Published: 08:00, 15 March 2016 |
Updated: 09:20, 17 March 2016
An independent review claims "fundamental failings" were shown by an ambulance trust in running a new helpline pilot scheme.
The report comes as Tony Thorne, who was appointed chair of the South East Coast Ambulance Service NHS Foundation Trust in 2011, announces his resignation.
A review was launched after the ambulance service came under fire for the implementation of the 111 pilot, which led to some patients having to wait longer for an ambulance.
The scheme, which was in place between December 2014 and February 2015, saw a delay before 111 calls were put through to the 999 number, meaning the service was able to meet its response time targets.
Some Red 2 calls - deemed serious but not the most life threatening - were being put through a re-triage process, where another paramedic or practitioner would call back to assess the seriousness of the patient's condition.
A window of up to 10 minutes, in addition to the eight minute response target for calls of this nature, was allowed for re-triage.
The intention was for a practitioner to decide whether an ambulance was the most appropriate response.
It was claimed by the Telegraph that at least 11 patient deaths had been linked to the policy, but this has been refuted by SECAmb.
The report claims the changes made by the pilot were not in line with the NHS England NHS 111 Commissioning Standards which state: “NHS 111 must be able to identify potentially life threatening problems and dispatch an ambulance without any delay or re-triage, and support the patient prior to the vehicle arriving."
The report, produced by Deloitte, states failings in governance at the trust 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."
Concerns were raised by a number of senior colleagues to the CEO in early December 2014 regarding the inclusion of Red 2 calls in the Pilot.
The concerns were not adequately addressed and the CEO instructed the pilot should go ahead.
Findings also suggest there was an intentional effort by members of the executive team to present the pilot in a positive light, while understanding its failings.
The review found clinical involvement was insufficient throughout the process, there was a lack of clarity over clinical accountabilities and there were inappropriately low levels of documentation in relation to key decisions and approvals.
Non-executive directors had no detailed knowledge of the pilot until it ended.
The decision to sign off the scheme should have been reported at clinical meetings in 2015, but it was not mentioned.
The report said given the critical and sensitive nature, failure of executive directors to disclose to the rest of the board or its committees represents a serious breach of executive accountability.
A Trust spokesman said chief executive Paul Sutton has taken "mutually-agreed" leave of absence, while the authority determines the appropriate actions to take.
Sir Peter Dixon has been appointed as the interim chair following Mr Thorne's resignation.
Earlier, chief executive of independent health charity Patient Association, Katherine Murphy said there were important questions for senior trust staff to answer.
She said: “Everyone working in the NHS should be making the right decisions based on the best way to protect peoples’ lives and their health.
“Everyone working in the NHS should be making the right decisions based on the best way to protect peoples’ lives and their health" - Katherine Murphy
"The public especially expects that those in leadership positions are held accountable for their actions.
"Any decision that downgrades urgent category ambulance calls in order to massage performance targets is deplorable, and undermines the confidence that the public places in NHS leaders.
“If Mr Sutton chose to ignore colleagues’ concerns about the dangerous consequences of downgrading emergency ambulance calls, this suggests exceptionally poor decision making by someone in a key leadership role.
"Such conduct would fall far short of the standards that the public expects. There are also important questions for other senior staff in the Trust to answer.
“This issue goes back to 2014 and should have been resolved long ago, rather than being dragged out through leaked reports. The Trust should apologise and the NHS should ensure this never happens again.”
A statement from SECAmb released today said: "The trust welcomes and accepts the findings of the review in full.
"It recognises that the governance surrounding the pilot was inadequate, and has already started to make serious changes to the way matters of governance are managed and dealt with to make sure lessons are learnt and a lapse in governance of this sort does not happen again."
The review did not look at the impact of the pilot on patients, which is subject to a separate, clinically-led report due to be concluded by June.
To read the full document click here.
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