• Ambulance trust faces “significant problems” warns regional chief
  • NHSE director also raises concerns about trust appearing to treat less urgent patients before those in greater need
  • NHSE says trust is making progress despite catalogue of concerns 

A senior system leader’s concerns about the “significant problems” facing a struggling ambulance trust are laid bare in meeting minutes obtained by HSJ.

NHS England midlands and east regional director Paul Watson raised a series of concerns about the East of England Ambulance Service Trust at a recent meeting of local leaders, including that it was appearing to prioritise less urgent patients over those in greater need.

Dr Watson did acknowledge “significant improvements” in some areas at the risk summit follow up meeting, held on 28 September.

But the detailed unpublished minutes revealed Dr Watson raised a raft of fundamental concerns about the trust, which faced whistleblower allegations last winter about patient harm caused by ambulance delays and cultural problems.

They included the that the trust’s winter plan was not “adequate”; that the trust would have less capacity on the road this winter than last winter, which he called “a significant concern”; and that the trust had failed to get near to its recruitment targets.

The minutes also raised fundamental concerns about clinical prioritisation. “[Dr Watson] challenged [the trust] on over-performance for category 4 calls [the lowest risk category] at the apparent expense of more clinically urgent C2 patients in particular,” the minutes said.

In response, the trust told HSJ: “Our winter plan has robust measures in place to ensure that capacity is prioritised for our most seriously ill patients while we continue to use innovative and flexible approaches to dealing with non-urgent patients, including agency staff and the use of private ambulances.” 

Dr Watson however praised the “significant improvement in terms of clarity and grip shown by the trust versus previous meetings; significant progress in demand management; closure of serious incidents and the reduced numbers of SIs since the last meeting”.

Any signs of improvement within what is looking like a highly challenging scenario will be welcomed by interim chief Dorothy Hosein who recently took charge following the departure of Robert Morton.

But the minutes – which rarely make their way into public view – detail the raft of challenging organisational and systemic problems facing the organisation.

North Norfolk MP Norman Lamb, a former health minister, said Dr Watson’s comments “cause me real concern”.

The meeting followed the trust publishing an “extensive [winter] plan” just a week earlier. The trust’s plan pledged to “keep more ambulances on the road [by] putting comprehensive staffing, resourcing and management arrangements in place”.

But Dr Watson said the trust’s blueprint “did not constitute an adequate winter plan and that he believed the trust was heading for “a significant problem over winter, particularly combined with the lack of additional staff going on stream. This needed to be urgently addressed”.

Trust chair Sarah Boulton defended the plan and said the additional staff would be on the road in time for winter and that “a full capacity plan was entirely possible”, the minutes said. The trust pledged to provide an updated version of the plan to regulators.

Performance against its recruitment and retention targets for the first two quarters of 2018-19 are also set out in the minutes. It recruited 64.5 against a target of 124.5 full time equivalents in quarter one, and 102 against a target of 156 FTEs in quarter two. It had 71 leavers against a target of 56 in Q2.

The trust said a national shortage of paramedics was underpinning its recruitment failure and attrition was driven by paramedics leaving to take up “better paid and more interesting roles within the NHS” – a nationwide issue previously highlighted by HSJ.

Trust deputy chief executive Lindsey Stafford Scott said recruitment was the trust’s “highest priority”.

The trust’s statement to HSJ also said: “The summary notes [of the meeting] ask for some further confirmation of capacity for peak winter periods alone and we are addressing that.

“The risk summit follow-up also noted the significant challenges that continue to be presented by hospital handover delays and concerns over the Norfolk system. A follow up meeting was held and the trust is working closely with system partners on an improvement plan.

“NHSE and NHSI have rigorously held us to account. Our most recently published comprehensive review confirmed our leadership and governance was well-placed to meet future challenges. We acknowledge that we need to make improvements in performance and are working hard to do so with our staff and our partners.”

Mr Lamb said: “The risk summit minutes cause me real concern. I fail to understand why the trust’s leadership do not appear to be held to account for the failure to deliver against the targets agreed at the first risk summit meeting. Key targets have been missed… and there appear to be no consequences.

He added: “NHS Improvement has sought to reassure me on the winter plan and insist that the trust is in a better position than it was this time last year [but] this does not seem to tally with the account [in the minutes].”

A statement from Dr Watson to HSJ said: “NHS Improvement and NHSE have been working together to support the trust as it prepares for this winter… to further strengthen capacity planning [and] build on the improvements that have already been made.”

“The ambulance service has already made a number of changes which have improved ambulance response times and staff availability.”