Labour accuses Bottomley over 999 failures

Virginia Bottomley was last night accused by Labour of ducking responsibility for the London ambulance service after a report said it suffered from management weakness, lack of staff training, high rates of absence, poor staff rostering, dangerou s shiftchanges and "virtually a complete lack of modern technology".

The review, commissioned after the death in June last year of 11-year-old Nasima Begum following an "inexcusable" delay of almost an hour in an ambulance reaching her, said that sweeping management and operational changes were needed. It called for a £2.7m a year increase in its annual budget, and almost £14m in capital and one-off costs to modernise it.

The service needs a new control room, a new telephone system, hand-held radios and a mass of new computer equipment and systems.

The Secretary of State for Health said that "no one can now be in any doubt about what needs to be done" and that this was the service's "last chance". She added, however, that the extra cash would have to be found from existing regional budgets. The review team warned that could only be achieved "with some difficulty."

However, Margaret Beckett, Labour's health spokesman, pointed out that in a letter to MPs in November 1992, Mrs Bottomley had identified deep-seated difficulties in the service, including "poor management-staff relations", high absenteeism, and continuedfailure to agree rosters which would put more vehicles on the road.

Mrs Bottomley had written: "This must change". Mrs Beckett said yesterday's report "highlights the same deficiencies as were identified by Mrs Bottomley more than two years ago. She has clearly failed to ensure that they were addressed. She must accept responsibility".

Yesterday's report says London ambulance has made progress since its computer-aided dispatch system collapsed in 1992 but "much still needs to be done". The service has "a blame culture" but has also suffered from a "remorseless rise" in 999 calls, including misuse of the service by the public.

With the benefit of hindsight, the report says, a wider review of the service in 1993 "would have meant that a significant number of deficiencies identified by the review team might have been rectified earlier".

In the original report, leaked to the Independent, the failure to carry out that review was pinned on the now defunct South West Thames regional health authority, which had managerial responsibility. That reference was excised from yesterday's final version, which fixed the blame on nobody.

At a press conference to launch the report, William Wells, chairman of South Thames regional health authority, denied the change had been made at the instigation of ministers.

But he also said he could not remember whether he had discussed that issue when he presented the review team's original findings to Mrs Bottomley before Christmas.

Martin Gorham, the chief executive of London Ambulance, yesterday publicly apologised to the Begum family for what the report says was its "inexcusable" delay in attending.

Action taken since her death included, 42 extra call-takers, a doctor providing clinical advice on priorities at the busiest times and an end to the virtual complete shift changeovers which the review team called disruptive and dangerous.

The report says the service should move to NHS trust status in June next year, providing the detailed and timetabled improvements it recommends are achieved.

Mr Wells, who has overall responsibility for the service, said that no single individual was responsible for the combination of circumstances which led to a 54-minute delay in attending Nasima Begum.