For the best part of 18 months I've been highlighting problems with the 111 non-urgent phone line which replaced the much loved NHS Direct advise line.
Little did I ever imagine that Ambulance chiefs would decide to secretly change the rules on response times to get themselves out of a hole; they were missing Government targets.
The answer?
Fiddle the books.
This is an excellent piece of investigative reporting by the Daily Telegraph and all the more important because whenever anyone in NHS management does something wrong the first response is to cover it all up.
DailyTelegraph
How trust made secret 111 plan to hit all-important NHS targets
The deaths of up to 25 patients have come under investigation, after
whistleblower reveals extent of policy that delayed help for seriously ill patients
By Laura Donnelly, Health Editor
31 Oct 2015
In December last year, South East Coast Ambulance trust was facing major problems.
Key NHS targets - to send an ambulance out within eight minutes for all cases designated as “life-threatening” were slipping far out of reach, with too few crews to send out to meet growing pressures as winter drew in.
The creation of the controversial 111 phone line was supposed to ease demand for ambulances, making sure those with more minor needs could get help without an ambulance being dispatched.
“The executives knew, there were people warning directors and senior managers in January and February that this was happening and it was extremely dangerous."
Instead, the phoneline was adding to pressures on services, with fears that “risk averse” call handling were too often sending out ambulances.
And so a plan was hatched.
Behind closed doors, senior managers at the ambulance trust devised their own protocols.
Any “life-threatening” calls which were sent their way would no longer get an automatic ambulance response.
• NHS 111 scandal: 25 deaths blamed on ambulance delays
Those which had been categorised as “Red 2”– life-threatening, but not the most immediately time-sensitive – would be allowed an extra ten minute delay, while the 999 service “re-triaged” them to decide on the best response.
Such cases would still be counted as hitting the all-important NHS targets, implying that a response had still been received within eight minutes.
In some ways, the policy appeared successful.
A meeting of the trust’s clinical committees was told that “pro-active” management of the cases meant up to one quarter of the ambulances called were being stood down.
Meanwhile, staff working in the trust’s own 111 call line had no idea that when they had ordered an ambulance to be dispatched, the case could be put aside for up to 10 extra minutes, despite its urgency.
At the start of this year, a series of clues began to fall into place.
111 call handlers from Ashford working occasional shifts in the 999 centre in Maidstone stumbled upon the policy – which had never been discussed at the trust’s board meetings, let alone announced publically.
Then a string of serious incidents occurred.
One, on January 28th, involved the death of a man, aged 60.
His wife called 111 when her husband was short of breath, clammy, vomiting and suffering pain high in his chest, towards his shoulder.
During the call, the man began to suffer signs of cardiac arrest, and his wife began attempts to resuscitate him.
Incredibly, under the system, the call passed on to the 999 centre was categorised as “Red 3” – meaning it remained unassigned to an ambulance crew for 10 more minutes.
Crews finally reached the man 39 minutes after the call was made, but could not save him.
The details are contained in a safety report, sent from senior NHS managers to the trust’s chief executive and other senior managers, on 4 February which concerns were raised.
Another email, sent by a senior NHS 111 manager two days earlier, warns of the potential of “severe” reputational damage if the truth came out.
In the correspondence, the health official says he has “personally amended” official reports to remove references to the controversial policy, but warns that “it is inevitable that this process will filter through to a wider audience at some stage”.
Yet the policy – described as a “rogue operation” by those outside the trust – remained in place.
Two weeks later, one of the trust’s senior managers became so fearful that he decided to contact health officials outside the trust, to warn them what was going on.
The man, who spoke to the Telegraph on condition of anonymity said: “The executives knew, there were people warning directors and senior managers in January and February that this was happening and it was extremely dangerous. “
“They simply did not listen. “
In emails seen by the Telegraph, he contacted two senior managers at local NHS commissioning groups – who are responsible for monitoring safety of the services – warning them of a string of deaths which had not been included in official serious incident reports.
The disclosure caused immediate panic: within two days, orders came from the clinical commissioning groups to close down the scheme. An NHS investigation was then opened, and handed information suggesting that up to 25 patients might have died after being subject to the deliberate delays.
But in public, there was nothing. No board papers have been published about the concerns, nor any public statement issue.
Meanwhile there were furious disputes within the trust about how many patients covered by the policy had come to any harm, and whether any such harm was explained by the delay waiting for an ambulance, or would have happened anyway.
But it was not until this week that NHS watchdogs suddenly announced that the protocols were under investigation, with a major review by regulators about how many patients had come to harm under the rules.
Health officials at NHS England said the trust had acted “unilaterally and inappropriately” while Monitor – the regulator for foundation trusts – said it would now hold its own investigation to establish levels of harm to patients.
The trust has refused to say who introduced the policy and whether any managers have been disciplined.
On Friday a trust spokesman said: “We will now work closely with Monitor as they undertake the reviews outlined in their recent media announcement and therefore do not feel that it is appropriate to comment further on specific points at
present.
The spokesman queried any suggestion that 25 people had died as a result of the policy. He added: "Our investigation and our own internal processes to date have not found that the process impacted negatively on patients."
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Yeah right, if you believe that you'll believe anything.
Neil Harris
(a don't stop till you drop production)
Home: helpmesortoutthenhs.blogspot.com
Contact me: neilwithpromisestokeep@gmail.com
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