SPECIAL REPORT: Priority to reach 999 emergencies altered to meet government targets, claim NHS insiders

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The ambulance service is fiddling emergency response figures to show crews get to life-threatening emergencies on time, it has been claimed.

The Express heard from staff members who said some patients waiting for an ambulance for life-threatening “red” emergencies had their priority downgraded if the ambulance was unable reach them in eight minutes.

As a result, failures to reach seriously injured patients in eight minutes were not showing up on official response time figures.

Less serious “green” emergencies were also being upgraded on the system to show they were life-threatening “red” call-outs if staff knew the ambulance could get there in eight minutes to help meet the targets, it was claimed.

Bosses at Yorkshire Ambulance Service (YAS) have refuted allegations that the priority of 999 calls is being altered on their computer system to hit government targets.

But a whistleblower said paramedics and emergency nurse practitioners had been placed in the call centre to sift through 999 calls and see if they were likely to hit the eight-minute figure.

They said: “If they know they are going to hit the target they do nothing, but if they know they are not going to hit the target they are to ring back patients who are already waiting for an ambulance and re-triage them.”

Figures released by YAS under freedom of information rules show more than 8,238 999 calls were re-triaged last year.

But the whistleblower claimed that around six calls per hour were re-triaged, and the true figure was far higher.

They also claimed figures were being manipulated so the ambulance service could meet targets to become a Foundation Trust, an elite status required by the government.

Another ambulance worker who spoke anonymously said: “Some absolutely major calls are being graded as green because they know they are not going to get to it. This is happening on a daily basis.”

A third source said: “It’s coming from the top. If you look at our response times for the last year we have fewer staff and more patient volume, but we are still hitting the targets 75 to 80 per cent of the time.

“They are playing with lives on a daily basis.”

Terry Cunliffe, regional officer for the Unite union, also claimed response times were being manipulated.

He said: “Some of these calls are being downgraded. Other calls which are green and they are on site within eight minutes are being upgraded to red.”

Mr Cunliffe said manipulation of response times meant YAS was not being properly scrutinised so it could make improvements.

He said: “If they are misleading those who are monitoring their performance then clearly that is a significant issue.”

YAS said the priority of 999 calls was sometimes changed, but only if it was in the patient’s interest.

David Williams, deputy director of operations, said: “There are occasions when we feel it would be beneficial to the patient for them to receive further in-depth assessment prior to the arrival of an ambulance.

“We therefore have highly-skilled senior clinicians based in our Emergency Operations Centre to provide further assessment, advice and support.

“This clinically-led process may identify that the condition of the patient is more or less serious than the initial assessment. This can result in those with a serious condition receiving a quicker response and those whose condition is not immediately life-threatening receiving the most appropriate care for their needs.”

Unite has also claimed that patient safety is being put at risk because less qualified emergency care assistants (ECAs) are being sent to 999 emergencies.

Mr Cunliffe said: “Again, it’s to hit targets, sending ECA’s to jobs if they can get to them within the target time.”

Bosses at YAS dispute the claims by Unite, saying patient safety is not being compromised.

Mr Williams said: “The Emergency Care Assistant role introduced at YAS is widely used in other ambulance services across the country.

“They respond to emergency calls in a clinical support capacity, as part of an A&E ambulance crew, under the supervision of a fully-qualified clinician (Paramedic or Emergency Medical Technician).

“On the rare occasion that an ECA is required to work with another ECA they will only be deployed to non-emergency calls.”

YAS also said meeting response targets was not its sole requirement to achieve Foundation Trust status.

Mr Williams added: “When an organisation is being considered for foundation trust status the quality of the services provided to patients is one of the elements assessed and for ambulance trusts, how quickly we reach our patients is just one of the many measures looked at as part of the application process.”

Ambulance crews are supposed to respond to 75 per cent of Red 1 calls - the most critical 999 category covering people who have stopped breathing or do not have a pulse - within eight minutes.

Figures for the last financial year show Yorkshire Ambulance Service NHS Trust (YAS) got to 71.7 per cent of the calls on time.

However, Trust bosses said they had met their targets, pointing out the eight-minute target for Red 1 calls comes into force this year.

The eight-minute target for Category A calls was split into two categories, Red 1 and less serious Red 2, which includes conditions like strokes and fits, for 2012-13.

When the figures were released in June, YAS bosses said that, as required, they achieved higher than the 75 per cent target when the two categories were averaged together.

It was the second consecutive year YAS had met this target.