North West Ambulance Service NHS Trust

5. Mrs E complains about aspects of the service provided to her late husband, Mr E by the Trust on 23 January 2024.

6. Specifically, she complains the Trust:

• did not categorise the 999 calls correctly and Mr E was not treated as an emergency patient when he was suffering with symptoms of a heart attack • provided the incorrect information to her about how long an ambulance would take to arrive • suggested Mrs E take her husband to A&E herself and the call handler did not know what hospital she should go to.

7. Mrs E says as a result of this, she decided to take Mr E to A&E herself which meant he had to wait in A&E to be seen and receive treatment. She says this delay resulted in his death. She explains if the Trust had given the correct information about how long an ambulance would take to arrive, she would have waited, and Mr E would have bypassed A&E and received treatment quicker.

8. She says she witnessed Mr E’s death which was horrendous, and she has flashbacks to that evening. She says this has been very difficult to cope with and she is receiving counselling.

9. She is seeking service improvements and a financial remedy.

10. On 23 January, at 10.17pm, Mrs E called for an ambulance as Mr E was suffering from chest pains.

11. Shortly after, at 10.25pm, she cancelled the ambulance as Mr E appeared to feel better.

12. Mr E started to deteriorate, and at 11.54pm, Mrs E called the Trust again to request an ambulance.

13. The Trust categorised the call as a category 2, which are classed as an emergency for potentially time-critical or serious conditions that may require rapid assessment, on scene intervention and/or transport to an emergency medical facility. These calls include a person having a heart attack or stroke.

14. In its complaint response, the Trust said it may be unable to allocate an ambulance immediately if its resources are already committed to other incidents and in addition, after allocation, there are a number of reasons why an ambulance may not reach the scene. This can be due to an ambulance being diverted to a category 1 call (critical calls for life-threatening injuries or illnesses) or due to suffering a vehicle breakdown.

15. It said the potential wait time for an ambulance on a category 2 call at that time, was 1 hour and 45 minutes, which was impacted in part by the handover delays that were seen at hospitals throughout the region.

16. It explained that at 10.00pm, 17 minutes before Mrs E made her first call, it had six ambulances waiting to handover at the local hospital, with the longest having to wait 143 minutes. At 11.40pm, it said six ambulances were still queuing up outside the hospital, with the longest wait time being 174 minutes.

17. The Trust told Mrs E of the potential wait time, and she took Mr E to the nearest A&E department herself. The Trust therefore cancelled the ambulance.

18. The Trust said if a patient can be safely conveyed, it would not override this choice as at times of peak demand, there is a risk that the wait for an ambulance would be longer than transporting to a place of definitive care.

19. Mrs E told us Mr E had to wait 40 minutes in A&E before the medical team reviewed him. Mr E was diagnosed with an aortic dissection (a tear in the inner layer of a weak area of the main blood vessel through which oxygen and nutrients travel from the heart to organs in the body).

20. While Mr E was being transferred to another hospital for treatment, he sadly went into cardiac arrest and died on 24 January 24.

Call categorisation

24. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong. We understand this was a distressing time for Mrs E and explain the reasons for our decision, below.

25. Mrs E complained the Trust did not categorise the 999 calls she made correctly, when Mr E was suffering with symptoms of a heart attack.

26. We reviewed this issue with help from our adviser and listened to the 999 calls Mrs E made to the Trust.

27. Ambulance response guidance defines the ambulance response categories used by the Trust. It says that category 2 calls are for patients experiencing a heart attack or stroke.

28. Both calls Mrs E made to the Trust received a category 2 response.

29. The symptoms Mrs E described indicated Mr E was suffering a heart attack. We think the calls were therefore correctly categorised and indicated an emergency response was required.

The Trust provided the incorrect information to Mrs E about how long an ambulance would take to arrive

30. In its complaint response, the Trust explained the potential wait times for an ambulance on 23 January was 1 hour and 45 minutes and it informed Mrs E of this during the call. The Trust said that Mrs E’s second request for an ambulance had a dispatch time of six minutes. Mrs E is unhappy the Trust did not inform her of this during the call. We recognise it was a distressing time for Mrs E, and she was worried about her husband.

