Independent London can reveal that the London Ambulance Service was operating at just over half capacity in east London on the Sunday night that Nasima Begum, 11, collapsed at her home in Whitechapel. The LAS has admitted it failed to provide vital cover due to absenteeism, staff shortages and crews on annual leave. Only seven manned ambulances were on duty, shared between nine stations in the East End. The number that should be on standby on a Sunday night is 13.
Yesterday one of the LAS's most senior managers said: 'The case has highlighted inadequate ambulance cover for the east of London and that the control room was inundated with work that they were not equipped to cope with.'
The investigation by the LAS reveals that Nasima's case was one of a string of 999 calls forced to wait for help on that June night. Some were left for 45 minutes or more. At Shoreditch, the ambulance station closest to the Begum home, two vehicles were rostered for duty but due to staff holidays and sickness neither were operational.
Andrew Brown, personnel director at LAS who headed the investion, said: 'Of the six ambulances that were off the road, four were due to annual leave which we did not have the relief staff to cover and two were due to absenteeism.'
He added: 'The primary reason why we were unable to provide an adequate service on Sunday 19 June was because we did not have sufficient ambulances available and there was a high volume of calls. In addition there were a number of mistakes which in isolation were not serious but as a whole combined to worsen the existing difficulty.'
Two crews were allowed to sign off duty and go home before their official finishing time.
The radio channels which link the main control at Waterloo to the crews had been changed earlier that day. Problems over radio contact meant that one ambulance which came on duty at 11pm could not be contacted for 14 vital minutes.
Confusion over vehicles at Newham meant that the availability of one ambulance which came on duty at 11pm was overlooked.
Four emergency calls which came in after the Begum family's were sent ambulances because they were deemed to be more urgent. An ambulance was dispatched to a patient described as bleeding from the mouth, but which later turned out to be someone suffering a headache.
At the worst point 19 calls were waiting, including Nasima's family. They had raised the alarm at 10.41pm and called five times begging for help as the girl suffered fits and lapsed in and out of consciousness.
Nasima had suffered from nephritic syndrome for six years, a condition which meant she lost vital protein from her kidneys. The illness is not normally dangerous but she suffered a rare complication, pulmonary oedema, and fluid spread to her lungs. This condition, unless rapidly treated, is fatal.
Mr Brown said: 'On this particular night a number of people received a poor service from the London Ambulance Service. I am aware that no explanation can help the family come to terms with the loss they have suffered. All we can offer is an honest
explanation for what happened. But we are acutely aware of the need to make improvements in all areas of the service.'
He said senior management had reviewed the case. 'They have been briefed to put into practice as a matter of urgency any steps that can prevent a similar occurrence.'
Mr Brown insisted that the undermanning which led to too few ambulance crews being on duty that night has been partially resolved by a mass recruitment campaign.
'The LAS was in the process of training 240 new staff. Unfortunately at the time of Nasima's death this training programme was incomplete. We were unable to provide sufficient relief crews to cover for those who were absent or on holiday.'
One ambulance worker told Independent London that crews disliked working on weekend night shifts because they are given no extra pay for doing so. Another said: 'Sunday nights are notorious. People simply do not want to work them.'
Mr Brown said one of the reforms which officials were considering was operational changes to rotas. 'We are looking at how to address the problem of staffing the unpopular shifts and to ensure they are adequately manned.'
The LAS has been dogged by controversy since the day its pounds 1.5 million computer system collapsed on 26 October 1992. Health unions have claimed the disaster cost 20 lives.
Mr Brown and Mr Gorham, the LAS's new chief executive, are part of a management team appointed as part of a series of changes made after the computer crash. The team's brief has been to improve the LAS's performance and response times.
In June, two weeks after Nasima's death, Government data shows, the LAS came bottom of the national league table of ambulance services, with 62.2 per cent of crews arriving at calls within the Department of Health's 14 minute allowance.
The LAS has been told to ensure that 80 per cent of its ambulances meet the 14 minute target by the end of this month. Statistics for last week show only 19 of its 70 stations were achieving that response rate. Overall 68 per cent of ambulances are arriving within 14 minutes and 79 per cent get there within 16 minutes.
The LAS says its goals have been impeded by an increase in the number of emergency calls. The health union Unison says the Government must invest more than the extra pounds 14.8 million allocated to improving services.
'There has been a 12 per cent increase in the number of calls received this August compared to last, which means that although we have recruited and trained more staff and have purchased more ambulances to replace the ageing stock, we still find ourselves running to go forward a little.' Mr Brown said.
Yesterday shadow health spokeswoman Dawn Primarolo described Nasima's death as an appalling tragedy. She said: 'Virginia Bottomley must guarantee that the LAS can provide the standard of service the public deserve and expect. She should consider enhanced payments to compensate for difficult shifts and in light of increasing demand review the overall number of ambulances available to respond to emergencies.'
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