16. Mrs V told us that her mother was unwell. She had pain in her arm, was off her food, and was tired and weak. She and her husband contacted the Trust to raise their concerns. The Trust categorised the call as category 3, which means it aims to meet a 2-hour response time for an ambulance.
17. The Trust transferred Mrs I’s details to the Ambulance Trust. The Ambulance Trust contacted Mrs I to complete its own triage. The Ambulance Trust confirmed with Mrs I that the pain was between her elbow and top of her right arm, which was inconvenient, and she had had it for a few days. She felt more tired than usual, was weak and not eating as usual. She confirmed that she did not have chest pain or pain in her jaw or neck. She did not have a crushing pain in her chest, back or upper abdomen or any heart issues.
18. The Ambulance Trust concluded that Mrs I did not require an emergency ambulance. It provided a contact number for a secondary service which it advised could provide further support and told Mrs I to contact them in the next 24 hours.
19. Mrs V said she was confused to find on 29 March 2023 that the Ambulance Trust had given her mother the telephone number of a local pharmacy service. She said the Ambulance Trust did not give any explanation as to why this number was given and this upset them both. We looked at the evidence available to explore if the Ambulance Trust’s actions on 28 March 2023 were in line with guidance. We explored with our adviser what should have happened that day.
20. Point 31.2 of the Trust’s Procedure says ‘if a call handler manages to contact the patient (or someone with the patient) and assistance is required, they must ensure they complete a first or second party triage utilising NHSP to reach an appropriate disposition and provide relevant interim care advice’. NHSP refers to the NHS Pathways tool, which ambulance trusts use to determine appropriate next steps on further clinical support, if needed.
21. We understand from our adviser that at the point the Ambulance Trust received the call back request it would have had limited information about Mrs I’s condition. The reported concern of pain in her arm may have indicated something more serious, depending on the context of the arm pain.
22. It is common and best practice for ambulance services where possible to try and gather more information to ensure that it arranged the right response. By contacting Mrs I directly and completing a full assessment, the Ambulance Trust acted in line with the above section of the Procedure and ensured that she did not receive a response inappropriate to her needs.
23. Our adviser confirmed that by ringing Mrs I back and completing its own triage and assessment of her symptoms using the NHS Pathways tool, the Ambulance Trust acted in line with its Procedure guidance and is consistent with best practice in the sector. There are several questions in the arm pain question sequence of the NHS Pathways tool which are designed to help the call handler understand whether a patient is having a heart attack.
24. The answers Mrs I gave did not indicate that she was having a heart attack, nor that she required an ambulance. We know this is a source of ongoing worry for Mrs V, given that her mother’s health deteriorated over the following week and that she very sadly died. We hope our independent view provides her with some reassurance that there was nothing to indicate to the Ambulance Trust at the point Mrs I spoke to it that this was a missed opportunity to send an ambulance.
25. Based on the evidence we have seen, including our independent advice, there are no indications of failings in relation to the Ambulance Trust’s handling of the call and its referral to the pharmacy. Its decisions and actions were made in line with the guidance.
26. NHS Pathways works alongside the directory of services (DoS), which is a national database of different NHS services and the clinical needs they can manage. When Mrs I’s symptoms and answers were inputted into NHS Pathways, it determined that she required contact with a primary care service within the next 24 hours.
27. Primary care providers are services such as GP surgeries, walk in centres or pharmacies. Our adviser confirmed that by using the DoS, the Ambulance Trust correctly directed Mrs I to a local service that was able to complete a full primary care service and prescribe medications, if needed.
28. The pharmacy the DoS identified had the appropriate staff and equipment to treat patients with the same clinical needs and symptoms as Mrs I. Therefore, the Ambulance Trust acted in line with section 31.2 of the Procedure in referring to the DoS and advising Mrs I to contact the pharmacy.
29. The Ambulance Trust identified in its later investigation and audit of the telephone call of 28 March 2023 that it did not clearly explain to Mrs I that why she was referred to the pharmacy and what to expect when she contacted the telephone number given to her.
30. Our Principles of Good Administration say that, to be customer focussed, public bodies should communicate effectively, using clear language that people can understand and that is appropriate to them and their circumstances. In not clearly explaining the reasons why it gave Mrs I the telephone number for the pharmacy, we can see indications of a failing here.
31. Mrs V said that her mother needed help from the Ambulance Trust and instead it gave her the telephone number for a local service which they did not understand to be suitable for her needs. This upset and confused her mother, which in turn upset Mrs V as well. We agree that in not providing clear information, the Ambulance Trust’s error caused Mrs I and Mrs I some confusion and distress, and we have looked at what it has done to put things right.
32. In its responses to the complaint the Ambulance Trust apologised to Mrs V for the confusion it caused. It provided the call handler with feedback to ensure that learning was taken from Mrs V’s complaint.
33. The NHS Complaints Standards say organisations should openly identify instances when things have gone wrong, or where services have had an unfair impact, and take responsibility for these. They make sure staff can offer a range of ways to put things right for the individual. Staff should also look at what action will be taken to learn from the experience to continuously improve services and help support staff.
34. We consider that by acknowledging it did not properly explain to Mrs I why it provided the pharmacy contact number, apologising for this and providing feedback to the call handler involved, the Trust acted in line with the Complaint Standards and has taken action to put right the impact caused by its error in communication.
35. We are glad to see that it recognised this poor service in its complaint investigation and took appropriate steps to put right the frustration and distress caused. With this in mind, we will take no further action.
36. We understand this complaint is very important to Mrs V and we thank her for sharing her concerns with us.