PERFORMANCE: The chief executive of an ambulance trust has taken “leave of absence” and the chair has been replaced on the day a critical report into a controversial pilot project was released.
Paul Sutton has stepped aside as chief executive of South East Coast Ambulance Service Foundation Trust, with commissioning director Geraint Davies becoming acting chief executive.
Monitor has installed an interim chair at the trust, Sir Peter Dixon, who has stepped in to chair several failing trusts, following the resignation of Tony Thorne.
The report, released on Tuesday, examined the trust’s decision to introduce re-triage of some calls assessed by the NHS 111 service as being emergencies and requiring an eight minute ambulance response – “red two” calls.
From December 2014 to February 2015, the trust unilaterally allowed itself 10 minutes to re-triage these calls – as “red three” – and decide whether they needed an ambulance. The pilot was halted after commissioners complained, and in October Monitor announced it was intervening. It required the trust to commission a series of investigations into the policy and its governance.
The report – the first of three ordered by Monitor – found “fundamental failings in governance at the trust which resulted in the implementation of a high risk and sensitive project without adequate clinical assessment or appraisal by the board, commissioners or the NHS 111 service”.
It said there was a strong suggestion there was intentional effort by members of the executive team to present the pilot in a positive light and underplay challenges and governance failings around it.
A previous report by NHS England failed to uncover who made some of the decisions around the pilot. However, the latest report, commissioned by Deloitte, said: “The CEO made the ultimate decision to proceed with the pilot and played a critical leadership role throughout.”
Non-executive board members had no detailed knowledge of the pilot until it ended, it added. The chair knew more, however there was no evidence he knew of the plan to delay clock starts by up to 10 minutes.
The report also criticised the board’s governance, saying its effectiveness was affected by having a non-unitary board; the chair’s style; lack of scrutiny and limited clinical focus; and silo based working.
In addition it said:
- concerns were raised with the chief executive over the inclusion of red two calls in the scheme and he instructed the pilot should go ahead;
- the level of challenge to the chief executive was inhibited by his “directive and persuasive management style” together with an impending management restructure;
- there was insufficient clinical involvement and a lack of clarity over clinical accountabilities for the pilot; and
- commissioners applied an insufficient level of scrutiny and should have questioned mentions of re-triage more robustly.
A second report, by the trust’s internal auditors, looked at how the trust retrospectively recorded red calls as being responded to within the eight minute target because there was a public access defibrillator nearby. There were 5,610 instances of this in 2014-15 and the report said in some cases national rules and guidance were being misapplied.
In one case a defibrillator was recorded as being near to the patient even though a staff member at a residential care home was unaware of it.
In a sample of red two calls that were classified as meeting the target because of this, the auditors found there was no mention of the defibrillator in any of the calls. In one case, the defibrillator would not actually have been available as it was in a locked location, and in others defibrillators were not discussed.
Monitor said Mr Thorne signalled his intention to resign last year, though it does not say whether this was before or after the revelations about the pilot. Further reports on the trust’s governance and on whether any patients were harmed by the pilot are due to be released later in the year.
Monitor and trust reports
15 March 2016