• Whistleblower says staff are “too scared to speak up” and patients are at risk
  • East of England Ambulance Trust admits it needs 1,000 extra staff to reach safe levels
  • Trust defends safety record and says it “does not recognise” concerns raised 

An ambulance trust has been accused of putting targets ahead of patient safety and creating a culture in which staff are too scared to raise concerns by a senior whistleblower within the organisation.

East of England Ambulance Trust has consistently denied putting patients at risk because of its focus on targets and said it encouraged staff to raise concerns.

However, it accepted the findings of an unpublished independent report, shared with HSJ, which found it needs 1,000 extra staff to hit safe levels – this would be a 35 per cent increase on its existing 2,700 workforce.

The experienced senior manager, who contacted HSJ on condition of anonymity, said the trust was facing a “crisis like at Mid Staffs” with employees too scared to speak out.

They said operational decisions were putting patient safety at risk, particularly relating to the use of rapid response vehicles in place of ambulances. Staff that had spoken out in the past “have either not been listened to or in some cases completely ostracised and sidelined by those above them”, they said.

The source added: “Senior managers and staff on the ground think it’s the worst it’s ever been here, and I agree. The most worrying thing is we regularly see patients waiting 15, 16 or even 17 hours for an ambulance to take them to hospital.” These were mostly patients being referred by GPs on callout. The source added: “It’s not safe.”

The trust said it “did not recognise this specific concern”, it “encouraged” staff to raise concerns and it “took all concerns seriously”.

A spokesman said it had recently introduced freedom to speak up guardians, who staff can contact to raise any concerns confidentially. Staff were using this new service and concerns were “rigorously investigated”. Further measures enabling staff to report issues were about to be implemented, he added.

However, the union Unison said many of its members agreed with the comparisons to Mid Staffordshire and it was “testament to depth of the problems in our trust” that a senior manager had chosen to speak out about the cultural and patient safety issues.

The whistleblower contacted HSJ after a senior paramedic, Unison and former health minister Norman Lamb last month raised concerns that the trust was putting patient safety at risk because of a “fixation” on hitting response time targets.

They alleged the trust was sending too high a proportion of single staffed rapid response vehicles, rather than ambulances, to its most serious 999 calls because this increased its chances of hitting response time targets. They said this was compromising safety.

A clinical commissioning group has also suggested that the trust was “increasing” its use of RRVs to hit targets. South Norfolk CCG’s annual report, published last month, said: “Specific measures being taken to improve performance in South Norfolk include the increasing the use of rapid response vehicles and working to ensure that RRVs only respond to red calls [the most critical emergency calls].”

The senior manager said: “We are still being told to focus on RRVs, which contradicts both the statement the trust gave [in response to the previous HSJ article] and what we’re being told to do by the Ambulance Response Programme.”

The trust insisted last month when the accusations were made that it “did not put targets before safety” and it had been “reducing the RRV vehicle hours it has been deploying since December 2016”.

The trust spokesman added this week: “We have seen a 40 per cent reduction in the number of serious incidents (24 cases compared to 40 cases in the same period last year) and a 50 per cent reduction in harm through the delivery of the trust’s quality and safety strategy over an 18 month period. No serious incident can be attributed to the attendance of an RRV rather than an ambulance.”

Meanwhile, an unpublished report by consultants ORH for the trust’s leadership in August 2016, seen by HSJ, said it would require 3,596 whole time staff to achieve its 2017-18 targets set out by commissioners.

Unison said due to the high rate of staff turnover at the trust, 1,000 extra staff would be needed to meet this requirement.

The trust accepted the report’s findings. It said: “We would agree with Unison, in that we believe we have a capacity gap in our frontline resourcing; ie: we believe that we do not have the correct funding to meet demand.

“This is why NHS England and NHS Improvement have commissioned an independent service review to understand what capacity and funding the trust requires to meet demand. That work is currently underway.”

A Unison spokeswoman said: “Members, including some operational managers, are being very clear with Unison that they feel we are not running a safe service based on the current staffing levels in those same areas.

“It is not clear why the trust did not openly share the ORH report from 2016 with staff or Unison. We have raised our members’ concerns directly with the Care Quality Commission over staff staffing, lack of ambulance cover and also the continued lack of openness by an NHS trust.”