Leading Article: A service that is still ailing

It is the stuff of a modern nightmare; a relative dying before your eyes as you call and wait and call again for help - in vain. For the family of Nasima Begum that was what happened last summer - their frantic calls to the London Ambulance Servi ce wentunanswered for almost an hour.

The report obtained by this newspaper was commissioned by Health Secretary Virginia Bottomley last October. It was to discover how the Begum incident could possibly have taken place and to ensure that the right lessons were learnt.

It is, in its own way, an extraordinary document. Cited in the report as factors responsible for the Begum case and others are low morale, bad discipline, inadequate equipment, inappropriate procedures and a "blame culture". Apparently measures are already in hand to deal with some of these problems.

Any such action is welcome. But it is insufficient, for the report is a tale of utter mismanagement. It is only two years since another major report into the London Ambulance Service (LAS), this time prompted by the disastrous failure of its new computersystem, identified many of the same problems. If the service is badly run from the top, then tinkering with aspects of it will do little to solve the problem.

The objectives of the ambulance service are simple, even if the measures needed to achieve them appear complex. Doctors and citizens make calls to the service which should be assessed and prioritised before ambulances are despatched.

At each stage it should be possible to monitor the success or failure of the service and to fine tune it as necessary. Those employed to manage the service can be held to account for their performance against these objectives. If managers fail to deliverthe goods, then they can be replaced.

Yet none of this has been happening. After two years the chief executive of the LAS, Martin Gorham, technically still enjoys only acting status. Why? This can hardly help him in his duties. Has he the qualities to be chief executive or not? What has the LAS committee, whose members include the chairman and chief executive of the South Thames regional health authority, been doing? Why have the many routine operational problems, some of them crippling, not been picked up and sorted out in the course of proper monitoring?

The chain of responsibility uncovered in the report helps answer some of these questions. In the LAS, a Byzantine structure has evolved in which accountability and management have been dispersed between a host of different agencies. In these circumstances bad management flourishes.

Hopefully Virginia Bottomley, unlike Michael Howard, the Home Secretary, will see that the question of public management is a policy issue and act accordingly.

It is intolerable that the public sector should accept for years a management performance that no supermarket chain would allow for a week.