Up to 20,000 patients had ambulances delayed by trust, NHS England review finds
Up to 20,000 patients had their ambulances delayed by an NHS trust intent on giving itself "extra time" to respond to calls, a report has found.
The review by NHS England, which will be published in full on Thursday, found South East Coast Ambulance Service NHS Foundation Trust drew up its secret plan without letting others know and failed to assess how it might affect patients.
The trust ran a pilot project to delay sending ambulances until it had time to assess some calls coming through the 111 telephone system.
National rules say 75% of Category A Red 2 calls should have an emergency response at the scene within eight minutes.
These calls are for conditions regarded as serious, such as strokes or fits, but less time critical than for calls where people are not breathing or do not have a pulse.
Under the project, the ambulance trust gave itself up to 10 extra minutes to reassess what type of advice or treatment patients needed, and whether an ambulance was really necessary.
The investigation by NHS England said the project was drawn up via a group which was established by the chief executive, Paul Sutton, and overseen by at least four executives.
But it was launched without the knowledge of 111 staff, board non-executives, the medical director or local commissioners of services.
Work is now ongoing to try to work out how many patients were harmed by the policy, including how many patients may have died as a result.
The NHS England document, reported by the Daily Telegraph and verified by officials, said 111 call handlers were assuring patients in "life-threatening" situations that an ambulance was on its way, with no idea that it was not.
Instead, paramedics with just one day's training in call-handling were ordered to phone thousands of cases back to see if ambulances were really needed.
The trust has insisted that its own investigations "have not found that the process impacted negatively on patients".
The draft report from NHS England says it is impossible to conclude that patients were not harmed, and has examined seven "serious incidents", including five deaths.
In one case - known to be the death of a 60-year-old Horsham man who had suffered a cardiac arrest - there was a "missed opportunity" to improve his outcome, it said.
The health sector regulator, Monitor, has said the trust did not give sufficient consideration to the impact on patient safety or fully informing the trust's board.
Last week, it said the project, which was run between December 2014 and February 2015, was "poorly handled" and it had concerns over how the trust was being run.
Monitor also said it has "reasonable grounds to suspect that the trust is in breach of its licence to provide NHS services", and has placed conditions on its licence.
A spokesman for NHS England South said: "We agree with Monitor's assessment that the trust acted unilaterally and inappropriately, and we support the action taken to rectify the relevant operational issues."
A statement from the trust said: "Last winter, during an extremely busy period, South East Coast Ambulance Service introduced a process to deal with certain calls passed from 111 to the 999 service.
"The purpose of this process was to protect patient safety by ensuring that our most seriously-ill patients received the care they needed as quickly as possible.
"There has been some suggestion that this resulted in less serious patients being harmed. We would like to make it clear that our investigations to date have found no evidence to support this suggestion.
"We would also like to stress that calls which went through this process were not counted towards nationally reported performance figures, as previously set out in our annual report."
The trust said it was working closely with Monitor.
Katherine Murphy, chief executive of the Patients Association, said: "The reports today about the conduct of South East Coast Ambulance Trust are truly shocking.
"There has been a complete disregard for patient safety through a policy that has put thousands of patients at risk.
"While the 111 service was designed for non-emergency calls, any situation that is categorised as 'life-threatening' should be treated as such. In emergency situations, every minute is vital and this doubling of response time is completely unacceptable.
"Executives should be in place to offer examples to their staff, and these findings are a huge betrayal of trust to those phone operators who work so hard to provide help for patients.
"Patients have suffered thanks to this policy and there must now be a thorough investigation into the project, particularly into those who implemented it."