• Critics warn “patient safety, and patient dignity badly compromised” by trust’s actions
  • Former health minister Norman Lamb slams trust’s action as ‘perverse in the extreme’
  • Trust said it does not put “targets before safety”

East of England Ambulance Trust faces accusations of increasingly putting patient safety at risk over the last 18 months because of a “fixation” with hitting response time targets.

Senior local paramedics, Unison and former health minister Norman Lamb have all raised concerns. Their accusations appear to be supported by previously unpublished internal trust data, seen by HSJ.

Norman Lamb

Source: Peter Searle

Norman Lamb: ‘It’s just a completely ludicrous state of affairs’

North Norfolk MP Mr Lamb said the trust was “at risk of chasing a target, rather than improving patient care”, which was “perverse in the extreme”.

A senior local paramedic said “care, patient safety, and patient dignity [were] being really badly compromised” and in the past 18 months the situation had become “as bad as I can remember in decades”.

They said the trust, which insisted it “did not put targets before safety”, had increasingly used a practice referred to as “stopping the clock”, which HSJ understands other ambulance trusts are moving away from, and national leaders want to stamp out.

The practice, which has been an issue in other parts of the country, involves sending single-staffed rapid response vehicles to 999 calls to hit the target to have a “vehicle capable of conveying patients” on scene within 19 minutes 95 per cent of the time.

However, in many cases it turns out that a double-staffed ambulance is required. If the patient cannot be transported by car they are forced to wait for an ambulance. Sources said patients could sometimes wait for “hours” in all weather including “frosty conditions”. These cases are still recorded as a success against the A19 target.

Trust figures, obtained by Unison from a freedom of information request, show increases in the proportion of rapid response vehicles being sent to calls rather than ambulances. The figures show the proportion of RRVs rose from 29 per cent in March 2016 to 36 per cent in March 2017. The figure in April 2016 was 31 per cent, in April 2017 it was 42 per cent.

The trust did not challenge or provide a direct comment to HSJ on this data.

National data on fleet ratios is not published, however HSJ understands a split of around 20 per cent RRVs to 80 per cent ambulances has been considered typical in recent years. But, crucially, some ambulance trusts are now said to be cutting RRV proportions – apparently in contrast to the East of England. In addition to quality risks, sending an RRV often means two vehicles are sent when one ambulance would have been sufficient.

Unison East of England ambulance branch secretary Fraer Stevenson said the figures supported concerns raised by “increasing numbers of staff [that the trust is] focusing on RRVs in order to hit targets”.

She added: “We saw this in 2012-13 and it’s really disappointing to see us returning to the same operating model. At a time when nationally it appears other ambulance trusts are moving away from and reducing their RRVs, our trust appears to be doing the opposite.”

The increasing ratio also appears to go against advice in a governance review carried out in 2013 by Anthony Marsh, the well respected chief executive who ran the trust in 2014-15, which recommended reducing the number.

Mr Lamb said: “[The trust] appears to be [behaving] contrary to what other ambulance trusts in the country are doing… It’s just a completely ludicrous state of affairs.”

The senior paramedic at the trust, who spoke to HSJ on condition of anonymity, said: “The trust has become so fixated with hitting the target by sending out RRVs to stop the clock. Care, patient safety, and dignity are really being badly compromised. Everyone has horror stories. It’s as bad as I can ever remember”.

They said “elderly, frail patients” were sometimes left “lying on the ground waiting up to two or three hours, for an ambulance to turn up”. “Often they’re in pain, maybe with a broken hip. When it’s in the winter, it’s often in cold, frosty conditions. Sometimes they are lying on a limb, and who knows what damage is being done as a result,” they added.

The National Audit Office highlighted in January that having more RRVs “helps trust meet response times targets… but [their use] may not always be in the best interests of the patient (for example, someone who needs to be taken to a hospital stroke unit)”.

The trust’s most recent performance report suggests its A19 performance averaged around 92 per cent between February and April against the 95 per cent target.

The trust’s response

A trust statement to HSJ said: “The trust does not put targets before safety, rather it prioritises its response to the sickest patients. In addition, the trust as been reducing the rapid response vehicle hours it has been deploying since December 2016.

“The trust continually monitors patient safety, responses to patients and any delays in getting patients to hospital. These form the basis of discussions around investing in additional ambulance capacity, something which is regularly discussed at board meetings.”

It indicated its use of RRVs was linked to growth in the proportion of urgent, red, calls it handles; and said it was reaching more urgent calls within the eight minute target. It also pointed out that, unlike some trusts, it was not part of a national trial which may allow them to use a different mix of vehicles…

 “The trust would welcome a review of how ambulance services are commissioned and the targets they are measured against.”