London’s ambulance service is to be placed into special measures after a number of major failures were identified by healthcare inspectors who branded the organisation’s performance as “inadequate”.
A 54-strong team from the Care Quality Commission assessed the service over a three week period in June and found a number of weaknesses and concerns which have been detailed in a damning report published today.
Ambulance crews told inspectors that the organisation lacked “enough appropriately trained staff to ensure that patients were consistently safe and received the right level of care.”
In addition some newly qualified paramedics said they’d been asked to work on the frontline without the guidance of a more experienced or senior colleague.
Staff also claimed that senior managers and board members had little understanding of the challenges they faced in trying to serve Londoners’ needs and “many reported feeling high levels of stress and fatigue” due to the “long hours” they worked.
The Commission says its inspectors found that a “large number of frontline staff” were demoralised and that the service has “a recognised issue with bullying and harassment” but that an independent report into bullying produced in November 2014 wasn’t presented to the board until June of this year.
Today’s report says “serious concerns” were also identified about how the NHS Trust which runs the service had been fulfilling its responsibilities to deliver a Hazardous Area Response Team service due to a lack of paramedics.
The CQC also says that, at the time of the inspection, major incident protocols which were meant to be reviewed annually hadn’t been updated since July 2012.
Furthermore, some staff said they were unaware of the major incident procedures and most ambulance crews had not been trained in them since they rehearsed for the London Olympics.
Inspectors also identified a “substantial decline in performance” with the LAS failing to meet a target response time of eight minutes for ‘category A’ calls despite being the best-performing service in the country just 16 months earlier.
Despite the failures the CQC says once an ambulance does arrive the service patients receive “is of a good standard”.
Explaining his decision to recommend placing LAS in special measures, Professor Sir Mike Richards, Chief Inspector of Hospitals, said: “I believe that this is the step necessary to ensure that this vital service – which provides emergency medical services to 8.6 million Londoners – gets the support it needs to improve.”
On the decline in response times he commented: “This is a very serious problem, which the rust clearly isn’t able to address alone, and which needs action to put right.”
The LAS has been led since January this year by Dr Fionna Moore who was appointed as interim CEO that month and was made the organisation’s permanent head in July.
Describing herself as “the newly appointed chief executive,” Dr Moore said she and other managers “are sorry we have fallen short of some of the standards CQC and Londoners expect of us.”
She added: “I am, along with my leadership team, completely focussed on addressing the challenges highlighted in this report.”
“We accept that we need to improve the way we measure and monitor some important standards and processes but we would like to reassure Londoners that we always prioritise our response to our most critically ill and injured patients and, in the event of a major incident, we are ready to respond and CQC recognise this.”
LAS says a number of issues identified by the inspectors, including high vacancy rates, have since been rectified and that the organisation “is confident it can respond to a Paris style attack” following a review of its major incident plan.
Labour says the recommendation to place the service in special measures “is the culmination of years of underfunding and understaffing.”
Dr Onkar Sahota, the party’s Health spokesperson on the London Assembly, said some of the blame rested with Mayor Boris Johnson who he claimed had “paid little attention to our warnings that London’s high cost of living and government cuts were making it increasingly hard to recruit and retain enough staff.
“Instead of standing up for the needs of Londoners and lobbying for support for the LAS, Boris Johnson has sat idly by and shamefully allowed the service to reach crisis point.”
Mr Johnson’s office stressed that, unlike the police and fire service, the Mayor has no control over the ambulance service but said he has “discussed the issues raised within the CQC report with Dr Fionna Moore” as well as Dr Anne Rainsberry, the Regional NHS Director for London.
His spokesperson added: “The Mayor is supportive of the London Ambulance Service’s plans to make the necessary improvements highlighted in the report.
“He will continue to seek assurances that every effort will be taken to build on the commitment of staff and that resources and support are in place and properly managed, to ensure the service is fit for the 21st century.”
Managers have previously rejected calls for the LAS to work closer with City Hall and the capital’s other blue light services however two parties on the London Assembly say today’s report means its status as an independent body should now be reviewed.
Liberal Democrat AM and mayoral candidate Caroline Pidgeon commented: “Londoners have for far too long suffered from an inadequate ambulance service, including shocking response times.
“I have long supported devolution of the running of the ambulance service as it will allow greater co-ordination of London’s emergency services and most importantly ensure our ambulance service is far more accountable and responsive to London’s 8.6 million residents.”
Green Party AM Darren Johnson said: “Clearly there is a problem here and the Assembly have already recommended that London would benefit from giving greater oversight of the NHS to the Mayor and Assembly.
“Part of that could include the London ambulance service coming under the remit of City Hall and working more closely with the other blue light services.”