Trust top team was ‘least cohesive I’ve ever joined’, says new CEO

Management consultancy Verita was commissioned by London Ambulance Service Trust to carry out a review of how it came to be misreporting category 1 (the most serious) response times.

The report, published in board papers on Thursday, said it was caused by a contractor’s programming error going unnoticed and concluded it was “impossible to typify the events of August 2020 as other than an avoidable failure of governance and process”. 

The report said the unnamed contractor was the only person who understood how the trust’s ageing computer-aided despatch system interacted with another programme which produced the data needed to report on performance to NHS England. The review said the contractor was working “largely in isolation” at a time when many staff were working remotely and there were no checks and balances. 

It also described the business intelligence directorate the contractor worked with as lacking “coherence, direction and accountability”, pointed to “silos” between clinical and operational functions leading up to and at the time of the error, and said the environment was one where legitimate questioning and discussion of issues “appeared to be received as an attack”.

Even more seriously, the reviewers were also told by the non-executive directors that the executive group was inexperienced, lacked unity and non-executives were asked to intervene in day-to-day operations.

Daniel Elkeles, who joined the trust as CEO in August 2021, told the review that when he joined the senior team it was “the least cohesive team I have ever joined” and said the organisation was not “psychologically safe” for those who wanted to speak up.

However, Garrett Emmerson, who was the trust’s CEO between 2017 and 2021, told the review that covid had put the organisation under pressure in 2020, including having to recruit 1,000 people within eight weeks and introduce new ways of working. 

The programming error led to the response time for LAS’s category 1 calls – which are for immediately life-threatening situations such as cardiac arrest – being underreported, making the trust’s performance seem better than it was. It happened because a change to allow extra time before “clock starts” for a small number of calls from healthcare practitioners was instead applied to all category 1 calls.

The mistake affected the data for 25 months – during nine of which LAS reported it met the seven-minute target time for category 1 calls when the review found it did not – until the trust noticed its performance suddenly deteriorated when it introduced a new CAD system in September 2022, prompting the review.

The review found LAS was responding to category 1 calls by a minute slower on average than was reported. While the review found no evidence of direct patient harm, it noted it had not sought to investigate the outcomes of the 225,000 affected calls and added that, had the trust known its category 1 performance was not as quick as thought, it may have taken steps to improve it. 

The review also raised questions as to whether different call triaging approaches, use of data warehouses and bespoke modifications to systems meant “nationally reported category 1 ambulance trust data is genuinely comparable” and suggested NHSE should look into these issues. 

Mr Elkeles said: “We are very sorry this error occurred, and would like to assure our patients and members of the public that we took decisive action to rectify the issue and thoroughly investigate the impact it has had.”

The trust has produced an action plan in response to the review. The review also praised the recent appointment of a head of business intelligence/chief information officer and other changes to the structure of the organisation. It called for the senior team to be given “space and support” to continue with their work.

Mr Emmerson and NHSE were also approached for comment.