Special measures for struggling services

In November of last year, London Ambulance Service NHS Trust (LAS) became the first ambulance Trust to be placed under special measures following an inspection of the service by the Care Quality Commission (CQC) in June 2015. The overall rating given by England’s chief inspector of hospitals, Prof Sir Mike Richards, was that the service was inadequate, and it was acknowledged that improvements were needed on safety, effectiveness, responsiveness and leadership (CQC, 2015b).

Of the key findings, it was noted that LAS had a high number of front-line vacancies, with some employees saying that there were not enough appropriately trained staff to ensure that patients were consistently safe and received the right level of care (CQC, 2015a). As a result of staff working long hours, many reported feeling high levels of stress and fatigue. Additionally, while the CQC recognised that staff were ‘overwhelmingly dedicated, hardworking and compassionate,’ they revealed that ‘some reported a culture of harassment and bullying’ (CQC, 2015a). It was highlighted how until March 2014, LAS was consistently the best performing service in the country to category A calls. However, since then there has been a substantial decline in performance, and the target time of 75% of calls being responded to within 8 minutes has not been met. This is something that has been affecting ambulance services across England, although LAS response times for Red 1 and Red 2 category A calls were reported as being the worst in the country. Serious concerns were also identified about the service’s Hazardous Area Response Team (HART) capability due to an insufficient number of paramedics. The result was the feeling that there was not a safe system of working where an effective HART response could be utilised (CQC, 2015b).

The decision to place LAS under special measures is a considerable blow, not just to the service, but to all members of ambulance Trusts. Fundamentally it highlights the CQC’s belief that LAS is unable to provide the level of care expected of it. This is despite the dedication and commitment that is clearly apparent in front-line staff, alluded to in the report. But while it is easy to consider the negative connotations of the CQC’s report, it is important to remember that one of the key reasons why services are placed under special measures is to ensure they get the support they need to improve. External partners such as the NHS Trust Development Authority and NHS England will give LAS access to a package of additional resources and support.

Ambulance services throughout the country are struggling to deal with increasing pressures, a national shortage of paramedics and insufficient funding. It is hoped that other ambulance services will not suffer similar findings from the CQC, but it should be reassuring to know that there is a system in place to offer support to services that are unable to make improvements required of them on their own.


Care Quality Commission (2015a) Chief Inspector of Hospitals recommends London Ambulance Service NHS Trust is placed into special measures. CQC, London. http://www.cqc.org.uk/content/chief-inspector-hospitals-recommends-london-ambulance-service-nhs-trust-placed-special (accessed 4 January 2015)

Care Quality Commission (2015b) London Ambulance Service NHS Trust Quality Report. CQC, London. http://www.cqc.org.uk/sites/default/files/new_reports/AAAD5514.pdf (accessed 4 January 2016)

Taken from Journal of Paramedic Practice, published 8 January 2016.

Investigation launched by London Ambulance Service into alleged exam cheating

London Ambulance Service NHS Trust (LAS) has had to suspend its paramedic final examinations following claims by an anonymous whistle blower that student paramedics had access to their final papers.

An external investigation has been launched that will look into the allegations that students going through the Trust’s in-house training programme between 2008 and 2012 had access to exam papers.

850 students went through the training programme during the four years but it is unclear as to the number who had access to the papers or how they may have gained access to them.

Ann Radmore, chief executive of LAS, said:

‘I was shocked and disappointed to hear this anonymous allegation and will not tolerate any form of cheating.

‘I am committed to sharing the findings of this independent investigation and being transparent throughout.’

It is unclear how long the investigation will take but it is thought the suspension of exams may cause a short delay in paramedics qualifying.

The external investigation will be led by Simon Brown, assistant medical director, north, for South Central Ambulance Service Trust, and chair of the Joint Royal Colleges Ambulance Liaison Committee Guidelines Subcommittee.

Taken from Journal of Paramedic Practice, published 2 June 2014.

Paramedic shortage leads LAS to recruit from overseas

London Ambulance Service NHS Trust (LAS) has been granted permission from the UK Border Agency to sponsor 100 work visas a year for non-European paramedics.

The initiative comes as part of a drive to help tackle the national shortage of British paramedics.

‘Year on year increases in demand and a requirement to have more registered health care professionals responding to patients means we are in need of a greater number of paramedics,’ said Mark Whitbread, Director of Paramedic Education and Development, LAS.

‘The same applies for other ambulance trusts across the UK but there is only a finite number of registered British paramedics.’

LAS currently has around 250 vacancies for registered paramedics.

While there are no plans to send a UK team overseas to help with recruitment, the service is looking to target countries such as Australia and New Zealand, where the skills and training of paramedics closely match those of the UK.

