'No evidence of harm' from delayed ambulance response policy

However, the investigation into South East Coast Ambulance Service Foundation Trust struggled with poor data and dropped plans to interview a cross-section of patients whose calls had been delayed.

The “red three” policy adopted by the trust in winter 2014-15 saw thousands of calls to NHS 111, which were initially assessed as needing an ambulance within eight minutes, delayed and the priority of the call reassessed. This led to some “red two” calls being delayed by 10 minutes. Some less urgent calls – “green twos” – which would normally get a response within 30 minutes were delayed by an additional 20 minutes for retriage.

The scheme, which was halted after concern from commissioners, led to NHS England and Monitor intervening at the trust and ordering a number of reviews, of which today’s is the last to be published. The chief executive and chair at the time of the red three pilot have left and the trust is in special measures following a critical inspection report.

The review was led by Andrew Carson, medical director of the West Midlands Ambulance Service FT. It says: “A review of all the evidence considered found there was no evidence of patient harm but the project cannot completely exclude that any incident of harm occurred.” In one case, a stroke patient had irreparable damage and was not considered suitable for thrombolysis, but it was unlikely that the delay contributed to an adverse outcome for the patient.

However, only a small percentage of cases where patients were delayed was examined for evidence of harm. During the time the scheme was in operation 9,616 calls through 111 were given a priority of red two and then treated as red threes and retriaged. Of these, just over two-thirds of the calls remained with the same priority. In nine cases, calls were upgraded from red two to red one – the most urgent category.

The original scope of the report included 18 strands of work. Some of these were abandoned or modified because data was missing or poor. Plans to talk to patients and families were also dropped. The report is also critical of how the pilot was set up, saying that effective clinical governance would have made it easier to measure positive or negative impacts on patients.

Acting trust chief executive Geraint Davies said: “We are satisfied that this report, which was led by an independent and external clinician and which looked at 185,000 calls, has identified no evidence of patient harm attributable to the pilot. We do however recognise that there were significant governance and other failings around the pilot.

“I am keen to ensure that the trust now moves forward. [The trust] is going through an extremely challenging time but I am, with my senior team, committed to making the changes required to improve our service.” 

An NHS Improvement spokesman said: “This report is a key part of what we asked the trust to do when we first took action over the red three project in 2015. We note the report states that there was no evidence of patient harm but the project cannot completely exclude any incident of harm occurred.

“In September 2016, we put the trust into special measures to bring about rapid improvement to its urgent and emergency care services. We will review the findings of this report to further support our work so that patients in the South East can be assured that they are getting the quality care they expect.”