THE head of an ambulance trust is under pressure after it emerged up to 20,000 patients had their ambulances delayed so the service had “extra time” to respond to calls.

NHS England is publishing a report tomorrow into the controversial scheme adopted by South East Coast Ambulance Trust (Secamb) chief executive Paul Sutton and senior managers last winter.

The report is expected to say that it is impossible to conclude patients were not harmed by the policy because all the facts of each case are not known.

NHS England has also examined seven "serious incidents", including five deaths, that happened while the scheme was in operation.

In one case - known to be the death of a 60-year-old Horsham man who had suffered a cardiac arrest - there was a "missed opportunity" to improve his outcome, tomorrow’s report is expected to say.

The regulator Monitor has also launched its own investigation into what happened.

The watchdog says the trust did not give sufficient consideration to the impact on patient safety or fully informing the trust's board.

Secamb says it is working closely with Monitor as the regulator investigates the issue.

The cases involved calls made to the NHS 111 non-emergency line that had been re-categorised as an emergency and passed through to the 999 system.

National rules say 75 per cent of Category A Red 2 calls - the code for cases of life threatening emergencies - should have a response at the scene within eight minutes.

These calls are for serious conditions such as strokes or fits, but less time critical than calls where people are not breathing or do not have a pulse.

Under the project, the ambulance trust gave itself up to 10 extra minutes to reassess what type of advice or treatment patients needed, and whether an ambulance was really necessary.

The investigation by NHS England said the project was drawn up via a group which was established by the chief executive, Paul Sutton, and overseen by at least four executives.

However it was launched without the knowledge of 111 staff, board non-executives, the medical director or local commissioners of services.

This meant patients were being told by an NHS 111 controller that an ambulance was on its way when in fact it was not.

Work is now ongoing to try to work out how many patients were harmed by the policy, including how many patients may have died as a result.

The trust has insisted that its own investigations "have not found that the process impacted negatively on patients".

Monitor said the project, which was run between December 2014 and February 2015, was "poorly handled" with concerns over how the trust was being run.

Monitor also said it has "reasonable grounds to suspect that the trust is in breach of its licence to provide NHS services", and has placed conditions on its licence.

A Secamb spokesman said: “Last winter, during an extremely busy period, South East Coast Ambulance Service introduced a process to deal with certain calls passed from 111 to the 999 service.

“The purpose of this process was to protect patient safety by ensuring that our most seriously-ill patients received the care they needed as quickly as possible.

“There has been some suggestion that this resulted in less serious patients being harmed.

"We would like to make it clear that our investigations to date have found no evidence to support this suggestion.

“We would also like to stress that calls which went through this process were not counted towards nationally reported performance figures, as previously set out in our annual report.”

111 POLICY ADDED TEN MINUTES TO SOME 999 RESPONSE TIMES

The Argus:

Last December and January was an exceptionally busy time for NHS services across the UK and Sussex and the south east were no exception.

The problem was made worse by a shortage of available hospital and community beds in Sussex, which led to long delays in accident and emergency departments.

This meant it was taking longer for ambulance crews to hand over patients, putting even more pressure on the system.

As a result, Secamb (South East Coast Ambulance Service) decided to run a project which it says was aimed at ensuring the most seriously ill patients were treated as quickly as possible.

This involved patients who had called the national NHS 111 non-emergency line but were switched by call handlers to the 999 system because they felt the patient needed an ambulance urgently.

Instead of automatically sending an ambulance out, paramedics at the control centre were asked to check and call back the patients to assess if an ambulance was definitely needed.

This led to delays of up to 10 minutes for what is said to be up to 20,000 patients during this period.

Secamb says its own inquiries “have not found that the process impacted negatively on patients”.

However a draft report from NHS England says it is impossible to conclude that patients were not harmed as all the facts of what happened to those patients involved was not known.

The NHS England document, reported by a national newspaper and verified by officials, said 111 call handlers were assuring patients in “life-threatening” situations that an ambulance was on its way, with no idea that it was not.