31. The Trust explained it cannot guarantee an ambulance will arrive even after allocation, so call handlers will routinely provide information relating to potential wait times for an ambulance response.

32. To review this issue, we considered the Trust’s ‘Regional Operational Command Centre’ (ROCC) report from 23 January, which details the resources it had available and any pressures on the service.

33. During Mrs E’s second call to the Trust, the response time for a category 2 response in the area was approximately 1 hour and 45 minutes.

34. Considering the ROCC report, we can see there is evidence of both the number of vehicles waiting and the longest wait at the local hospital. The data supports that throughout the period, handovers from ambulance to hospital, were significantly longer than expected. When handovers take longer, this stops an ambulance being available to respond to another emergency and has a negative impact on overall response times.

35. We think the Trust gave Mrs E a reasonable estimate of how long an ambulance may take to arrive. It is impossible to predict future demand and capacity. Where an ambulance has been dispatched, it is also not known whilst the ambulance is travelling, if it will be diverted to a category 1 incident, or if a breakdown or a road traffic accident occurs, which will impact the ambulance reaching its destination.

36. Ambulance resources being diverted to other emergencies is commonplace. Therefore, it would not be appropriate to rely on an initial dispatch of a vehicle to assure a caller that a response was going to arrive in a specific timeframe, given this could change at any moment.

37. We therefore think the information provided to Mrs E about how long an ambulance was potentially going to take to arrive, was reasonable and correct. This is in line with our principles which says organisations should communicate effectively and inform people of what they can expect.

The Trust suggested Mrs E take her husband to A&E herself and the call handler did not know what hospital she should go to

38. Our principles also say organisations should behave helpfully, dealing with people promptly and tell people if things take longer than expected.

39. As detailed above, we think the Trust gave Mrs E a reasonable estimate of when to expect an ambulance. During periods of longer waits, it is appropriate for the call handler to ask the caller whether they are able to get the patient to hospital themselves.

40. At the call handling stage, it is impossible to confirm if a patient is having a heart attack or other specific cardiac event (in this case an aortic dissection). In this situation, the consideration was whether it was riskier for Mr E to wait with no care at home, than arriving at definite care in a hospital faster. With the delays that were present on 23 January, it was reasonable for the call handler to ask Mrs E if she felt she could take Mr E to A&E herself.

41. During the call, Mrs E indicated she did not know where the local A&E department was. Initially the call handler said they did not know but checked this promptly and told Mrs E which the nearest A&E department was.

42. It would be inappropriate for call handlers and outside of their scope of practice to attempt to direct callers to specific hospitals with specialist services.

43. The call handler provided the right information to Mrs E to try and get help for Mr E sooner, due to the delays the Trust was experiencing. We are sorry to hear Mr and Mrs E had a wait when they arrived at hospital, and understand it was a worrying time.

44. We recognise this has been a difficult time for Mrs E and understand the events complained about were distressing for her. We have not identified that anything went wrong with the service provided by the Trust and therefore we are taking no further action on the complaint. We hope our decision provides some reassurance to Mrs E that the Trust did treat Mr E as an emergency patient and provided the correct information to her.

1. We have carefully considered Mrs E’s complaint about the Trust. We have seen no indication that anything went seriously wrong in Mr E’s care and treatment.

2. We recognise how difficult this time has been for Mrs E and the distress she has felt during these events. We are sorry to hear of Mr E’s sad loss and the impact this has had.

3. We reviewed how the Trust handled Mrs E’s 999 calls, and the advice provided to her. We have seen the Trust categorised the calls correctly in line with relevant guidelines. It also provided the correct information about how long an ambulance was likely to take to arrive and provided the right advice to her.

4. We have therefore decided we do not need to take any further action on the complaint. We understand our decision may be disappointing to Mrs E and we are sorry if this adds any further distress to an already challenging time.