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.”
1992
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.)
2006
In 2006 the London Ambulance Service systems crashed nine times in a fortnight. Each time staff reverted to pen and paper.
2008
In 2008, when systems failed, repairs took 12 hours. Again the Service reverted to pen and paper.
2011
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.
2013
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.
2015
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.”
Comment
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
London Ambulance Service hit by new year fault – BBC online
Campaign4Change 
Very interesting. Other countries, such as France, have mitigated issues like this by instigating a ‘hybrid cloud’ backup provider such as Datto. Read more here (skip to the end): http://www.datto.com/uk/blog/london-ambulance-service-suffers-downtime
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Thank you for this post, Tony, although it brought back very painful memories for me personally.
In 2001, my mother unexpectedly suffered a severe seizure to the extent that I thought she was dying and said my goodbyes. I had plenty of time to do this, as well as rendering first aid as best I could, as my 999 calls were met with a recorded message. I never even got to the point of being able to choose which emergency service I needed.
After ten minutes of running up and down stairs trying to use the landline and seeing to my mother, I had to run out of the house and scream for help. A neighbour then spent another protracted period trying to get official help by phone.
To cut a very long story short, the police arrived before the ambulance. The latter were very pleasant, but I was expecting to hear stories of their being overwhelmed by a busy Friday night – apparently not so.
Two weeks later my mother was discharged from hospital, and I heard a similar story of a delayed response by the London Ambulance Service to that of a severely ill child. The parents had officially complained, and I followed their lead.
I did get a response from the LAS. All that I now recall was my impression of yet another excuse for non-frontline staff to have another meeting whereby they can sit in comfort on well-upholstered chairs and chatter amongst themselves.
It’s the same response we all get when complaining to any and all official bodies. The investigation is never investigatory and/or analytical – it’s more philosophical and certainly administrative. No one is ever held accountable. No one ever seems to be inconvenienced let alone sacked.
After reading your article, I am left with two perennial thoughts. One is that our communications systems have been weaponized and used against us, the innocent. The second – I fantasize that our, self-serving, self-preserving, failed bureaucrats can, somehow, find themselves tied to their chairs and be, somehow, hurled into the Thames.
Sorry – too many people are getting away with, if not murder then, manslaughter.
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Ringing 999 repeatedly and getting an answerphone each time is not the hallmark of a first world nation. Thank goodness your mother eventually had the treatment she needed. You’ve explained a horrific story very clearly.
London Ambulance Service would probably say its service is now much improved – and no doubt the frontline staff are doing their best – but in important ways the LAS doesn’t seem to have changed.
Public sector press offices are often a window on the culture of an organisation. If you judge London Ambulance Service from its very brief website statement on the New Year’s Day failure of its systems http://www.londonambulance.nhs.uk/news/news_releases_and_statements/technical_issues_in_our_contro.aspx
you could easily get the impression it’s a defensive organisation. The statement explains nothing. It is intended to assure the public everything is fine. There is not the slightest hint the LAS will publish, or learn from, the results of its investigations. The LAS press office has declined to answer journalists’ questions.
If the Service’s systems go down regularly in the coming years, will it simply put on its website more assurances that suggest using pen and paper is an adequate back-up, and carry on much as before?
Your mother’s experience is a warning that delays can put lives at risk. Your comment about hurling bureaucrats into the Thames reminded me of Disraeli’s comment about Gladstone. “The difference between a misfortune and a calamity is this: If Gladstone fell into the Thames, it would be a misfortune. But if someone dragged him out again, that would be a calamity.” I am not sure the Thames will cure the London Ambulance Service’s unnecessarily secretive and defensive culture. But the least the LAS could do when delays put lives at risk is to explain openly what went wrong. Having that onerous duty would provide an incentive to avoid repeating past mistakes. Tony Collins.
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