Mother made four ambulance calls and had 90-minute wait before son died in hospital from sepsis, inquest hears
Kayleigh Kenneford dialled 111 on the evening of July 7, 2022, because her three-year-old son, Theo Tuikubulau, had been getting continually sicker over the space of around 36 hours.
Poorly Theo had been suffering with a high temperature and flu-like symptoms and was reluctant to eat or drink after spending the previous day in Derriford Hospital, Plymouth, with a suspected upper respiratory infection, before being discharged.
Devon Coroner's Court heard the 111 operator, who worked for Herts Urgent Care, graded Ms Kenneford's call as a category two - urgent but not life threatening - meaning an ambulance should respond by an average of 18 minutes.
But it took a further three calls over the space of an hour-and-a-half by the distressed mother for the ambulance to arrive at her home.
Theo returned to the hospital shortly after midnight on July 8 where he died a few hours later from sepsis, caused by an 'invasive' Strep A infection.
Louise Wiltshire, assistant coroner for Devon, questioned Dr Hannah Graham, the clinical director of Herts Urgent Care, about the length of time it took for the ambulance to reach the three-year-old.
She said: 'I think in this case, it took another 90 minutes and then three more calls, two of which were diverted incorrectly before the ambulance arrived.
'I'm wondering if there is any additional safety netting that could be done in that situation to prevent someone just waiting, thinking it's coming.'
Dr Graham replied: 'We work across quite a broad footprint of the country. Certainly, the East of England Ambulance Service will send us alerts now if they are under pressure, so that we know that response times will be slower.
'I think having that sense of response times and pressures on the service is really helpful, and certainly something that we are now getting from the East of England so that we know that response time.'
Dr Graham said she was unaware of Herts Urgent Care being provided with this information from other ambulance trusts.
The inquest heard that callers would be advised of what level their call was being graded and an idea of how long the ambulance would be.
'If it was an emergency ambulance, we'd give a sense that it's going to be an emergency response,' Dr Graham continued.
'I don't think they get specific time in minutes.'
She said a request would be made to the local ambulance trust for an ambulance but they would not know how busy that service was, adding: 'What we do is we would always say if things are worsening, if you've got further concerns, then call 999.
'You can't always just upgrade because response times are longer.
'If every category three becomes category two or every category two becomes category one, then what's the value of people having a cardiac arrest in that moment?
'How do we differentiate? It's really difficult with the resource that we have.'
The coroner queried why Theo's case had been graded at two different levels 24 hours apart by the South West Ambulance Service and Herts Urgent Care.
Ms Wiltshire said: 'I'm sure you can understand my concern that there seemed to be two different algorithms, two different systems in place within the UK that would lead to a different category, different ambulance disposition - one a category one and one a category two.
'Now in a situation where you don't have shortage of ambulances that might not make a huge amount of difference, but it possibly did in this case.
'Are you able to assist me with why there is a difference in the assessment?'
Dr Graham replied that the grading system they used was provided by NHS England.
'NHS Pathways is an NHS England product, and individual providers don't have any jurisdiction over that product,' she said.
The inquest before a jury at County Hall in Exeter continues.
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