Scottish Ambulance Service Call Handling
The next item of business is a statement by Nicola Sturgeon on Scottish Ambulance Service call handling. The cabinet secretary will take questions at the end of her statement, so there should be no interventions or interruptions. This is a 10-minute statement.
14:34
I welcome the opportunity to make a statement to Parliament on the telephony problems that the Scottish Ambulance Service experienced on Wednesday 21 July. I will cover the cause of the problem, what happened on the day to ensure that calls were answered, the steps that have already been taken to prevent a recurrence and the audit that the Scottish Ambulance Service is undertaking to provide assurance that patient outcomes were not affected.
First, I will give some background. The 999 calls to the Scottish Ambulance Service are answered by one of our three emergency medical dispatch centres, which are in Inverness, Glasgow and South Queensferry. A call handler answers the calls and obtains the necessary details to allow the appropriate ambulance response to be dispatched. The systems that are in place make that a seamless process. The Glasgow telephone system is the main hub for the three centres in Scotland and it manages the local telephone systems at the other sites.
At just after 1 in the morning on Wednesday 21 July, the EMDC in Inverness started to experience disruption due to a fault in its telephony system. That fault in Inverness caused the corruption of the processor memory at the Glasgow hub, and that subsequently affected the telephony systems across the EMDCs. Throughout the day, the ambulance service and BT worked to resolve the situation, and all centres were back in full operation by 3.30 that afternoon. Contingency arrangements were activated at all three centres, and those arrangements allowed calls relating to more than 90 per cent of the incidents that the ambulance service dealt with that day to be handled in Scotland.
The Inverness centre was unable to take calls in the usual way between 1.05 am and 2.55 pm. The South Queensferry centre was unable to take calls between 9.42 am and 3.30 pm. At both those centres, BT was able to route 999 calls to mobile telephones as part of the contingency arrangements. The Glasgow centre experienced disruption between 9.56 am and 2 pm. During most of that time, four call takers were able to continue using the normal system and the remaining five call takers had to use mobile phones. However, between 1.10 pm and 2 pm, the Glasgow centre undertook a controlled closedown and restart of the system to clear all faults. During those 50 minutes, all call takers in the Glasgow centre used mobile phones.
In short, although the whole incident lasted from 1.05 am until 3.30 pm, it was only between 9.56 am and 2 pm that all three centres were affected and it was for only 50 minutes—between 1.10 pm and 2 pm—that the normal system was completely disabled. Scottish Government officials were advised of the telephony problems at about 12.25 pm and ministers’ offices were informed about 15 minutes later. The Scottish Ambulance Service has advised that the 999 calls that were answered in Scotland, either in the normal way or by mobile phone, experienced no delays between the information being received from the caller and the details being logged on the ambulance dispatch system. In addition, there was no impact on ambulance response times.
As I said, calls answered in Scotland accounted for more than 90 per cent of the total number of incidents that the Scottish Ambulance Service dealt with that day. A small number of calls were, however, routed to other ambulance services through what are known as buddy arrangements. Those arrangements form part of the contingency arrangements for a scenario such as the one that the Scottish Ambulance Service experienced on that day, and are established across all emergency services in the UK. The arrangements involve information being taken by call handlers in the buddy organisations and then passed back to the SAS for an ambulance response to be dispatched.
As a result of utilising the buddy system, a total of 149 calls were answered outside Scotland and then passed back to the Scottish Ambulance Service—121 by the Northern Ireland Ambulance Service and 28 by the North West Ambulance Service. Although those calls represent less than 10 per cent of the 1,609 incidents that the Scottish Ambulance Service dealt with that day, I want to take this opportunity to record my thanks to the services in Northern Ireland and north-west England for the invaluable support that they gave us during this period.
The Scottish Ambulance Service is undertaking a thorough review of the events of 21 July and I will return to the output of that review at the end of my statement. However, it is already clear that most aspects of the contingency arrangements worked well. For example, BT has confirmed that all 999 ambulance calls were answered during the period of disruption and I can also confirm that, once the patient information was logged on the ambulance dispatch system, ambulance response times were unaffected.
