London Ambulance service in special measures: report finds 'culture of bullying and poor response times'

Rachel Blundy27 November 2015

The London Ambulance Service NHS Trust (LAS) is to become the first ambulance trust in the country to be placed in special measures.

Inspectors found a culture of bullying and major problems with poor ambulance response times at the trust, which is the biggest in the UK.

England's Chief Inspector of Hospitals, Professor Sir Mike Richards, said he was recommending LAS be put in special measures as it was a necessary step for improvement.

"The Trust has been performing poorly on response times since March 2014," he said. "This is a very serious problem, which the trust clearly isn't able to address alone, and which needs action to put right.

"The frontline staff who CQC inspectors talked to and observed in their work were overwhelmingly dedicated, hardworking and compassionate, which is why I have rated this service 'good' for caring.

"However, these staff were not being properly supported to do their jobs.

"Some reported a culture of harassment and bullying and we found that in many cases there just weren't enough properly trained staff, or that the proper equipment wasn't available to them."

During inspections, CQC experts found dirty equipment, a lack of staff training and poor leadership.

Bullying and harassment was a major problem and an external report commissioned by the trust last year had found this to be widespread.

Reports into the trust showed a shortage of trained paramedics, reflecting a national shortage, but some junior staff were sent out on the frontline with little supervision.

The staff sickness rate has risen above the England average since May 2014, and has continued to rise.

An external report on bullying was received by the trust in November 2014 but not presented to the board until June 2015.

LAS report: main findings

- culture of bullying

- poor leadership

- dirty equipment

- staff sickness rate above England average

- response time for most urgent calls is worst in the country

The CQC said: "We found a large number of frontline staff to be demoralised.

"Most ambulance crews told us the organisation was a good place to work in the past, but now they felt unsupported by the service and were forced to work with a new rota system which was very demanding with little or no rest between shifts.

"This had also increased the number of days they were working overall.

"Bullying and harassment was a major concern for the organisation. Several frontline ambulance staff perceived that they were bullied by managers, and an independent, external review into bullying and harassment in the organisation found that the problem was widespread."

A few black and minority ethnic staff told the CQC that at times they felt "humiliated" and "ignored" by managers. Some claimed that they were overlooked for promotion.

The response time for the most urgent calls - Category A to be responded to within eight minutes - is the worst in the country.

Since May 2014, there has been a significant decline in the number of Category A calls attended within the target time of eight minutes, and the trust has not hit the target once.

LAS also has the worst re-contact rate within 24 hours for patients following treatment and discharge at the scene.

Most ambulance stations inspected by the CQC were found not to be clean, some were covered in black dust and so were medical supplies.

Inspectors found that some vehicles on early shift were fully stocked with equipment but late shift crews sometimes found themselves short of supplies.

"This sometimes delayed or prevented vehicles going out or crews had to make a decision to go out not fully stocked," inspectors said.

"LAS had a policy that a paediatric advanced life support (PALS) pack should be carried on all response vehicles. However, we found some ambulances did not have these in place."

Sir Mike 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."

GMB national officer, Rehana Azam, said "The underlying problem is a shortage of staff. There is a seriously high vacancy rate in the LAS and other ambulance services.

"We are pleased CQC have identified this and perhaps now it 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."

Unison general secretary, Dave Prentis, said: "This is a shocking indictment of the lack of funding that has gone to the ambulance service over the last five years. This is a particular problem in London where demand has soared in recent years.

"Sadly the CQC action was entirely predictable. Unison has been warning for over a year that the chronic problem of underfunding, lack of staff and the knock-on effect placed on those who remain would lead to a crisis."

In a statement, the London Ambulance Service's chief executive Dr Fionna Moore, 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.

“As the newly appointed chief executive, I am, along with my leadership team, completely focussed on addressing the challenges highlighted in this report.

“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.”

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