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6 Apr 2005 : Column 461WH—continued

Staffordshire Ambulance Service

11 am

Mr. William Cash (Stone) (Con): I am raising questions relating to the dreadful and tragic death of Benjamin Moston. It is a serious case, which requires serious answers from the Minister as well as from Staffordshire ambulance service, not just an apology or an internal inquiry. I should state at the outset that I have genuine respect for those who work for Staffordshire ambulance service, which generally performs a role in difficult circumstances which deserves our thanks and gratitude. However, this deeply tragic case requires much more than an internal inquiry.

On Sunday 13 February 2005, 10-year-old Benjamin Moston, the son of Mrs. Jayne Moston and Mr. David Layton of Barn Common, Woodseaves in my constituency, was showing signs of wheezing due to his asthma. He was given Ventolin by his parents, but that was having no prolonged effect. Benjamin required a repeat dose some 45 minutes later. At 6.08 pm Jayne Moston called the out-of-hours service, which is manned by Staffordshire ambulance paramedics. Her call took approximately 14 minutes to get through followed by a further 14 minutes relaying patient information together with symptoms present.

The paramedic answering the call told Mrs. Moston that someone would be with her shortly. It was explained to the paramedic that Ben was a severe asthmatic, he was wheezing and his Ventolin was having little effect. The parents believe that the paramedic wrongly categorised this call: instead of an immediate response it was categorised as a case to be seen within the hour. I understand that it was the paramedic's first shift as a call taker and required supervision. There was no supervision. At the paramedic's disposal is the triage software, which I understand was not used. However, the family have since been told that had it been used, it would also have failed them in triggering an immediate response for Benjamin's condition. I will return to the triage software later.

Also, situated four and six minutes away are a community first responder and Mr. Roger Thayne, the chief executive of Staffordshire ambulance service, who was on call. Those individuals should have been paged to respond, and it appears that due to human error this was not done. At approximately 7.01 pm, Benjamin's condition worsened, resulting in a second call which was a 999 emergency call made by Jayne Moston. The same information was relayed again about Benjamin's condition and it was made clear that a previous call had been made. Again, the first responders previously mentioned were not paged to respond. This call was taken by the call centre supervisor.

At approximately 7.15 pm, Benjamin's condition deteriorated rapidly. He became cyanosed, agitated and confused, and a further 999 call was made by Mr. Layton, Benjamin's father, informing the call-taker of Ben's deteriorating condition and asking where the ambulance was. They replied that the ambulance was in the area but could not locate the home address. This was due to its not being in the satellite navigation system, despite the road and houses having stood and been clearly mapped for many years.
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At 7.18 pm, David Layton tried to attract the attention of the paramedic who was further up the street by waving his arms. The paramedic drove past and Mr. Layton had to give chase while shouting at the driver to stop. Tragically, by this stage, Benjamin had collapsed and apparently died in his mother's arms in front of his four-year-old sister and 21-month-old brother. David Layton informed the paramedic that Ben had collapsed and he was unsure whether he was even breathing. On arriving at the house at 7.34 pm, the paramedics immediately began cardio-pulmonary resuscitation—CPR. At 7.35 pm, the trust doctor arrived on the scene, but he could not intubate and asked the paramedic to do so, which he did.

It was some 15 minutes before Benjamin was attached to a monitor to ascertain heart activity and saturation levels, and some 25 minutes before any adrenalin was administered. The doctor observed by monitor that there was no electrical activity in the heart by then. It appears that the community first responder arrived at 7.35 pm after he had been paged at 7.23 pm. He is only six minutes away from Benjamin's home address. Another two paramedics and a doctor arrived at almost the same time; CPR continued and adrenalin was administered at approximately 7.45 pm.

The doctor decided that Benjamin should be taken by ambulance to Stafford district general hospital. The ambulance left at 7.55 pm and arrived at 8.08 pm. The doctor continued to give CPR in the back of the ambulance, despite an apparent protocol that at least two or more persons are required during emergency life support for children.