However, it is also clear that, as with any incident of this nature, we must take the opportunity to learn lessons. First and most obvious, we must work to prevent any recurrence of the situation. Immediately following the problem, BT was instructed to undertake a full review of system resilience. All the findings of that technical and complex review will be acted on and factored in to future contingency arrangements. Already, upgrades have been installed across the telephony system and analogue phones have been installed to support future resilience.
The second area in which we must learn lessons is use of the buddy system. The buddy system is an essential part of ensuring the resilience of the 999 service. However, because details are first taken by a call handler in the buddy service before being passed back to the SAS for an ambulance to be dispatched, there is an inevitable delay compared with the normal process, in which there is a seamless transfer of information from the call taker to the dispatcher. Use of the buddy system also means that, at virtually no notice, staff in another ambulance service are dealing with demand over and above the levels that they are resourced to manage.
The ambulance service has thoroughly reviewed each of the 149 calls that were passed from the Northern Ireland Ambulance Service and the North West Ambulance Service. Of them, 24 were duplicate calls, which means that 125 patients had their calls dealt with through the buddy arrangements. Of the 44 that were category A calls, the delay in the information being passed back to the Scottish Ambulance Service was less than 10 minutes in 55 per cent of cases, the average delay was 13 minutes and the longest was 57 minutes. For the 53 patients who were category B patients, the average delay was 32 minutes. The remaining 28 patients had non-emergency clinical needs.
I am very aware that these delays will have been distressing to the individuals concerned, including one of Jackie Baillie’s constituents who wrote to me about the delay that she experienced. I would like to convey to all of them my apologies and those of the chair of the Scottish Ambulance Service.
Making changes to the operation of the buddy system to address such delays will be one of the key action points from the on-going investigation. However, at this stage, I again acknowledge the hard work of all staff on duty that day, including all the staff in the buddy services.
Of course, what matter most are clinical outcomes for patients, which is why, as part of its investigation, the Scottish Ambulance Service has undertaken a clinical audit of every 999 call received on the day. The audit has focused particularly closely on the 125 patients who were routed through the buddy system. Dr George Crooks, who is the medical director of the Scottish Ambulance Service, is now in a position to assure me that the clinical case mix and outcomes that were achieved on 21 July reflected those that are experienced when the service works as normal. As is the case every day, it is not possible to achieve a positive outcome for every patient who requires an emergency ambulance. However, the service has informed me that no adverse outcomes were attributable to the delays associated with the buddy system.
I emphasise to members that the Scottish Ambulance Service investigation is still on-going. I believe that it is important for the Scottish Ambulance Service to complete its thorough and detailed investigation into the incident and for the public to be reassured about the service’s resilience, so I have asked the Scottish Ambulance Service to provide me with a detailed report on all aspects of the incident. To allow the SAS’s audit and clinical governance committees to consider the report fully, I have asked for it to be submitted to me by the end of November. I will then make it available to members through the Scottish Parliament information centre.
Of course, that does not mean that no actions will be taken until that report is published. In fact, many of the telephony actions that are required to ensure resilience in the system are already complete and the service will continue to act quickly in response to the lessons that emerge from its investigations.
As I said, the Scottish Ambulance Service’s detailed investigations remain on-going, but I hope that members are assured that the difficulties that the service experienced on 21 July are being responded to with the thoroughness that they deserve.
The cabinet secretary will now take questions on the issues that have been raised in her statement. We have no more than 20 minutes for such questions, after which we must move to the next item of business.
I thank the cabinet secretary for her statement and join her in thanking the Northern Ireland Ambulance Service and the North West Ambulance Service for their assistance on 21 July.
The cabinet secretary will agree that it is unprecedented for Scotland’s three ambulance centres to go down simultaneously. At the time, she said that there was no impact on patient care. As she admits in her statement, though, there clearly was an impact—as I will illustrate with the experience of two of my constituents.
