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16.03.16

SECamb chair resigns as report on ‘fundamental failings’ over 111 calls published

The scandal over allegations that South East Coast Ambulance Trust (SECamb) introduced a secret protocol to deliberately ignore urgent 111 calls has worsened as the trust’s chair resigned after a report was published into its failings.

Tony Thorne confirmed his resignation, which he had first announced to Monitor in December, after the regulatory body appointed Sir Peter Dixon as interim chair yesterday. The trust’s chief executive, Paul Sutton, is on voluntary leave.

The review was conducted by Deloitte after SECamb introduced a pilot to impose delays of up to 10 minutes for Red 2 calls and up to 20 minutes for Green calls after they were referred to 999 from 111.

The report concludes: “There were a number of 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.

“Furthermore, the level and nature of disclosure surrounding the pilot during the period after it was live and shortly after it ceased strongly suggests there was an intentional effort by members of the executive team to present the pilot in a positive light in certain board discussions and to commissioners, while understating some of the challenges and governance failings.”

Report finds pressure on trusts and lack of scrutiny

The Deloitte report says that the pilot was introduced in late 2014 following intense pressures on SECamb including the onset of winter, Ebola preparedness, hospital hand-over delays, and increased transfers from 111 to 999.

It also says many SECamb staff felt that some calls were being incorrectly categorised as Red 2 and wanted to meet key performance indicators.

It says that leaders the Operational Delivery Strategy Group (ODSG) responsible for the pilot, initially chaired by Sutton, did not report to appropriate authorities such as the Operational Performance and Governance Working Group and the Risk Management and Clinical Governance Committee.

Sutton, who the report says has a “direct and persuasive management style” that discouraged colleagues from raising concerns,  ignored colleagues in December 2014 when they did question the inclusion of Red 2 calls in the pilot.

The only formal clinical validation of the pilot was the chair’s action by the director of clinical operations, which the report says was inappropriate.

Commissioners failed to properly scrutinise the pilot and were unaware that it included Red 2 calls, and there was a lack of clear clinical accountability.

Non-executive directors at the trust other than Sutton had no detailed knowledge of the pilot until it ended.

Further review and changes required

The report recommends that SECamb undertakes a wider governance review and that it improves communication and collaboration between 999 and 111 as a matter of urgency.

SECamb said in a statement that it recognised governance was inadequate and is making changes and developing a joint recovery plan with Monitor.

Monitor also asked the trust to carry out independent reviews of decision making across the trust and of the impact of the pilot on patients.

The trust said in a statement: “SECAmb would like to take this opportunity to reassure members of the public that the trust and its staff are, and always have been, committed to delivering a high level of patient care and service.”

The Patients Association have called for an apology from SECamb.

Sir Peter Dixon, whose previous chair positions include Imperial College Health Partners, the Housing Corporation and University College London Hospitals NHS Foundation Trust, will focus on implementing the report’s recommendations.

Claudia Griffith, regional director at Monitor, said: “The way these projects were managed and the associated decision-making processes were flawed from the outset, and we expect the trust to use the findings of today's report to make sure no decisions are taken in this way again.

“We have asked the trust to appoint Sir Peter Dixon to address the failings identified by these reports, so that the trust can emerge from this as one which is stronger and more effectively run in the interests of patients.

“Sir Peter brings with him a wealth of experience supporting NHS trusts facing challenges, and following the changes to the trust’s leadership team, we will support him to quickly stabilise the trust’s board.”

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