Benjamin was pronounced dead at the Stafford district general hospital at 8.30 pm. Mrs. Moston and Mr. Layton believe that Benjamin did not stand a fighting chance due to those errors. His asthma attack was no worse than any other he had experienced. It was simply that the early medical treatment that was required was not forthcoming.

The lives of Benjamin's parents have been torn apart as a result of the tragic circumstances surrounding his death. They constantly relive his final hour and see his frightened face asking them to help him. No parent should lose a child, and most definitely not as a result of the failure to act quickly and with expertise, as we rightly expect from our emergency services.

I said that I wanted to make some important points about the triage policy, which can be described as an emergency transport request generally made through a 999 call but which might also include calls from GPs. The prioritisation of emergency calls to ensure that immediately life-threatening cases obtain the quickest response was introduced as a pilot in 1995–96. There are three categories. Category A covers emergency calls that are classified as life threatening, and ambulance services are expected to reach 75 per cent. of category A calls within eight minutes.

Category B is for non-life-threatening emergency calls, 95 per cent. of which should receive a response within the national 14 minutes in urban areas or 19 minutes in rural areas. Category C calls are regarded as non-life threatening and non-urgent, and are a large proportion of the work of the ambulance service. In some cases, telephone advice or referral to another agency may be adequate to meet the callers' needs and may be a more appropriate clinical response.
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Why was not Benjamin's case immediately classified as Category A and an ambulance despatched with paramedics? This is one of the most critical questions. The answer that I will receive from the Minister goes to the heart of this tragic case. Above all, I insist on a full public inquiry and not merely the internal inquiries that have been suggested so far.

In addition, I have been told of serious allegations about other deaths, including references to impending cases at Birmingham employment tribunal, which are connected to what are described to me as

and a failure to anticipate rises in demand in 2003.

I have also been told of allegations of threats and bullying to dissuade people from speaking out. I cannot verify those allegations now, but they appear to be part of the case before the employment tribunal, and in so far as they have a bearing on the question of resources, they are directly relevant to the tragic death of Benjamin Moston. In any event, I will not be satisfied with an internal review or one conducted merely by the strategic health authority. I want and demand a public inquiry in which all these matters and their interconnection, including the issue of resources, are fully investigated, and not merely an apology or internal inquiry. A child has died by error and by fault, and the parents deserve no less.

11.10 am

The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman) : I congratulate the hon. Member for Stone (Mr. Cash) on taking up this issue on behalf of his constituent, and express my great sadness on hearing the details of the case. I hope that he will pass on my sincere condolences to Benjamin Moston's family. This must be a very sad time for them and I am sure that they are devastated by what has happened, as the hon. Gentleman has said.

The incident has had a profound effect on the Staffordshire Ambulance Service NHS trust, which provides the out-of-hours service in the area. The chief executive of the trust has been to see Benjamin's parents; he has formally apologised on behalf of the local NHS and offered his personal condolences. The trust has been the highest performing ambulance trust in the country for many years, but we—and it—must recognise the importance of learning from such events.

The staff of the trust are hardworking and diligent, but they would be the first to say that they owe it to Benjamin and his family to use this experience to do even better in future and, if it emerges that their performance was less than optimal on this occasion, to do everything in their power never to let the same thing happen again. But I stress the "if"; the only way to find out whether their performance was less than optimal is to carry out an inquiry and face the issues honestly, and such an inquiry has not yet been carried out. Until it is, we should not speculate about where fault may lie but should stick to discussing the facts as we know them. It would be inappropriate for me to discuss the details of Benjamin's illness at this time, but I can tell hon. Members what I know of the events following his parents' call to the out-of-hours service. What I am
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about to say is based on what I have been told by Shropshire and Staffordshire strategic health authority and, of course, it is subject to review in the inquiry that I will talk about later.