The first constituent is Mandy Sweeney, whose father called 999 for an ambulance because she was in excruciating pain. He had to call back 50 minutes later and, in total, it took an hour and 15 minutes for an ambulance to finally arrive. The second constituent was an elderly lady who fell and hit her head on the pavement. It is unclear whether she lost consciousness, which surely made the call a category A one. She waited 45 minutes; the ambulance had to be called again and, in total, it took a total of an hour and a half to arrive.
It is clear that the cabinet secretary has not described the total delay experience. Instead, she has noted only the delay in passing information from Northern Ireland to Scotland, although there was evidently a further delay in the arrival of ambulances at their destinations. Will she provide that fuller information?
The cabinet secretary also mentioned that there were no adverse outcomes, other than those that we would normally expect, for the 125 patients who were affected by use of the buddy system. However, can she say whether there were any adverse outcomes at all for those 125 patients?
My final questions are on transparency. The cabinet secretary has made a 10-minute statement with not one mention of why she did not tell us about the matter. The Scottish Government is not normally known to be reticent when it comes to press releases, so why did I need to go to Belfast to find out what is happening in Scotland? Why did I need to rely on the Northern Ireland Ambulance Service for information and not the Scottish Ambulance Service? Who took the decision not to tell the public? Was it the cabinet secretary, the Scottish Ambulance Service or both? Cabinet secretary—why the big secret?
Jackie Baillie covered several issues, but I will try to respond to all of them.
In relation to the two cases that she mentioned, I am aware of the first of those, and I referred to it in my statement. However, I am not aware of the second case. If Jackie Baillie wants to provide that information to me, I will ensure that the Scottish Ambulance Service looks into the case. The Scottish Ambulance Service stands ready to discuss the detail of individual cases with any patient or their family, or any member of the Scottish Parliament on behalf of constituents.
To answer some of Jackie Baillie’s other points, I refer her back to much of what I said in my statement. I did not attempt for one minute to underplay the seriousness of the incident and I will not do so now. However, it is not the case that all three ambulance centres were disabled for the entire period that she spoke about. As I said in my statement, the entire normal system was completely disabled for a period of only 50 minutes. That is a serious situation, but Jackie Baillie should have reflected those details in some of her questions.
Jackie Baillie also asked about outcomes. As she will appreciate, I am not at liberty to go into individual patient details but, as I said, the Scottish Ambulance Service is willing to discuss details with patients or their families directly. There will always be a variety of outcomes associated with calls to which the SAS responds; that is in the nature of the work of that emergency service. The important point is the information in my statement that I have been informed by the service that the full clinical audit that it carried out on all the cases found that there were no adverse outcomes that were attributable to the delay. In other words, no outcomes would have been changed had the delay not happened. That is an important point of assurance.
Finally, Jackie Baillie raised the issue of making an announcement on 21 July. She will appreciate that the situation was not on-going; instead, it was addressed and resolved. Had it been on-going, the balance of judgment might have been different. As I said in my statement, all the detail of the investigation by the Scottish Ambulance Service will be in the report that will be made available in SPICe. I am sure that all members will take great interest in that when it is published.
I thank the cabinet secretary for providing advance sight of her statement. I welcome her reassurance that there were no adverse outcomes attributable to the breakdown. I also welcome the existence of the buddy system with the Northern Ireland Ambulance Service and the North West Ambulance Service, which is a clear example of the union dividend in practice.
The cabinet secretary acknowledged that distress was caused to individuals. It is therefore vital that lessons be learned and steps taken to prevent any repetition, if possible. The Scottish Ambulance Service is conducting an investigation, but did the cabinet secretary consider an investigation by an external agency rather than an internal investigation? Secondly, what will be the timescale for implementation of any recommendations in the final report when it is produced?
I echo Murdo Fraser’s comments about the buddy system. I said in my statement that I am grateful for the contributions of both of the other ambulance services on the day. Let us remember that the Scottish Ambulance Service stands ready to provide that service to other ambulance services in the eventuality that they need it, which we hope will never be the case.
Lessons will be learned. As with any incident of this nature, that is absolutely essential. I made clear in my statement the particular areas where lessons need to be learned. Like all members, I will reflect on those fully when I see the final report that the Scottish Ambulance Service will produce. On the question of internal investigation, it is important that the report goes through the clinical governance and audit committees of the Scottish Ambulance Service, which will subject it to considerable and robust scrutiny. That final report will be available for all members to scrutinise when it is published.
