North West Ambulance Service NHS Trust

3. Miss P complains about the care provided by NWAS in November 2024. She complains about NWAS’ decision to refer her to an Urgent Care Centre (UCC) instead of taking her to A&E.

4. Miss P say she suffered in severe pain for extra hours due to the delay caused by NWAS. She says her bowel had nearly ruptured, and knowing this could have happened has caused her further anxiety and distress.

5. As outcomes, she would like the Trust to acknowledge its failing and apologise for the impact it has had. She would like financial remedy.

6. Miss P called 111 in November 2024, complaining of abdominal pain and constipation for nine days. She also reported severe pain, needing to go to the toilet frequently, and having blood in her stool. She said she had taken 20 laxatives, but she was still constipated.

7. A clinician triaged Miss P’s call and decided she need an ambulance dispatched. She was assigned a category two ambulance.

8. Paramedics arrived at Miss P’s house at approximately 4.17pm. Following their assessment, they suspected Miss P had gastritis (inflammation of the stomach lining), and considered Miss P should go to the UCC.

9. Miss P agreed and got a taxi to the UCC. She was assessed, and the UCC considered Miss P needed to go to A&E via ambulance. An ambulance was called at around 6.10pm and took Miss P to A&E, where she was diagnosed with a bowel blockage and she required emergency surgery the next morning.

13. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.

14. Miss P complains NWAS failed to recognise she needed emergency care and inappropriately advised her to go to the UCC.

15. When the paramedics arrived at Miss P’s home, it took some clinical observations, which were normal and examined her abdomen, which was soft on palpitation. She reported her nine-day history of constipation, and a four-day history of loose bowel movements, which she stated was intermittently ‘brown liquid’ and ‘clear liquid’.

16. Miss P reported intermittent abdominal pain when she had to open her bowels. The paramedics scored her pain a four out of ten.

17. The paramedics discussed transferring Miss P to A&E via a NWAS provided taxi, a GP referral to A&E, or Miss P attending the UCC. The paramedics made Miss P aware the UCC does not accept patients from an ambulance transfer. It is noted that Miss P said she would prefer to attend the UCC, and she could get her own taxi transport.

18. The paramedics discharged Miss P as she was attending UCC and gave safety netting advice that if Miss P’s symptoms worsened, she should contact 999 and seek further medical assistance.

19. The JRCALC guidelines are used by all UK ambulance services. The JRCALC guidelines say abdominal pain is a common presenting symptom to ambulance services, and a precise diagnosis of the cause of abdominal pain is often not possible without access to tests and investigations in hospital or via primary care.

20. It says the most common diagnosis for patients with abdominal pain is non-specific, and many cases are relatively minor in nature. It says for patients with abdominal pain, transfer to further care (consider the most appropriate centre). It does not specify this centre as A&E.

21. The MTS is a form of emergency triage, which NWAS has developed its guidance on. The MTS has ‘cards’ which explain what the response should be for people with specific symptoms.

22. The ‘diarrhoea and vomiting’ card, which the paramedics used, outlines someone with moderate pain, with blood in the stool, is category ‘yellow’.

23. The ‘abdominal pain’ card says moderate pain is also category yellow. For category yellow, it says the care pathway can be the emergency department or primary care and to ‘consider Primary Care referral, UCC centre or Walk in centre’.

24. Our adviser said as the paramedics reported Miss P’s pain as a four, this would be considered ‘moderate’ pain. According to the MTS, the appropriate care pathway for Miss P was either A&E or primary care, including the UCC. As such, NWAS acted in line with its MTS by referring Mrs P to the UCC.

25. In line with the JRCALC guidelines, the paramedics had to consider the most appropriate centre for further care, and they considered the UCC was the appropriate centre.

26. Our adviser said based on Miss P’s observations, she was not presenting as an emergency and there is no guidance that says a patient with Miss P’s symptoms must be transferred to A&E. They said Miss P’s observations were within normal parameters, and NWAS did not discharge her in the context of her not needing care, more that it reached a shared agreement with Miss P that she needed further care at an UCC and that she could self-transport there.

27. The NHS website says urgent care centres can provide urgent medical help when it’s not a life-threatening emergency, and they can diagnose and deal with many common problems people go to A&E for. It says they can help with common problems such as stomach pain, vomiting and diarrhoea. In line with this, Miss P was not presenting as a life-threatening emergency, and the UCC was an appropriate place to consider her symptoms first.

28. We understand why Miss P thinks NWAS missed an opportunity for earlier treatment, and we are sorry for the distress she experienced because of this. We consider NWAS’s decision to refer Miss P to the UCC was line with the JRCALC guidelines and the MTS, and we have seen evidence Miss P agreed to taking herself there. Therefore, we are not investigating Miss P’s complaint further.

1. We have carefully considered Miss P’s complaint about North West Ambulance Service NHS Trust (NWAS). We are sorry to hear NWAS did not take Miss P to A&E. We understand when Miss P later arrived at A&E, staff identified she had a bowel blockage, and she required emergency surgery the next morning and was told she may have died had it not been treated. We recognise knowing this has caused Miss P distress and anxiety, and she has lost her trust in the ambulance service.

2. Miss P complains NWAS failed to recognise the urgency of her symptoms and take her to A&E, and it inappropriately advised her to take herself to a walk-in centre. We have seen evidence that based on Miss P’s symptoms, the advice NWAS gave her was in line with guidance. Therefore, we are not going to investigate this complaint further.