I am told that the call from Benjamin's parents to the    out-of-hours service, at 6.08 pm on Sunday 13 February, was handled by a paramedic call handler who made a clinical decision, based on the information available, that Benjamin should have a home visit within an hour of the end of the call, which was at 6.21 pm. That is covered in the ambulance service trust's internal investigation report, and it would not be appropriate for me to comment on that decision at this time. At 7.01 pm, Benjamin's parents, worried that Benjamin's condition had deteriorated, made an emergency 999 call, and a community paramedic officer was dispatched to the Mostons' home at 7.02 pm. The parents made a further emergency call at 7.18 pm to ask where the ambulance was. The paramedic arrived at about the same time as that second emergency call.

On arriving at the scene, the paramedic found that Benjamin was in cardio-respiratory arrest and requested that an ambulance be sent as quickly as possible. The ambulance was mobilised at 7.27 pm and arrived at 7.34 pm. The ambulance trust's doctor arrived at 7.35    pm. At 7.45 pm, Benjamin was taken to Staffordshire general hospital; he arrived at 8.08 pm. Sadly, as we know, he did not survive.

I should point out that a coroner's inquest into Benjamin's death has been launched and is currently adjourned. It would not be appropriate for me to comment on what its findings might be. However, I can reassure the hon. Gentleman and Benjamin's family that the local health community has taken this incident very seriously and absolutely understands the need to look into the matter with a view to avoiding similar incidents.

The hon. Gentleman will be aware that the ambulance trust immediately launched an internal inquiry into the circumstances surrounding the incident. The initial findings of the inquiry and the detailed action plan drawn up as a result have already been shared with the family. The investigation report will be tabled at the ambulance trust's risk and clinical governance committee, which reports to the trust board. The detailed action plan is already being implemented by the trust. The plan addresses areas such as staff training and the introduction of dual paging/SMS texting and clinical policies.

I can advise the hon. Gentleman that on 1 April the trust moved to a single computer-aided dispatch system, which allows better control of the interface between the out-of-hours service and the emergency ambulance system. The strategic health authority, which is responsible for monitoring and improving the quality of health care in the area, has also commissioned an independent inquiry into the incident to determine any contributing factors and to recommend any actions that should be taken to prevent a similar occurrence.

The inquiry is being undertaken by Dr. Matthew Cooke, accident and emergency consultant at the Heart of England NHS foundation trust—formerly the Birmingham Heartlands and Solihull Hospitals NHS trust—and national A and E medical advisor, and Dr. Richard Fairhurst, medical director of Lancashire Ambulance Service NHS trust.
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The inquiry is in two parts. The first will look at the out-of-hours service, which, although it is provided by Staffordshire Ambulance Service NHS trust, is in fact the responsibility of South Western Staffordshire primary care trust. The second will look at the response of the emergency ambulance service. It would not be appropriate for me to pre-empt the findings of the review, and the results will be presented to the boards of the PCT and ambulance trust in due course.

Both the ambulance trust and the PCT will respond to any further recommendations that come out of the inquiry. I am also requesting a copy of the report so that any wider issues to do with either out-of-hours or emergency services can be considered, and any lessons that can be applied nationally can be disseminated.

Mr. Cash : The Minister will know that I have called for a full public inquiry. I accept that there has to be a first-stage inquiry, but he has just said that he will call for a copy of the report—I am glad to hear that. On the basis that that report will be made available to me and to others who have responsibilities in such matters, will he commit to the idea of a full public inquiry if, on reflection and in light of the report, it is clear that those matters need to be pursued in public?

Dr. Ladyman : Yes, I am happy to commit to that. If on receiving the report there are still outstanding questions, and those directly involved and in positions of authority—including the Minister who holds the appropriate portfolio after the election—believe that questions may still be unanswered, clearly we will have to commit to further inquiries. It may well be that the hon. Gentleman, if he is returned after 5 May, will want to seek another Adjournment debate to discuss the matter in the Chamber. If I am still Minister after 5 May, I will certainly be happy to meet him to discuss the findings of the report and how matters should best be moved forward, after we have the results of the inquiry.

