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‘No evidence of patient harm’ following SECAmb 111 call downgrades

A controversial measure to delay answering 111 calls at South East Coast Ambulance Trust (SECAmb) did not lead to patient harm, a new report says.

However, West Midlands Ambulance Foundation Trust, who wrote the report, said its investigation was held back because SECAmb’s governance procedures meant not enough data was collected.

Nevertheless, the report concluded that “through the work strands undertaken there was no evidence of patient harm”.

Between 20 December 2014 and 24 February 2015, SECAmb introduced a second review stage to determine whether some 111 calls required an ambulance.

The procedure did not apply to the most serious (red 1) calls, but it meant that red 2 calls, which include serious but not life-threatening conditions such as strokes and fits, could be re-categorised as red 3 –  allowing an extra 10 minutes for clinical staff to call the patient back or upgrade or downgrade the call.

Green 2 calls were re-categorised as green 5, allowing an extra 20 minutes to reclassify them.

The report noted that these changes breached NHS England’s NHS 111 commissioning standards and national standards that require red 2 calls to be answered within eight minutes in at least 75% of cases.

The scandal over the 111 calls has led to the resignations of SECAmb’s chair and its chief executive.

The CQC has since found that the trust is still failing to answer calls effectively and on time, and it has now been placed in special measures.

In the most recent report, authors noted that it was not possible to carry out all the research they’d originally intended. Like-for-like comparisons between 111 and 999 performance indicators were not available, it was only possible to find mortality information for a few patients, and the authors decided not to interview patients and their families.

Of the small number of cases they did examine, the authors said there was only one where it was “not possible to totally exclude harm as a consequence of the project”.

They also found that the extra review meant some calls were identified as more serious incidents, with nine red 2 calls upgraded to red 1 and 80 green calls upgraded to red 2.

The report added: “It is evident that if effective clinical governance arrangements had been in place it would have been easier to measure any positive or negative impacts of the project, including patient harm.”

As well as recommending that the trust review its governance arrangements, the report said that all future projects should have an identified matrix to measure their impact developed at the planning stage, and clinicians who are expected to re-triage calls should be trained to the required standard.

Geraint Davies, acting chief executive of SECAmb, responded: “We are satisfied that this report, which was led by an independent and external clinician and which looked at 185,000 calls, has identified no evidence of patient harm attributable to the Pilot. We do however recognise that there were significant governance and other failings around the Pilot.

“I am keen to ensure that the trust now moves forward. SECAmb is going through an extremely challenging time but I am, with my senior team, committed to making the changes required to improve our service.”

An NHS Improvement spokesperson added: “This report is a key part of what we asked the trust to do when we first took action over the red three project in 2015. We note the report states that there was no evidence of patient harm but the project cannot completely exclude any incident of harm occurred.

“In September 2016, we put the trust into special measures to bring about rapid improvement to its urgent and emergency care services. We will review the findings of this report to further support our work so that patients in the South East can be assured that they are getting the quality care they expect.”

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