May, focused on the emergency care provided by the service.

While most patients told the commission they were positive about the care and support they received from staff, inspectors were told about “excessive waiting times” for calls to be answered and for ambulances to arrive, and for admission to emergency department.

The commission issued a warning notice to the trust, demanding improvements.

Denna Westwood, director of CQC’s South Network, said: “As a result of our concerns, we have issued the trust with a warning notice so it’s clear about the areas it immediately needs to address to ensure people’s safety.

“While staff were doing their very best to provide safe care to patients and support to each other, leaders sometimes appeared out of touch and were not fully sighted on issues that impacted the overall effectiveness of the care they were providing.

“We also found there were frequent and prolonged delays in reaching people who had requested emergency assistance, and this resulted in poor outcomes for some people.”

She added: “Staff described a dismissive attitude from trust leaders when they raised concerns and also told us people who raised concerns were treated badly as a result, and it was evident that the trust did not adhere to its own policy for whistle-blowers.

“We will continue to monitor the trust closely to ensure people’s safety whilst they are making the improvements we have told them to.

“If at any stage we find the trust’s patients are at immediate risk of harm as a result of unsafe care, we will not hesitate to take immediate further action.”

The ambulance service said that it had taken immediate actions including increasing staff in ambulance crews and call centres.

Will Hancock, chief executive of South Central Ambulance Service NHS Foundation Trust, said: “The CQC has highlighted some serious concerns which we must, and will, fix as a matter of urgency. “I want to reassure everyone that we have already taken swift action, but I recognise we have more to do.

“Providing the best possible care to all our patients remains our top priority.

“We have an extensive improvement plan and we are committed to making things better. We will keep focused on putting things right until we and the CQC are confident all the concerns have been fixed.

“It is vital that every member of our team can raise concerns with the confidence they will be dealt with quickly and effectively. We are also working with our partners across the NHS to manage the on-going pressures so we can improve response times and hospital handover times.”

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