Ambulance targets shake-up urged

Herald Series: Peter Nelson died from a brain haemorrhage after an ambulance took two hours to reach his home in Blakeney, Norfolk. (Nelson family/PA) Peter Nelson died from a brain haemorrhage after an ambulance took two hours to reach his home in Blakeney, Norfolk. (Nelson family/PA)

A health minister has called for a shake-up of paramedic response targets in rural areas after a young chef died from a brain haemorrhage when an ambulance took two hours to reach his home.

North Norfolk MP Norman Lamb, minister of state for care and support, said he would urgently raise the issue with NHS England medical director Sir Bruce Keogh after Peter Nelson, 26, became the latest person to die following an ambulance delay in the east of England.

Mr Lamb said the case was "all too familiar" adding that rural areas were often neglected as ambulance trusts focused on easier urban response times as they chased national targets.

The Liberal Democrat added: "We need to re-think these targets because they distort behaviour.

"I don't have a complete blueprint for the answer but I'm clear there is a massive risk that the current system is distorting clinical priorities and rural patients are suffering as a result."

Mr Nelson collapsed at his home in the remote coastal village of Blakeney, Norfolk, after returning from a shift at a local hotel with a headache.

His parents watched as his condition deteriorated, culminating in him coughing up blood and collapsing on the bathroom floor.

His father Sidney Nelson, 59, and stepmother Haylie Wardhaugh, 45, dialled 999 at 11.15pm but an ambulance did not arrive until after 1am the next day - taking more than six times longer than targets dictate.

By the time he arrived at the Norfolk and Norwich University Hospital, nothing could be done to save Mr Nelson's life.

Sidney Nelson, who is disabled and cared for by Miss Wardhaugh, said he was disgusted by the delay.

He added: "He was an otherwise healthy young man. He just came home one night and it was obvious there was something seriously wrong.

"We just wanted to get him to hospital as quickly as we could to get him the treatment he needed."

The East of England Ambulance Trust has recently appointed a new chief executive after criticism that response times in the region were among the worst in the country.

Targets have been put in place for paramedics to reach the most urgent 999 calls within eight minutes and get a vehicle to patients within 19 minutes.

Mr Nelson's death comes four months after a coroner described the trust's crews as "chaotic" after hearing that three-month-old Bella Hellings died after paramedics took more than three times longer than national targets dictate to reach her home in Thetford, Norfolk.

An inquest heard that one vehicle got lost because "there were too many blue doors" on her street, while another stopped for petrol while answering a 999 call in March.

In October, an inquest heard that Evelyn Heath, 93, from Attleborough, Norfolk, died from an irregular heartbeat in the back of an ambulance after the vehicle took more than four hours to reach her care

Mr Nelson and Miss Wardhaugh forced their way into the locked bathroom after becoming concerned for Mr Nelson's condition and found him lying on the floor.

A paramedic arrived at the house within 15 minutes after the call on November 14.

But the family said the treatment he could offer was limited and the emergency worker contacted the East of England Ambulance Service control room three times to ask for an ambulance to come more quickly.

After arriving at hospital, scans and tests were carried out but he soon stopped breathing.

"It was obvious his condition was worse than they were letting on," Mr Nelson said. "The paramedic himself seemed quite angry and frustrated that it was taking so long. By the time he went out of the door, I would say he was pretty much dead.

"I don't know if they could have saved his life but two hours seems like a long time and you can't help thinking that, had they acted quicker, he would still be alive today."

The ambulance service has not offered the family any explanation for the delay but has told them an investigation has been launched.

A spokesman refused to comment on an ongoing inquiry but clinical operations manager Duncan Moore wrote to the family acknowledging that it appeared to have been a "serious incident".

Mr Lamb said he was due to meet Sir Bruce, who recently launched a review of emergency care, in the New Year.

He added: "I first raised concerns over poor response times in rural areas in the east of England in 2011.

"At the time I remember feeling positive that the trust was taking steps to improve things.

"What followed was the most extraordinary recruitment freeze on paramedics during 2012 and a total failure to focus on achieving acceptable standards, particularly in rural areas.

"It seems that if they meet the target for the whole of the east of England, it satisfies the Government target but the danger is they focus on urban areas where they can easily hit the target and rural areas get neglected.

"I'm sure this isn't limited to the East and you can't have a system that allows rural areas to lose out while trusts apparently meet Whitehall targets."

Mr Nelson, who was a keen footballer, worked at the George Hotel in nearby Cley-next-the-Sea.

Since his death his organs have been donated to four different people.

Miss Wardhaugh said: "He was a lovely bloke and he had so many friends. He would help anybody."

An NHS England spokesman said: "Sir Bruce Keogh's Urgent and Emergency Care Review is examining ways to strengthen the delivery of urgent and emergency care, including ambulance services.

"As part of this review we are conscious that different approaches will be needed in metropolitan, rural or remote areas.

"NHS England have also recently appointed a national clinical director for remote and rural care and services, again because we understand that the needs of these communities are different."

A spokesman for the East of England Ambulance Service said: "The ambulance service has written to Peter's family to confirm an investigation is under way and, until this is complete, it would be inappropriate to discuss the matter further."

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