- Second senior whistleblower speaks out after review says no one died because of delays
- Source said review findings “simply do not tally with” frontline experience
- MP raises concerns about potential conflict of interest for review leader
- Lead commissioner says review team: “Approached their task in a rigorous manner without any prejudice”
An “independent” review which said nobody died because of long ambulance delays in the East of England this winter “simply does not tally with the experiences of frontline staff”, senior whistleblowers have told HSJ.
MP Norman Lamb also raised concerns to HSJ about the review and a potential conflict of interest because the review’s lead investigator works at the same hospital as the ambulance trust’s medical director when the incidents occurred.
The East of England Ambulance Services Trust this week announced the top line findings of the independent review, which followed whistleblower allegations of deaths and serious harm caused by delays.
The review, carried out by a team led by senior emergency medical consultant David Kirby, investigated 22 serious incidents escalated by the trust out of 138 “significant delays” during a chaotic period from 17 December last year to 16 January.
The review said it found 15 cases in which patients were “harmed as a direct consequence of ambulance delays”, three of which suffered “severe harm” - but said none of the 14 deaths it investigated were a direct consequence of ambulance delays.
HSJ has also asked the trust why only 14 deaths were investigated as part of the 22 serious incidents, when the original whistleblower’s evidence, seen by HSJ, detailed 19 deaths during the period. The trust declined to explain why five of these deaths had not been referred to the review team.
The trust said it could not publish the review - the robustness of which has been defended by local commissioners - because it would compromise patient confidentiality. However, the findings and process have come under significant criticism from trust sources.
A senior paramedic contacted HSJ following publication of the review. The source said: “When I saw the reports of the review I was staggered. To say that not one single one of those deaths was because of the delays? Come on. That really is stretching credibility.
“The review’s findings simply do not tally with what myself or my colleagues have dealt with on the frontline. We don’t know which 22 serious incidents were included. We don’t know why it was whittled down to so few. We don’t know why so many deaths were not investigated. How can we know if the report is credible when it’s not been published?
“What we need is a full public inquiry so the frontline staff can say what they saw, the families can give their experiences, and those in charge can explain the actions they took and why they took them.”
The concerns were echoed by other trust sources. And Mr Lamb revealed concerns had been raised to him by his North Norfolk constituents.
He told HSJ: “I have been contacted by a family whose loved one was left waiting hours for an ambulance, suffered a stroke, and now has a permanent disability and I don’t think their case is one of the three where severe harm was identified. If that’s the case, we need to know why it wasn’t investigated.
“I don’t dismiss the report, but it’s really important to listen to these dissenting voices. I will be raising these fresh concerns with the Care Quality Commission and NHS Improvement.”
Mr Lamb also raised concerns about why the review was led by a doctor who has for many years worked at the same trust of Mark Patten, the medical director of the ambulance trust at the time of the delays. The review team also included NHS Improvement head of quality April Brown, as well as representatives from the CQC and local commissioners.
Dr Patten was the ambulance trust’s medical director between 2016 and January 2018. But he split the role with working at Luton and Dunstable University Hospital Foundation Trust, where he has been for many years. Mr Kirby has also worked at Luton and Dunstable since 2008.
Mr Lamb added: “I would like clarity over what could be a conflict of interest. When there is a conflict of interest, it does not mean the conclusions are wrong, but it does raise questions about the validity of the report.
“We all want to believe that this is an independent report and to trust it. But this casts doubt over that and I think that needs to be explored by the regulators as well.”
Ed Garratt, chief officer of NHS Ipswich and East Suffolk Clinical Commissioning Group, which leads the consortium of 19 CCGs that commission services from ambulance services, said the independent review team “approached their task in a rigorous manner without any prejudice”.
He said: “[the trust] was open and honest in its dealings with the review panel, which was made up of healthcare professionals who approached their task in a rigorous manner without any prejudice, and whose knowledge of the healthcare landscape in the eastern region gave them enhanced insight into the issues raised by the review.”
The trust stressed it was investing in staff and more ambulances to try and address the delays (see full statement below).
Trust statement in full
The trust said: “Every case that is highlighted by staff or picked up through the normal reporting systems every day is taken seriously. We have said for some time that there have been delays in ambulance responses which mean patients wait much longer than they should. More investment to recruit more people and [buy] ambulances – which was announced last week – will support improvements in responses. The NHS is working hard together to help ambulance crews see patients as quickly as possible.
“Serious Incidents must be declared internally as soon as possible, with immediate action taken to establish the facts, ensure the safety of the patient(s) and others, and to secure all relevant evidence to support further investigation. Of all incidents reported in the 2017-18 financial year, 98.9 per cent were graded as no harm or near miss incidents.”
Ipswich and East Suffolk CCG’s Dr Garratt said: “Although the review found that no patient died as a result of the ambulance delays, it has highlighted that some patients did experience harm. We deeply regret this and our thoughts are with the families of those patients who suffered.
“[The trust] and the wider health care system are already acting upon the lessons from the review, such as reducing handover delays at our emergency departments, and are committed to avoiding such a situation again.
“Additionally, commissioners from across the east of England recently committed to significant additional investment for more staff and ambulances to boost the service and deliver lasting improvements.
“The commissioning of this review was an important and necessary action which has enabled us to best understand the consequences this very busy winter had on patients who used [the trust’s] services.
“[The trust] was open and honest in its dealings with the review panel, which was made up of healthcare professionals who approached their task in a rigorous manner without any prejudice, and whose knowledge of the healthcare landscape in the eastern region gave them enhanced insight into the issues raised by the review.”