CQC places first ambulance service in special measures

London Ambulance Service NHS Trust (LAS) has become the first to be put into special measures after Care Quality Commission (CQC) inspectors rated it ‘inadequate’. 

A team of inspectors found that the trust delivered services that were caring, but that improvements were needed on safety, effectiveness, responsiveness and leadership. 

Professor Sir Mike Richards, chief inspector of hospitals at the CQC, said: “I am recommending that London Ambulance Service be placed into special measures because I believe that this is the step necessary to ensure that this vital service - which provides emergency medical services to 8.6 million Londoners - gets the support it needs to improve.” 

He added that LAS has been performing poorly on response times since March 2014. 

During the inspection, which took place over a three week period in June, a team of 54 CQC inspectors, found the trust to be operating with a shortage of trained paramedics, that there was a lack of equipment, and there were concerns about a reported culture of bullying and harassment. 

The CQC stated that the service had a high number of frontline vacancies, adding that all the ambulance crew members said there were not enough appropriately trained staff to ensure that patients were consistently safe and received the right level of care. 

Serious concerns were also identified about how the trust had been fulfilling its responsibilities to deliver a Hazardous Area Response Team (HART) service because of insufficient paramedics, although the trust has told CQC that it has now recruited to 97% of the posts in this team. 

LAS chief executive, Dr Fionna Moore MBE, said: “While we are pleased that our caring and compassionate staff have been recognised in this report, we are sorry we have fallen short of some of the standards CQC and Londoners expect of us. 

“We accept that we need to improve the way we measure and monitor some important standards and processes but we would like to reassure Londoners that we always prioritise our response to our most critically ill and injured patients and, in the event of a major incident, we are ready to respond and CQC recognise this.” 

LAS added that since the inspection it has recruited 167 additional frontline staff responding to incidents in London and over 200 staff are in training and under supervision while our recruitment campaign continues. 

But Rehana Azam, GMB National Officer, said “The underlying problem is a shortage of staff. There is a seriously high vacancy rate in the LAS and other ambulance services for some time. 

“We are pleased CQC have identified this and perhaps now this can be addressed in full. As a result of staff shortages, existing staff have had to shoulder more responsibility as crews are not well resourced with adequate numbers on each shift whilst responding to 999 calls across the capital.”

The report identifies a number of key actions for the trust, including developing and implementing a detailed and sustained action plan to tackle bullying and harassment, recruiting sufficient frontline paramedic staff to meet requirements, and improving the trust’s system of governance and risk management. 

Professor Richards said: “While we do have significant concerns about the performance of the ambulance service, I want to provide Londoners with some reassurance. Firstly, that once care arrives, it is of a good standard - and dedicated and caring call handlers, drivers, paramedics and other frontline staff are working hard to ensure this. 

“And secondly, that urgent steps are being taken - and improvements have already been made - to ensure that everyone who relies on this service receives excellent, timely care and that London has the ambulance service it deserves.” 

On 2 December 2015, CQC will present its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Summit is to develop a plan of action and recommendations based on the inspection team’s findings. 

Earlier this year, the Migration Advisory Committee (MAC) recommended that paramedics should, for the first time, be added to the ‘shortage occupation list’, which would allow positions to be “sensibly” filled using labour from outside Europe.                                                      

But the College of Paramedics told NHE that the situation was ‘solvable’ but the problem will require the right people to have the “will” to do it.


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