The service is also working with universities, sponsoring student paramedics and encouraging ex-military personnel to consider a career in the ambulance service in an attempt to increase their number of paramedics. However, Mr Whitbread stresses that it takes up to three years for those entering the profession to qualify as a paramedic, which is why LAS have decided to look abroad for new recruits.

Martin Flaherty, Managing Director of the Association of Ambulance Chief Executives (AACE), said:

‘The national shortage of paramedics is affecting all trusts and AACE is working closely with Health Education England to improve the situation. Ambulance Trusts are also having to think of ever more creative ways to recruit vacant posts.’

Once the paramedics are recruited they will undergo a short conversion course enabling them to treat patients in the UK.

Taken from Journal of Paramedic Practice, published 17 February 2014.

LAS and SECAmb retain strong positions in Stonewall’s Workplace Equality Index

The London Ambulance Service NHS Trust (LAS) and South East Coast Ambulance Service NHS Foundation Trust (SECAmb) have both retained a place in Stonewall’s top 100 employers list 2014, which was published on 15 January.

The annual guide, now in its tenth year, features Britain’s top employers for lesbian, gay and bisexual staff. Stonewall receives hundreds of submissions annually to the Workplace Equality Index, their audit of workplace culture for gay staff.

This year 369 employers entered the Index from across the public, private and third sectors. LAS ranked 19, making the top 20 for the first time and rated the second highest NHS organisation, behind Nottinghamshire Healthcare NHS Trust.

Duty station officer and co-chair of the service’s Lesbian, Gay, Bisexual and Transgender Forum, Lee Hyett-Powell, said: ‘We’re delighted to be in the top 20 and to have improved again for the third year running is amazing. The news is especially welcome because it becomes more difficult every year as the competition gets tougher.’

SECAmb ranked 61, having become the second ambulance Trust in the country to join Stonewall’s equality programme in 2008.

Paul Sutton, chief executive of SECAmb, said: ‘I’m delighted that SECAmb has once again been ranked in Stonewall’s Top 100 employers list. We are committed to supporting equality and diversity at SECAmb and this is evidence of that. We are dedicated to supporting all our staff and providing a service that meets the needs of all our patients. We will continue to work hard to ensure that SECAmb is a workplace of choice where everyone is confident they can be themselves.’

‘Participation in Stonewall’s Index sends a powerful signal to an organisation’s commitment to its most vital resource, its people,’ says Ben Summerskill, chief executive of Stonewall.

‘Through our extensive research, Stonewall has established the truth behind the adage “people perform better when they can be themselves”. Staff who can be open about their sexuality are more likely to enjoy going to work, feel able to be themselves, form honest relationships with colleagues, are more confident and, ultimately, more productive. Put simply, improving the working environment for gay staff makes good business sense.’

Taken from Journal of Paramedic Practice, published 27 January 2014.

LAS improves out of hospital cardiac arrest survival rates

As part of a call to action from health secretary Jeremy Hunt to reduce the number of avoidable deaths in the UK, the Department of Health has published an outcomes strategy on cardiovascular disease (CVD), which will support the NHS and local authorities in delivering improved outcomes for those with or at risk of CVD.

The announcement comes following The Lancet’s recent report on the UK’s health performance, which highlighted that the UK was a long way behind many other countries.

CVD affects the lives of millions of people and is one of the largest causes of death and disability in the UK. However, fast responses to emergencies can save lives and, in some cases, reduce disability.

According to the strategy about 50 000 out of hospital cardiac arrests (OHCA) occur each year in England. Due to a variety of reasons, such as co-morbidity, resuscitation may be inappropriate, and so attempted resuscitation by ambulance services occurs in less than 50% of cases.

However, there is significant variability between ambulance services in rates of successful initial resuscitation (13-27%) and survival to hospital discharge (2-12%) following an OHCA. If survival rates were increased from the overall average (around 7%) to that of the best reported (12%), it is estimated that an additional 1 000 lives could be saved each year.

The strategy revealed that since 2004/2005 the London Ambulance Service (LAS) has improved overall OHCA survival to hospital discharge from a rate of 4% to 11% in 2011/2012. This is as a result of quicker response times; taking heart attack and cardiac arrest patients direct to heart attack centres; and improving bystander resuscitation.

Despite improvement in the LAS, variation in the quality of acute care in other parts of the country mean that much can still be done if patient mortality from CVD is to see considerable change.

The CVD outcomes strategy claims that the NHS Commissioning Board (CB) will work with the Resuscitation Council, the British Heart Foundation and others to promote automatic external defibrillator (AED) site mapping/registration and first responder programmes by ambulance services, and consider ways of increasing the numbers trained in cardiopulmonary resuscitation (CPR) and using automated AEDs.

Taken from Journal of Paramedic Practice, published 14 Mar 2013.