Staffordshire Ambulance Service NHS Trust Took Risks With Patient And Staff Safety, Says Healthcare Watchdog, UK

Main Category: Public Health
Article Date: 11 Apr 2008 - 5:00 PDT

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Managers at Staffordshire Ambulance Service NHS Trust took risks with the safety of patients, staff and volunteers, according to an investigation published by the Healthcare Commission.

The investigation, covering the period April 2004 to June 2007, highlighted problems at the former trust including the poor management of controlled drugs, "community first responders" (emergency ambulance volunteers) and an out-of-hours GP service.

The Commission points out that the trust was a good performer in terms of response times for emergency calls. It was considered to be innovative in its introduction of new equipment and services and had good relationships with patients and the public.

But, the investigation found that these achievements were undermined by a culture and approach that did not prioritise safety and that put patients at risk.

The Commission stresses that West Midlands Ambulance Service NHS Trust (WMAS), which took over Staffordshire Ambulance Service NHS Trust in October 2007, has already made progress on addressing these issues, and the Commission is confident that it will continue to do so.

It was symptomatic of the culture at Staffordshire Ambulance Service NHS Trust that:

- Ambulance staff and volunteer community first responders were supplied with controlled drugs that they were not legally supposed to possess, such as the sedatives diazepam and midazolam. This practice was a potential risk to patients and volunteers, and has now been stopped.

Medicines in the trust's stations regularly went missing or were unaccounted for due to poor recording and monitoring. Patients were sometimes given larger packs of controlled drugs than they needed and told to dispose of the excess themselves.

- Community first responders were allowed to drive at speed using blue lights and sirens, without the necessary advanced driving training. This put both the volunteers and the public at risk of a serious accident.

- The doctors employed in the out-of-hours GP service, provided by the trust for south Staffordshire were not always GPs, nor were they approved by the relevant primary care trusts. This contravened NHS guidance and meant that patients may not have received the best possible care.

- The ambulance trust introduced new equipment without guidance on which patients it was appropriate for or evidence that it was beneficial or cost effective.

- Delays in transferring patients from ambulances to A&E were not well managed. On some occasions the trust would threaten to put tents up in the car park of the hospital to receive the patients. A realistic solution for patients needs to be developed by the trust and the hospitals working together.

- Some ambulance staff told the Commission that previously they were threatened with disciplinary action over the issue of delays in A&E, over which they had no control. In one instance a staff member was contacted 12 times with instructions to get back on the road while they waited to hand over a patient at A&E.

Staff were hard working and resourceful and did not always receive the necessary support from the trust.

The Commission also found that the trust's board, the previous strategic health authority and commissioning PCTs did not ask searching questions about how the trust was balancing its competing priorities - namely meeting Department of Health targets and introducing new services and technology - at the same time as there was a reduction in resources and demand on the service was growing. This complacency was brought about by the trust's ability to exceed the Department of Health's targets.

During the course of the investigation, the trust began to address these serious concerns. In October 2007 the trust merged with West Midlands Ambulance Service NHS Trust (WMAS), which has already begun to respond to the investigation's recommendations to ensure that all unsafe practices have stopped.

WMAS is now responsible for running the ambulance service and community first responder schemes in Staffordshire. WMAS has introduced a new system for supplying medicines to community first responders and ambulance staff and no longer provides the GP out-of-hours service. Formal pharmaceutical advice is now available to the trust.

Anna Walker, the Commission's Chief Executive, said "The managers at Staffordshire Ambulance Service NHS Trust were motivated by the best intentions - to provide high quality care for patients. However, some of the practices in the trust put the safety of patients, volunteers and staff at risk.

"Patients, staff and the public could have been seriously hurt as a result of the compromised safety culture.

"The trust sought to be innovative, and that is to be applauded, but it did not have effective systems in place to handle this innovation safely. This undermined many of the good achievements made on behalf of patients."

The Commission is calling on all ambulance trusts to read the report and take note of the recommendations.

The Commission launched its investigation of Staffordshire Ambulance Service NHS Trust in January 2007 in response to serious concerns raised by staff, the West Midlands Strategic Health Authority (the SHA) and others. These concerned the trust's management of risk, its use of medicines and its community first responder scheme.

The Commission's recommendations state that WMAS must:

- ensure that there is an effective framework in place to monitor the quality of care and safety of services, including information for the trust board
- carry out robust assessments of the potential risk to the safety or patients before introducing any new services, practices or equipment
- carry out a review of the training, education, support and government arrangements for its volunteer community first responders
- ensure that it has robust arrangements in place for the management of medicines
- ensure that it has effective methods of communicating with staff, to ensure that they are up-to-date with new working practices and guidance

The Healthcare Commission will monitor the implementation of these actions, together with the SHA, until it is satisfied that necessary improvements have been made.

The Commission is also calling on the Department of Health and the Home Office to improve guidance to trusts on licenses to possess controlled drugs.

Investigation into Staffordshire Ambulance Service NHS Trust - April 2008 (pdf 946kb) (opens new window)

More information about Staffordshire Ambulance Service NHS Trust

Notes

Community first responders are volunteers, primarily lay people, who respond to some medical emergencies on behalf of an ambulance trust. They are used in addition to, not instead of, ambulances.

Information on the Healthcare Commission

The Healthcare Commission is the health watchdog in England. It checks health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.

Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.

The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.

Healthcare Commission