Instead, paramedics with just one day’s training in call-handling were ordered to phone thousands of cases back to see if ambulances were really needed.

The report also said the trust’s reliance on its own staff to report serious incidents was unreliable.

It said: “We cannot conclude that patients were not harmed by the project, as all the facts are not known for the calls that went unanswered or for the callers who had significant delay by the re-triage process.

“Serious incident reporting by staff was the only review process offered by Secamb. This on its own is an unreliable way of ascertaining this, as it is a well-reported fact that clinicians under-report events.”

Trust efforts to check whether harm was done to patients were neither “appropriate” nor safe, it said.

The trust was relying on a “look back” exercise after the project to see whether patients were harmed.

Highlighting the main concerns found by the investigation, the report said there was no transparency with the public, as they were not told their call was going into a queue.

They thought an ambulance was on its way when this was not true.

The study, verified by officials, said the governance structures that the trust had in place were not followed and the “risks of the project were either not recognised or were ignored”.

Key staff were also not consulted during the design and implementation of the project, which was overseen by at least four executives.

Three days after the project went live concerns were lodged with the trust’s head of compliance, who had no idea the policy had been introduced.

The official was told that the project would only last until early January, so failed to act.

It was not until a senior NHS manager raised concerns anonymously with senior managers at two NHS commissioning groups that orders were issued to abort the policy immediately.

Regulator Monitor is already investigating the trust, saying the whole project was poorly handled.

A spokesman for NHS England South said: “We agree with Monitor’s assessment that the trust acted unilaterally and inappropriately, and we support the action taken to rectify the relevant operational issues.”

In a statement Secamb said: “Last winter, during an extremely busy period, South East Coast Ambulance Service introduced a process to deal with certain calls passed from 111 to the 999 service.

“The purpose of this process was to protect patient safety by ensuring that our most seriously ill patients received the care they needed as quickly as possible.

“There has been some suggestion that this resulted in less serious patients being harmed. We would like to make it clear that our investigations to date have found no evidence to support this suggestion.

“We would also like to stress that calls which went through this process were not counted towards nationally reported performance figures, as previously set out in our annual report.”

Katherine Murphy, chief executive of the Patients Association, said: “The reports today about the conduct of South East Coast Ambulance Trust are truly shocking.

“There has been a complete disregard for patient safety through a policy that has put thousands of patients at risk.

“While the 111 service was designed for non-emergency calls, any situation categorised as ‘life-threatening’ should be treated as such. In emergency situations, every minute is vital and this doubling of response time is completely unacceptable.

“Executives should be in place to offer examples to their staff, and these findings are a huge betrayal of trust to those phone operators who work so hard to provide help for patients.

“Patients have suffered thanks to this policy and there must now be a thorough investigation into the project, particularly into those who implemented it.”

SECAMB SCRUTINY

What did South East Coast Ambulance Service (Secamb) actually do?

NHS 111 non emergency calls which were upgraded to an emergency and referred to the 999 system were delayed by up to 10 minutes while the caller was called back and the case re-assessed to make sure an ambulance was really needed.

Why did it do this?

The trust was under severe pressure as it dealt with a high number of calls from across Sussex, Surrey and Kent during December and January. Hospital A&E departments were also struggling with bed shortages, meaning ambulance crews were delayed in handing over patients, putting even more of a strain on the system.

Why was this controversial?

Because it was not a nationally agreed protocol and Secamb was the only ambulance trust to try out the system. It also meant patients who may have had potentially life-threatening conditions were waiting longer to be seen instead of the statutory eight minutes. NHS England says there was no transparency with the public, as they were not told their call was going into a queue. They thought an ambulance was on its way when this was not the case.

How many patients were affected?

Reportedly up to 20,000.

Did this have a serious impact on patients?

Secamb says no. It says its own assessment of the project concluded no harm came to patients as a result. However NHS England believes this is impossible to say for certain because all the facts were not known. It is reported at least seven serious incidents have been investigated, including five deaths.

What happens now?

NHS England releases its report tomorrow and Monitor has already announced it is investigating what happened.