• CQC raises concerns about “lack of leadership” and demoralised frontline staff
  • But it says East of England Ambulance Service Trust has made “some progress”
  • Fresh internal data obtained by HSJ reveals trust performance worsened in June 

East of England Ambulance Service Trust has been rated requires improvement by the Care Quality Commission, which raised concerns about a “lack of leadership”, “low staff morale” and an “unsustainable” strategy in key areas.

The CQC report follows an inspection in March, which was sparked by a senior whistleblower’s concerns about patient harm and deaths caused by significant ambulance delays and a lack of senior leadership over a chaotic winter.

The CQC said there had been “some progress” since its last inspection in April 2017, when it was also rated requires improvement, and highlighted the outstanding rating for how caring staff were, despite being under extreme pressure.

But governance concerns, “a culture of low morale, late shift finishes, and disengagement between front line staff and the senior management team” were also highlighted in the report. A risk summit process is on-going. 

The report added: “The majority of staff we spoke with felt the temporary management roles contributed to a lack of leadership, openness, and staff engagement.

“Whilst the emergency operations centre staff remained focused on providing quality care for the patients, and respected and valued their colleagues, the majority of staff said that executives were not always visible.”

Inspectors did however state: “The leadership of the organisation was aware of the challenges the trust faced and was focused on improving the service to patients as well as improving working conditions and experience for staff. The executive team worked towards a clear vision.”

The report comes as internal data leaked to HSJ laid bare the performance challenge facing the trust. The unpublished data showed response time performance for the most urgent “category one” calls deteriorated in June following the trust recording the worst C1 average response time of the NHS’s ten English ambulance trusts in May.

The trust responded to category one calls in an average of eight minutes 43 seconds for the first 28 days of June against the seven-minute national target. This is down from eight minutes 35 seconds in May, according to official data.

The trust told HSJ: “The trust has a well-publicised capacity gap and is pleased that commissioners are investing £11.5m into the trust, which will include 330 additional frontline staff over the next three years, however, these changes cannot be implemented overnight. In the meantime we are working with private ambulance providers and offering overtime to our staff to help ensure we continue to provide outstanding care to patients.”

The trust was rated requires improvement for whether its services were safe, effective, well-led and responsive. It was however rated as outstanding for whether its services were caring.

The inspection report said: “Staff in the emergency and urgent care service displayed outstanding patient centred care and we saw evidence of staff going the extra mile to ensure that patients were cared for.

“All staff we spoke with were caring and respectful of the patients they cared for. A number told us they were frustrated that they were not able to provide the best possible care for patients due to the pressures they faced.

“Staff cared for patients with compassion, treating them with dignity and respect. Patients, families and carers gave positive feedback about their care.”

The report however noted that the “staff survey results were consistently below other ambulance trusts, though there had been improvement in two measures since the 2016 survey; in incident reporting and staff receiving appraisals”.

An external review of 22 serious incidents identified by the trust out of 138 “significant” ambulance delays between 17 December and 16 January concluded last month that nobody died as “a direct consequence” of the delays. HSJ revealed last month that one of the incidents involved a 91-year-old stroke patient who waited nearly 19 hours for an ambulance.

Trust chief executive Robert Morton praised staff for their outstanding rating highlighting that this came despite the inspection taking place during one of the toughest winters on record.

He added: “The CQC inspected the trust at a time when staff were extremely tired and under pressure. There will always be room for improvement. We are aware of the many challenges we face here in the east.

“We are working to ensure the leaders at every level in our organisation are given the time and space to build effective, communicative teams at a local level – particularly during tough periods like winter. We are a united board level team with a wide range of expertise and experience to help us strengthen our service and help EEAST remain focused on our patients. With the right investment, including £11.5m of additional funding this year - we will get better and better.”

CQC chief inspector of hospitals Ted Baker said: “Our inspectors found some progress had been made at the East of England Ambulance Service Trust, since our previous inspection, but that a number of improvements were still clearly needed.

“The trust leadership knows what action it must take to bring about improvement and we will return to inspect and check on its progress.”