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South East Coast Ambulance 'failure' over NHS 111 calls South East Coast Ambulance 'failure' over NHS 111 calls
(about 2 hours later)
Ambulance managers could be forced to step down after a trust changed the way it handed some NHS 111 calls, a health regulator has said. An NHS ambulance trust is being investigated after it dodged national response targets to gain more time to assess some seriously ill patients.
South East Coast Ambulance (Secamb) transferred some NHS 111 calls to the 999 emergency system to give staff up to 10 minutes more time. In a pilot project, South East Coast Ambulance delayed sending help for certain 111 calls and transferred them to the 999 system, thus gaining an additional 10 minutes to respond.
Monitor said the calls involved patients with life-threatening illness. Health regulator Monitor said it had not fully considered patient safety.
Secamb said it wanted to ensure the service could respond promptly to the most seriously ill patients. The trust has defended the project but acknowledged the "serious findings".
The ambulance trust, which covers Kent, Surrey, Sussex, Brighton and North East Hampshire, changed its call-handling system between December 2014 and February 2015. South East Coast Ambulance Service NHS Foundation Trust (Seacamb) covers Kent, Surrey, Sussex, Brighton and North East Hampshire.
How the call handling system was changed As part of the pilot from December 2014 to February, the trust transferred some calls between systems to re-assess what type of advice or treatment patients needed and whether an ambulance was really required.
How call handling was changed
Secamb provides NHS 111 services across the region and responds to 999 calls.Secamb provides NHS 111 services across the region and responds to 999 calls.
Some NHS 111 calls were transferred to the 999 system to give Secamb more time for more urgent calls.Some NHS 111 calls were transferred to the 999 system to give Secamb more time for more urgent calls.
The calls affected were in the second most serious category - issues which may be life-threatening but less time-critical. The calls affected were in the second most serious category - Category A Red 2 - which covers conditions like strokes or fits but which are less critical than where people are non responsive.
Ambulance trusts are supposed to deal with 75% of these calls within eight minutes, but the trust gave itself up to 10 minutes extra to assess what treatment or advice patients needed and whether an ambulance was required. Under NHS rules, calls designated as life-threatening are supposed to receive an ambulance response within eight minutes.
Health regulator Monitor said the project was implemented in response to high pressure on the service. The trust allowed itself an extra 10 minutes to deal with some calls by "re-triaging" patients in the 999 system.
It said there was a clear failure of management processes and reasonable grounds to suspect the trust was in breach of its licence to provide NHS services. Monitor said the project was "poorly handled" and there were "reasonable grounds to suspect that the trust is in breach of its licence."
The trust is to review the way the project was handled and how it makes decisions. It has added a condition to Secamb's licence, so that if insufficient progress is made the leadership team could be changed.
Monitor has added a condition to Secamb's licence, so that if insufficient progress is made the leadership team could be changed. Paul Streat, regional director at Monitor, said: "It is understandable that trusts want to explore better ways of delivering the best possible care but this was poorly-managed and done without the proper authorisation and without enough thought given to how it might affect patients."
"This project was poorly managed from the start, done without the proper authorisation and without enough thought given to how it might affect patients," said Monitor regional director Paul Streat. The trust said it had faced "unprecedented call volumes" and "serious hospital handover delays" last winter.
Secamb said it welcomed Monitor's recognition it was under severe pressure from unprecedented call volumes and serious hospital handover delays. Chief Executive Paul Sutton said it had wanted to make sure the most ill patients were responded to promptly, but acknowledged that it had not acted in the right way.
"We recognise that it was not well implemented and we did not use our own corporate governance processes correctly," said chief executive Paul Sutton. "These are serious findings," he said. "We have already begun to take steps to address Monitor's concerns and as part of this process, independent reviews will assess how decisions are made within the trust, governance processes and our approach to patient safety."
"These are serious findings.
"We have already begun to take steps to address Monitor's concerns.
"As part of this process, independent reviews will assess how decisions are made within the trust, governance processes and our approach to patient safety."