On timescales, as I made clear in my statement, the action that the Scottish Ambulance Service requires to take will be taken as and when those lessons have been learned. As I also said, much of the work around the telephony systems and the resilience of those systems has already been undertaken. We will ensure that any other recommendations that the report makes are implemented with all due haste.
I, too, thank the cabinet secretary for providing an advance copy of her statement.
Although we are reassured that the incident did not last for a prolonged period and that the contingency arrangements that had been put in place appear to have worked satisfactorily, the cabinet secretary will concede that making a statement of this nature serves a useful purpose in ensuring that the public understand that although there was an important and potentially difficult failure, the systems to cope with it were in place. The public can be reassured by that.
Early in her statement, the cabinet secretary advised Parliament that the calls were dealt with in the normal way or by mobile phone and that there were no changes in the way in which the system operated. Do we infer from that remark that there is no electronic logging of calls, or does that mean that the calls are logged anyway, before they are diverted to a mobile phone? It would be useful to know that. It is difficult for me and for members of the public to see that there is no change when the system diverts calls to mobile phones. If calls were not electronically logged, that suggests that there must be some manual logging. I would be grateful for clarification on that.
I welcome the fact that Ross Finnie is reassured by the operation of the contingency arrangements. Yes—it is important and useful to share the Scottish Ambulance Service’s information and understanding, as it develops, about why the problem occurred, what needs to be done to minimise the chances of a recurrence and the impact on patients in terms of outcomes.
With Ross Finnie’s permission, I will get back to him in writing on his third question, as I am not sure that I understand the point that he is making. I am also not sure where, in my statement, I said that there were “no changes” to the normal system. I was trying to convey the fact that 90 per cent of the calls could be dealt with in Scotland. Some of the calls were dealt with in the normal system, through the call handlers at the Cardonald centre, who were, with the exception of 50 minutes, able to continue to take calls in the normal way. The rest of the calls that were dealt with in Scotland were answered by mobile phone. Obviously, the systems were not identical because of the use of mobile phones. I will speak to Ross Finnie after the questions and will be more than happy to give him as much information as he needs on the operation of the system on that day.
We come to open questions. There are seven members and seven minutes; therefore, brevity is the watchword.
We are forewarned. Does the cabinet secretary have a timescale for the completion of BT’s review of its system resilience? Can she detail any further actions that BT has taken or is undertaking?
I outlined in my statement some of the actions that had already been taken as a result of the BT investigation, which include the upgrade of systems and the installation of more analogue phones in order to provide greater resilience in the event of something going wrong with the system. BT has provided a much more detailed investigation and tactical plan to explain in technical detail exactly what went wrong that resulted in the problem, and to set out the measures that are required to ensure that it does not happen again. I am not technically proficient in all these issues, but they will all be detailed in the report.
On the timescale, as I said earlier, all the lessons that emerge from this will be acted on as they emerge. I have already demonstrated how that has happened with some of the telephony solutions. There is a deadline of 15 October for absolute completion of the BT report, in order that we get an absolute and comprehensive view of what has been done and what might still require to be done. All that information will be produced in the final report.
The cabinet secretary has not really explained why she had to be asked for a statement rather than going public on this issue. The 24 duplicate calls reflect the level of patient concern. Has every category A and B call patient who survived—or the families—personally received an apology for, and explanation of, the problems that arose and the delays to which the cabinet secretary referred in her statement?
All the cases have been clinically audited. As Richard Simpson will appreciate, I have given some statistics for the delays that were associated with the calls that went through the buddy arrangements, but not all those calls were subject to delay. In my statement, I personally and on behalf of the chair of the Scottish Ambulance Service apologised to anybody who experienced additional distress because of that. I am under no illusions about how serious an incident it is when the telephone systems of the Scottish Ambulance Service do not work as they are intended to work. That is why this matter is being taken so seriously.
