Girl's death leads to call for sweeping changes

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Sweeping changes to the management and operation of London Ambulance Service, and a further cash injection to modernise it, have been demanded by an inquiry launched after the death of an 11-year-old girl who waited almost an hour when rapid treat ment was required if she was to live.

Nasima Begum's death in June last year was first reported in the Independent. An inquiry was only set up in October, after an LAS tape-recording of her screams was made public.

Drafts of the report circulating in the Department of Health - the second on the service in less than two years - show it to be suffering from years of neglect, misuse by the public, and operating with a "blame culture", high rates of absence, dangerous working practices, weak management and, in some cases, poor discipline.

The LAS is running with virtually no modern technology in the control room.

The drafts blame the present state of affairs on the former South West Thames Regional Health Authority, which had management responsibility for the service, and on a special committee the authority set up to oversee LAS after its Computer-Aided Dispatch(CAD) system collapsed in 1992.

In the time available, the inquiry was unable to establish whether these bodies discussed the wider state of the service after the computer collapse.

The findings are all the more remarkable for the inquiry having been conducted by William Wells, chairman of the South Thames Regional Health Authority, who as chairman of the successor body to the South West Thames region, has himself been responsible for the service since last April.

Margaret Beckett, Labour's shadow Secretary of State for Health, said: "This report raises as many questions as it answers. Virginia Bottomley [the Health Secretary] said in 1993 after the last inquiry that she was demanding `regular reports' on progress. We are going to want to know what has she been doing, and what is she going to do now?"

The inquiry found that on the night of Nasim's death only 12 ambulances were staffed of the 18 which should have been available. Two were allowed off-shift early, and, because of a shift change, only seven vehicles were actually available. Two of these were given the same radio identification. As a result, one was not used for the first 54 minutes of the shift.

The almost universal shift change of both crews and controllers at 11pm, 7 am and 3pm is "disruptive and therefore dangerous", the report says.

The inquiry says the standard of technology with which the service operates is "totally inadequate". Call-takers fill in a slip of paper and check the reference in a map book, a runner takes the paper to a sector desk, an allocator allocates the call, and a dispatcher contacts the crew by radio or telephone.

But the emergency lines into the control room are "old-fashioned and of poor quality". The room is noisy, compounding hearing difficulties, particularly where English is not the caller's first language. No computer-based information is available to identify addresses. Telephone companies have the technology to pass phone numbers and their location, but that facility "is not available". The service has no means of prioritising calls, and no systematic means of recognising that several calls have been made about the same patient.

Allocators are expected to hold in their head what each ambulance is doing. Because the service has only five emergency radio channels, crews must queue to inform control when they have finished a job. As a result, ambulances can be available, but the control room hasno idea that they are free.

Steps to tackle many of these issues are under way, says the report. But the LAS has never enjoyed the benefits of well-maintained technology and the CAD collapse has destroyed its faith in information technology.

London's emergency, page 2

Leading article, page 13