West Midlands Ambulance Service downgraded as patients forced to wait longer for ambulances

Although WMAS's rating fell, it is still the best in country for answering 999 calls but in the category 'Effective' it dropped from outstanding to requires improvement.

Charlotte Rudge, CQC deputy director of operations in the Midlands, said: “External challenges across the healthcare system meant that ambulances were queuing for hours at accident and emergency departments due to handover delays at hospitals, which impacted on people’s care and wellbeing.

“This resulted in longer response times for people calling an ambulance, it also had a negative effect on staff, who were doing their best to provide safe care and treatment to people."

However, Ms Rudge was impressed with the leadership of the trust.

She said: "When we inspected West Midlands Ambulance Service University NHS Foundation Trust, we found leaders had the skills, knowledge and experience to run services well.

“We found the trust was working hard to improve its culture, so people using the service, their families and staff could raise concerns without fear. The trust had improved staff wellbeing and freedom to speak up guardian services.

"However, during the inspection, some staff told us they still felt unable to speak up and be listened to. The trust must continue to address this issue, as we know services which don’t have an open culture, has a negative impact on people’s care."

The CQC found staff had become skilled at dealing with people traumatised when an ambulance was not on the way immediately.

Ms Rudge said: “In the trust’s two emergency operations centres, the service was the best in the country for answering 999 calls. Also, it was reassuring to hear that when we were listening into emergency operations centre calls, staff understood the emotional impact the situation had on people’s wellbeing and on those close to them, particularly when the service was experiencing delays. They were well trained and responded in a professional way to help people receive the care they needed.

“We will continue to monitor the trust, including through future inspections, to ensure the necessary improvements are made so people are safe and can continue to receive a good standard of care.”

Despite the downgrade in rating, trust chief executive Anthony Marsh welcomed the report into the service which has seen the struggles staff face become a TV ratings hit on the Channel 4's 999 On the Frontline.

He said: “The overall rating has dropped from Outstanding to Good, which is disappointing given how hard our staff work every single day, but we are delighted that the inspectors continue to believe that the caring domain remains outstanding.

“In addition, the inspectors have now rated our Emergency Operations Centres (EOCs) as outstanding; the only one in the country. As the report notes, we have the best call answering in the country and treat more patients over the phone than any other trust.

“However, the biggest change the inspectors noted was in our effectiveness, which has dropped from outstanding to requires improvement. The report is very clear that the route cause of this change is as a result of hospital handover delays that see our crews stuck outside hospitals for hours on end, unable to respond to patients in the community. They also note the hugely negative impact these delays have on our staff and their wellbeing.

“As a trust, this is an issue that we have raised time and time again, with the Trust Board rating this risk at 25, the highest available. We understand the pressures our partners are under and we will continue to do everything we can to work with them to make the changes necessary to allow us to get to patients much more quickly going forwards."

There have been persistent complaints about bullying at the trust, with staff complaining about the pressure they are under.

Mr Marsh added: “Given this inspection happened at perhaps the most challenging time within the history of the NHS, there is much to be proud of. However, we do also note the comments about our culture. The report notes the work we have done ensuring staff feel able to speak up and our colleagues treat each other with the respect they deserve.

“The trust has been working hard over the last 18 months with staff fully involved in creating a new cultural statement, the launch of our sexual safety charter, the development of our six staff networks and the substantial increase in the health and wellbeing support available to individuals."