Review into London Ambulance Service New Year outage reveals ‘significant shortcomings in IT processes’

Outage in early hours of 2017 saw call-handling and dispatch system fall over

The London Ambulance Service claims the fault that caused the outage ‘cannot now happen again’ Credit: PA

A review into the causes of a system outage that took place in the early hours of New Year’s Day has shone a light on “significant shortcomings in [the] IT processes and governance” of the London Ambulance Service.

But, in a statement, service chief executive Garrett Emmerson also asserted that appropriate remedial actions have already been taken, and that the system for handling 999 calls is “fit for purpose”.

“The system fault that occurred on New Year’s Day has been fixed and cannot now happen again,” he added. “However, I would like to apologise to patients who had to wait longer than they otherwise would have for medical help on that morning, and pay tribute to our staff who responded incredibly well, ensuring patients continued to receive care during our busiest time of the year.”

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The outage, which affected the service’s call-taking and dispatch system, began 30 minutes into the new year. It was reportedly caused by “a historic upgrade” that led to the recycle bin of the system’s database failing to empty when it became full. According to the review – the key findings of which have been published in a report – this caused the system to slow down to the point where it became unusable. 

At this point, those answering calls began simply recording information on paper and passing details to ambulance crews via a radio system. The outage lasted 90 minutes, but the need to transfer paper records to the computer system meant that normal service was not resumed until 5.15am – some four hours and 45 minutes after the system initially stopped working.

Having to use manual methods during this time resulted in longer waiting times for many patients. This included one patient who waited for a total of 48 minutes for treatment. By the time crews arrived, the patient had died.

Today’s release from the London Ambulance Service stressed that, until a coroner determines the cause of death, “it is difficult to determine what effect the delayed response had on the patient’s outcome”. Nevertheless, the service has met with the family of the patient to share and discuss the findings of its investigation thus far.

Anne Rainsberry, NHS England’s regional director for London, said: “We are satisfied with the immediate actions that the London Ambulance Service took to rectify the cause of the outage, as well as the organisation’s assessment of the impact that this had on patients. The service has made substantial progress against the investigation’s recommendations and over coming months we will seek assurance that the outstanding recommendations have been actioned.”

The outage could hardly have been worse timed, coming as it did during what is typically an incredibly busy period for the emergency services. And this New Year saw an even higher volume of calls than the previous year, with 2,810 received by the London Ambulance Service during the early hours of 2017. This compares with 2,517 in the corresponding period in 2016 – equating to an increase of 8.6%.

Sam Trendall

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