Killer Application? The CAD system for the London Ambulance Service
Reproduced with permission from Which Computer? January 1993

The very public failure of the computerised command and control system at London Ambulance Service (LAS) has raised many questions about the design and running of mission critical computer systems, and their relationship with the businesses they serve. Whatever the result of the inquiry due to report by February, many other organisations will want to learn from LAS's experience.

LAS has an unhappy history with computers. Its first attempt to computerise was abandoned at a cost of £7.5 million, because the system could not cope with the volume of calls (LAS is currently suing the supplier). In July 1991 a new system was ordered. In common with most ambulance systems, it logs 999 calls and helps the operator to select the most appropriate vehicle to send. Unlike other systems, it is designed to speed up despatch by automatically transmitting instructions to a mobile data terminal in the ambulance, instead of using the usual voice radios. The crew then acknowledges the message and reports events such as arrival at the accident scene.

London is by far the largest ambulance service in the country and handles more than 2000 calls a day, one every 12 seconds at peak times. LAS therefore opted for a bespoke system rather than buying one of the standard packages on the market. About 16 firms tendered for the contract, which was awarded to a small software house, Systems Options, with a bid of around £1.25 million. Some of the unsuccessful bidders took the unusual step of writing to LAS and the Secretary of State for Health to express concern about aspects of the system.

On the advice of computer firms in his constituency, Robert Jones, MP for West Hertfordshire, wrote to the minister warning that Systems Options was a small firm with a limited track record in ambulance systems. Since the problems with the system, he has suggested that the vetting procedure for such contracts is tightened up and that the quality threshold for tenderers should be reviewed.

Installation began in January 1992, just six months after the award of the contract. 'Possibly the original timescales were too tight,' says Robert Carr, public sector director of Apricot which supplied the computer hardware. The timescales meant that none of the systems suppliers were prepared to commit themselves to penalty clauses.

Mike Smith became the Service's system manager in October 1991 and immediately reviewed the command and control project. He identified 'an element of risk', in that the timescales depended on the first-time delivery and integration of elements from five different suppliers. However, LAS needed the system as soon as possible to improve service standards so Mr Smith did not recommend putting back the timescales. 'Certainly there was pressure to get the system up and working as fast as possible,' he says.

The Service's major problem at the time was its consistent failure to meet the government's performance targets set out in The Patient's Charter. These state that for 95 per cent of calls an ambulance should be on the scene within 14 minutes, and 50 per cent should arrive within eight minutes. In order to improve its service, LAS planned to amalgamate its three regions into one, allowing ambulances to be shared across the whole of the capital. This meant a lot of new information for operators to learn, so computers were deemed essential.

The amalgamation of the three regions took place on Monday, 26 October 1992. By the end of that week, 20 people were alleged to have died after ambulances took up to three hours to answer emergency calls. Almost immediately LAS's chief executive resigned and the system was mothballed pending an inquiry. This will examine not only the procurement and operation of the system, but also the general operation and management of LAS.

Some press reports have represented the