A ‘FLAWED decision’ was to blame for an ambulance turning back only one minute from a patient’s home – who then died hours later.
The service being ‘stretched’ on the day in question also played a part.
These details were revealed in an internal investigation carried out by South Central Ambulance Service after Ann Walters was found dead by her son Lawrence Thorpe, 10 hours after she called for help.
The report concluded the initial 111 call handler acted correctly by sending an ambulance to the 61-year-old’s home in St Piran’s Avenue, Baffins, just before 8.20am on December 28, last year.
Ms Walters had a known heart condition and was having difficulty breathing as she spoke over the phone.
This call was then passed on to a 999 clinician, but the report found he did not ask the patient the correct questions and a decision to stand the ambulance down was ‘flawed’.
I’m glad they have admitted liability, but it doesn’t change muchSon Lawrence Thorpe
At this point an ambulance was only a minute away from Mrs Walters’ home. The clinician cited ‘east shortages’, ‘rapid-response vehicle and North Harbour vacant due to sickness’, ‘queuing at Queen Alexandra Hospital’, and ‘shift unavailable at Petersfield due to paramedics becoming hospital ambulance liaison officer’, as pressures the service was facing that day.
Due to Ms Walters’ reluctance to go to hospital, and to still ensure care was given, the clinician arranged for an out-of-hours doctor service to contact the patient within one hour.
But this did not happen and help did not arrive until Ms Walter’s son Lawrence, 24, found his mother on the floor at 6pm. Ms Walters was pronounced dead at 6.10pm. Scas has accepted liability and Care UK, which provides the out-of-hours service, said it is still carrying out its investigation.
Teacher Lawrence said: ‘I’m glad they have admitted liability, but it doesn’t change much. I don’t have much faith in the NHS as I know it is struggling financially and this might happen again.
‘I just don’t want this to happen to anyone else.’
Councillor John Ferrett is chairman of Portsmouth City Council’s health, overview and scrutiny panel, and said lessons need to be learned.
He said: ‘This is a very tragic case and mistakes have led to a tragic outcome.
‘The NHS is trying to do its best, but it’s feeling the pressure with limited resources and tight budgets. I hope lessons will be learnt from this because we can’t start denying ambulances to those who genuinely need them.’
Portsmouth North MP Penny Mordaunt echoed these thoughts.
She said: ‘We need to ensure this doesn’t happen again. It’s clear it’s unacceptable, the clinician should have followed the triage path and lessons need to be learnt from it.’
In a statement, Scas said: ‘We have been liaising with the family during the investigation and there is nothing further the trust wishes to add at this time.’