Exclusive: Chair of under-fire trust triggers 'independent' review of winter

Chair Sarah Boulton revealed she and NHS Improvement were jointly commissioning a “senior ambulance figure” to scrutinise how the organisation has been led this winter, which included a crisis-hit three week period in which the trust recorded 138 “significant” delays including one of 16 hours and another of 14 hours.

She said she had approached a leader from another ambulance service to lead the review, but would not say who as discussions were ongoing.

Ms Boulton disputed allegations by a whistleblower that at least 40 patients were “harmed or died following significant ambulance delays”.

The full picture was not yet clear as investigations into 22 serious incidents were “ongoing”, Ms Boulton said. The incident reports will be completed over the coming weeks, with the first wave expected next week, but the trust said it has found no evidence of patient in its investigations “so far”.

She also said:

• she was “very concerned and upset about the delays [and wanted to] apologise to the patients that we were delayed in getting to them”;
• lack of funding and handover delays at hospitals were “contributory factors” to the trust’s tough winter; and
• she was “totally confident” in the trust’s executive leadership, which has been criticised by MPs.

Ms Boulton has set a provisional March completion date for the management review, which would be made public. 

The move follows North Norfolk MP Norman Lamb calling for a “fully independent governance review” in the wake of the allegations. Mr Lamb told HSJ his “very serious concerns [about the trust and its leadership] remained”.

Ms Boulton, who is a former strategic health authority chair, said the review would investigate her executives’ decision not to raise the operational status to REAP 4, the highest risk category for ambulance trusts, until 31 December – two weeks after it came under significant strain.

MPs said in Parliament that senior managers had urged the board to escalate to the top risk level significantly “before [31 December] so that mutual assistance could have been secured from surrounding trusts”.

Asked if there was anything the trust should have done differently over the winter, Ms Boulton said: “I don’t think I’m in a position to answer that… we have questioned ourselves and said: ‘could we have done something differently?’ about raising to REAP 4.

“What I have asked for is a review of the operational management of winter. But obviously within that will be the whole REAP decision. 

“Hopefully the outcome of that will be: what is the cause [of the significant delays over winter]? That will give me an indication of [if we] could have done things differently. Are there things for us to learn? I would be the first person to tell you we ain’t perfect, we always have things to learn. We can always improve.”

Ms Boulton, trust chief executive Robert Morton and other directors met yesterday with local MPs to provide an update following the deaths of constituents and a risk summit convened by NHS England.

Suffolk Coastal MP Therese Coffey, who organised the meeting, said: “MPs agreed to ask the [NHS England] director responsible for the East of England, Paul Watson and health minister Steve Barclay to meet us very quickly so we can accelerate solutions to issues that we know have been around for some time.

“Fundamentally though, despite some improvement being made, we need more improvement more quickly and the very top level of the NHS involved in making that happen.”

Mr Lamb, a former health minister, who has raised several concerns about the trust, said: “We have a cold spell coming up. I don’t have confidence that the emergency care system is in a fit state to cope with these continuing pressures. My understanding is performance, particularly in Norfolk, continues to be pretty dire.”