I hope that all members will be reassured by the information about clinical outcomes, which are ultimately what matter. To be told by the Scottish Ambulance Service that those outcomes were not affected by the delays is a source of great reassurance to me. I hope that it is to others, too.
The cabinet secretary outlined that there were, in the course of using the buddy system, some delays in information being passed back to the Scottish Ambulance Service. Although I recognise that an investigation into that matter is taking place at present, given that we remain committed to the buddy system in the meantime, is the Scottish Ambulance Service introducing any interim changes to try to ensure that in the unlikely event that we require to do the same again, we minimise delays?
I am grateful to Michael Matheson for raising an important aspect of this matter. I am reluctant to anticipate and pre-empt the specific recommendations that might be forthcoming from the full BT-led investigation. However, as I outlined in my statement, interim steps have been taken to improve the resilience of the Scottish Ambulance Service. Those steps are, in part, designed to minimise the chances of the buddy arrangements being required, which is an important interim measure.
Michael Matheson is absolutely right to highlight the importance of the buddy arrangements. It goes without saying—although I am about to say it—that we all hope that they would never be required in circumstances such as these. However, it is important that they are in place. They work both ways, they are an important part of the service’s resilience and I am very grateful to the ambulance services that operated them.
As we have heard, it all started in Inverness, where the system went down for nearly 14 hours. Can the cabinet secretary tell me—possibly in due course—why the system went down, why it went down for so long in a remote and sparsely populated area and whether it was due to old or defective equipment? A postcode lottery in this kind of service is completely undesirable.
It is certainly not my understanding that the problem was down to old equipment. There was an issue with the systems, which is why systems upgrades have been carried out already, not just to Inverness but to the entire system. As I said in my statement, the issue started in Inverness. The investigation so far tells us that that fault in the telephony system corrupted the processor memory, which affected the whole system. More of that technical information will be available as the investigation proceeds, but I assure Jamie Stone that the issue is not a question of equipment, as far as I understand it.
The cabinet secretary said that the disruption spread from Inverness to Glasgow through the connection between the systems. Will the review look into whether the response centres can be isolated or separated without affecting integration of services?
I am sure that the investigation will cover all such matters. As I said in response to Michael Matheson, it would not be helpful to pre-empt some of the investigation’s technical aspects. I hope that members are assured that the Scottish Ambulance Service, in partnership with BT, will consider all possible options to minimise the chances of a recurrence of the problem.
I was stunned to discover on a visit to Northern Ireland on 11 August that the serious systems failure had occurred. I am even more stunned now to discover that not making that public was not accidental and that the cabinet secretary chose on a balance of judgment not to make public what happened. I would like her to reflect on that.
Given the importance of confidence in the call-handling system, the cabinet secretary’s welcome announcement of a rigorous review and her apology, will she meet me to discuss how she is ensuring that systems issues that arise from two tragic constituency cases of mine of which she is aware, which involved Nikki Williamson and Mackenzie McManus, are being addressed? Have those cases been subjected to the same rigorous review as she committed herself to today?
I say to Johann Lamont in all sincerity that I reflect carefully on all such incidents and on everything that is said in the chamber by members from across the spectrum. This incident will be no different. I respect her right to make her point about a public announcement on 21 July but, in return, I ask her to reflect on the fact that making such an announcement would not have changed a single aspect of the outcome.
As for Johann Lamont’s request for a meeting, I am always prepared to meet members to discuss constituency cases, and this situation is no different—I am happy to meet her. However, to avoid any misunderstanding, I stress that the constituency cases to which she referred have nothing to do with the events of 21 July—they are completely separate.
I am reassured because the system’s resilience was as good as it was. I am sure that that reassures the cabinet secretary, too. Will she consider reviewing the resilience of NHS 24’s out-of-hours telephone systems, which tend to work across NHS board areas? As she knows, I am particularly concerned about rural areas where the boundaries of boards such as NHS Tayside and NHS Grampian meet, where systems tend to be back-ups for each other and where it is important that the systems work.
Please answer as briefly as you can.
I am happy to meet Nigel Don to discuss any concerns that he has about the operation of NHS 24. It is important to stress that NHS 24 was not affected by the problems that we are discussing today.