London’s ambulance service has become the first ambulance trust in England to be put into special measures, after inspectors found improvements were needed across the board on safety, effectiveness, responsiveness and leadership.

Until March 2014 the trust was consistently the best-performing service in the country in responding to ‘category A’ calls, but there has been a substantial decline in performance ever since, and it is now failing to hit the target time of 75% of calls being responded to within eight minutes. 

The Care Quality Commission inspection also found the Trust lacking on the provision of staff support, training, and equipment. Staff were working long hours and many reported feeling high levels of stress and fatigue, while a large number on the frontline staff were found to be demoralised. There was also a recognised issue with bullying and harassment and a perception of discrimination which had not been dealt with.

Also, although staff had access to clinical advice by telephone or radio, some felt they did not have enough supervision or support when on the road. Some newly qualified paramedics said they were expected to work on the frontline without the guidance of an experienced or senior paramedic while they settled into the role.

On the plus side, while deemed ‘Inadequate’ overall the trust was rated ‘Good’ for caring, as patients were treated with compassion, dignity and respect by ambulance staff often in difficult and distressing situations. Staff were dedicated and proud of their work, while being open and honest about the issues they faced, the CQC noted.

"While we do have significant concerns about the performance of the ambulance service, I want to provide Londoners with some reassurance,” said Sir Mike Richards, chief inspector of Hospitals. “Firstly, that once care arrives, it is of a good standard…And secondly, that urgent steps are being taken - and improvements have already been made - to ensure that everyone who relies on this service receives excellent, timely care and that London has the ambulance service it deserves.”

A&E wait times worsening

Meanwhile, national data collected by the Royal College of Emergency Medicine shows that A&E wait times are increasing. 

From October 2 to November 13, 88 percent of A&E patients were treated or admitted within four hours, falling well below the 95 percent target. 

The data also shows that 76 percent of hospitals increased their acute bed capacity, while a total of over 6,300 elective operations were cancelled over the seven-week period. 

“It appears as though hospitals are doing this in preparation for increased demand during the winter period. Regrettably elective care has sometimes had to be cancelled to cope with the recent increased numbers of acute admissions,” said College President Cliff Mann.