I hope that the hon. Gentleman would agree that there is no cover-up and no lack of willingness on behalf of the trust, the local health authorities and the NHS to learn from events. In due course everyone will know exactly what happened and how such tragedies can best be avoided in future.

The hon. Gentleman mentioned the policy on ambulance service and response. He and his constituents should be aware that there is substantial progress and high performance in their area. He mentioned the various categories of response; the NHS plan has an objective to improve ambulance response times so that 75 per cent. of 999 calls to life-threatening emergencies—the category A responses that he referred to—are responded to within eight minutes. The latest information for 2003–04 shows that 75.7 per cent. of category A calls in England resulted in an emergency response arriving at the scene of the incident within eight minutes, which was slightly up from the previous year's figure of 74.6 per cent. In Staffordshire, 86.6 per cent. of category A calls received a response within eight minutes in 2003–04.

Other emergency calls, category B and C calls, should receive a response within 19 minutes 95 per cent. of the time in rural areas such as Staffordshire.
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Mr. Cash : The Minister will notice that I asked why this case had not been immediately classed as category A. Had the circumstances and procedures been followed in accordance with the category A system, eight minutes—if that is the right figure—would have applied, and we almost certainly would not be faced with such a situation.

Dr. Ladyman : Clearly, that must be a key matter for the inquiry to determine. It must decide whether the triage process, as the hon. Gentleman describes it, was accurately followed, whether it is defective in some way for this particular type of condition, and whether the call should have been assigned to category A.

For the sake of the hon. Gentleman's constituents and their peace of mind, let me continue with the comments that I was about to make. In Staffordshire, 99.7 per cent. of category B and C calls are responded to within 19 minutes. That is far higher than the target, so I hope that the hon. Gentleman accepts that his local ambulance trust provides a high-quality service to his constituents. If errors were made on this occasion, they will be identified, made public and learned from, and we will move forward on that basis.

Mr. Cash : Will the Minister take note of the allegations that I mentioned, which, as I stated, I cannot verify? In the light of the fact that they appear to be related to what is going on before the Birmingham employment tribunal, which is a responsible tribunal, I hope that he will take note of the situation and consider also the allegation about deliberate reductions in emergency care resources. I am not in a position to verify that allegation either, but if there is a connection between the incident and the allegations, I am sure that the Minister will want to look into it.

Dr. Ladyman : I certainly do want to look into that. I was not aware of the allegations that the hon. Gentleman raised today, so I am not in a position to verify or deny them, but I will say that threats to stop people from speaking out are absolutely unacceptable. There are procedures to protect people who want to speak out about their concerns.

I shall write to the strategic health authority and the ambulance trust to bring to their attention the official record of today's debate, and I shall ask them to ensure that their inquiries consider the wider ramifications and the possibility that there are connections between this matter and the issues that the hon. Gentleman has raised. Hopefully, we will be able to resolve these matters collectively.

I hope that the hon. Gentleman will accept my good will. I hope that he accepts also that I am determined to ensure that everybody gets to the bottom of this. That good will is shared by the ambulance trust and the strategic health authority, which are equally determined to get to the bottom of this and to ensure that Benjamin's parents receive all the answers to the questions that they are bound to be asking, for what little comfort it will give them. It may provide some closure for this event. Once again, I pass my deepest regrets to them for this experience. I hope that they are able to move forward.

Mr. Cash : Just to wind up, as it were, I am extremely glad to hear the Minister say that in the light of the
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information made available to him and, indirectly, to me and other people in appropriate positions of responsibility, he will have a public inquiry should the circumstances warrant it. That is an important first step. We look forward to receiving the information that comes from the inquiries that have been set up.

Dr. Ladyman : I very much hope that it will not be necessary to have any further inquiries because we get all the answers that we need from the inquiries that have been set up. I look forward to being in a position to discuss these issues with the hon. Gentleman after the events of the next four weeks.

11.24 pm

Sitting suspended until Two o'clock.

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