By Tony Collins
In November 2016 London Ambulance Service had its busiest week for seriously ill and injured incidents in the history of the Service.
“The Service is …expecting demand to increase even further throughout December,” said London Ambulance Service at the time.
A few weeks later, on one of the busiest nights of the year, the systems went down, from 12.30am to 5.15am on 1 January 2017. The result was that 999 calls were logged by pen and paper.
When systems are working normally an incoming 999 call displays the address registered to that number – if the address is registered. The London Ambulance operator confirms the location, assesses the severity and an ambulance can be despatched within seconds, with the address on its screen and a satnav pointing the way, according to a comment on The Register.
Pen and paper takes longer because the address and other details need to be given over a radio, which can take minutes.
But pen and paper is the London Ambulance Service’s back-up for IT failures. Whether it can cope with unprecedented demand – or with a major incident in London – is in doubt.
A former London Ambulance Service paramedic told the BBC there had been waits of an hour for ambulances on 1 January 2017. He said call handlers had been “amazingly helpful”, but it was “easy to become overwhelmed especially in the midst of high call volumes”.
London Ambulance Service declined to answer any questions on its latest system failure.
Malcolm Alexander of the Patients’ Forum for the London Ambulance Service said: “We want to know why it is that this system that cost so much money and is supposed to be so effective is not fail-safe.”
He added: “If this system fails at a time when there is huge pressure in the system, for example if there was a major disaster or a terrorist attack, we are going to be in trouble. We really need to make sure it doesn’t collapse again.”
A report into the collapse of London Ambulance Service systems found that they had had failed for many reasons. The Service had taken a “high-risk” IT approach and did not test systems thoroughly before putting them into service.
(Some may question how much has been learned since then.)
In 2006 the London Ambulance Service systems crashed nine times in a fortnight. Each time staff reverted to pen and paper.
In 2008, when systems failed, repairs took 12 hours. Again the Service reverted to pen and paper.
In June 2011 an IT upgrade caused the system to go down for about three and half hours. Pen and paper was again the back-up “system”. At the time the London Ambulance Service was upgrading the Commandpoint system, supplied by Northrop Grunman, which the Service deployed in 2010 and still uses.
In 2013 on Christmas Day and Boxing Day the systems went down for separate reasons for several hours each day, with staff reverting to pen and paper.
The Chief Inspector of Hospitals, Mike Richards, recommended that the London Ambulance Service be placed into special measures.
He said at the time,
“The Trust has been performing poorly on response times since March 2014. This is a very serious problem, which the trust clearly isn’t able to address alone, and which needs action to put right.”
It’s becoming the norm for parts of the public sector to regard the public as captive customers when it comes to going live with new IT or upgraded software.
Rather than test new systems, procedures and upgrades thoroughly before introducing them, some parts of the public sectors are going live with a “let’s see what happens and fix things then” approach.
This has become the semi-official approach to the introduction of Universal Credit – with long delays in payments for some claimants.
Within the NHS, at some hospitals introducing new patient record systems, there has been an internal acceptance that patients may suffer from delays, perhaps with tragic consequences, at least for three year-old Samuel Starr.
The NHS e-referral service was launched with nine pages of known problems. And when NHS England launched a streamlined GP support service with Capita, officials knew of the possible problems. But it launched anyway.
After the London Ambulance Service’s IT failure on New Year’s Day, it’s clear that many emergency workers did their best to give a normal 999 service. St John’s Ambulance helped.
But to what extent does senior management at the London Ambulance Service have a “stuff happens” mindset when IT goes seriously wrong?
There’s no individual accountability and no commercial imperative to learn lessons from any of the failures.
And there’s no fervent business or political will to ensure the same or similar mistakes don’t recur.
Every time systems fail, the London Ambulance Service promises an investigation. But where are the results published so that lessons can be learned?
Pen and paper is tried and tested. But demands on the London Ambulance Service are much greater than in the past.
With an unprecedented demand for its services how is it London Ambulance Service’s senior management can comfortably rely on pen and paper as its back-up system?
It can – if nobody in power requires an earnest answer to the question.
Another wider question is whether it’s acceptable to use the public as guinea pigs for new or upgraded IT, with potentially serious or even tragic consequences.
London Ambulance Service suffers New Year’s crash – Computer Weekly