Britain’s busiest ambulance service has had its safety rating downgraded by the care watchdog over fears it does not have enough staff to answer 999 calls consistently.
Inspectors from the Care Quality Commission (CQC) were told workers at London Ambulance Service‘s two emergency operations centres (EOC) were concerned about staffing levels, struggled to get clinical advice and could not always send out enough paramedics because of demands on the service.
Overall, the CQC rated the ambulance trust, which responded to nearly one million callouts in 2017-18, as good. But its report, published today, found that in March 2019, only 70 per cent of shifts in the emergency operations centre were filled. The CQC said the EOC as a whole had a turnover of 18 per cent.
Between May 2018 and May 2019 the CQC said there had been 43 treatment delays classed as a serious incident.
“All members of staff we spoke with told us their main concern was staffing levels”, the inspectors said, adding that “management staff told us they were 33 call-handling staff down from planned levels”.
The inspectors concluded staff working in the call centres, based in Waterloo and Bow, were not “able to respond to incoming calls as quickly as they would like”, and that “the staffing numbers and rota system in use did not enable calls to be responded to as quickly as expected and to a consistent level”.
Separately, in the call centre handling less serious NHS 111 calls, the CQC said the “department remained short of substantive staff on a regular basis”.
Inspectors cited at least five occasions during the inspection when call handlers in the EOC could not get clinical advice due to a shortage of staff, which meant on some occasions ambulances being dispatched unnecessarily.
In one example, a response unit with one paramedic was sent to an elderly woman who had fallen and was unable to stand. This required a two-man crew but “the challenging demand on resources” meant dispatchers had no alternative option.
Staff told inspectors the lack of clinical advisers had been raised with managers “a number of times” but inspectors said senior managers did not appear to know this.
In an evidence appendix to the main report the inspectors said: “Staff told us they were increasingly concerned regarding their ability to cope with normal activity and were concerned with their ability to cope with any major unplanned event. Staff told us the weekend before our inspection, at one stage during the weekend, over fifty people were waiting for their calls to be answered by call-handling staff.”
It added that after this was alerted to managers, “they did not see any active response to help with the challenging demand”.
After the inspection, the ambulance trust told the CQC it was planning to carry out an independent review and would increase staffing in the call centres.
For the whole ambulance service, the CQC rated the trust as “good” for being effective, caring, responsive and well-led and as “requires improvement” for safety.
Despite the staffing concerns in the call centres, inspectors concluded there were enough frontline staff to care for patients and there was good communication and records about patient care, with staff said to treat patients with compassion, kindness and respect.
The trust was told to improve the storage of medicine and equipment as well as the security of vehicles.
The regulator said trust leaders encouraged an open and honest culture and understood the issues the service faced.
England’s chief inspector of hospitals Ted Baker said: “The London Ambulance Service has again been rated good overall. It has to cope with a number of additional pressures working in the capital.
“Frontline staff deserve fulsome praise for the way they coped with terrorist incidents like the recent London Bridge attack. The trust also trained staff well, so they had the training in the key skills needed for their roles.”
London Ambulance Service chief executive, Garrett Emmerson, said: “The Care Quality Commission inspectors reviewed our call handling performance between 12 August and 8 September last year, which included a prolonged period of hot weather and the hottest August bank holiday on record. The heatwave caused a significant spike in demand, and the inspectors noted that during this period staff were not always able to respond to calls as quickly as they would like, but that there were safety mechanisms in place to ensure priority patients were responded to as quickly as possible.
“Following the CQC’s visit, we have taken action to further increase our staffing levels across our two control rooms by 7.4 per cent, and are considering further improvements including amending rostering arrangements to ensure they are staffed appropriately at peak times.
“Since August this increase in staffing has enabled us to halve our average call waiting times throughout the months of November and December, despite us facing an significant increase in demand over this winter period.”