That was in fact the issue. It is now resolved. However we have run into another issue.
ITFlow isnt Interpreting tickets via email.
according to: https://docs.itflow.org/ticket_email_parse
step 4 is "Add a cron job to run email_parser_cron.php every minute"
after looking that file doesnt exist.
We've already checked an the cron is configured correctly as per the https://docs.itflow.org/cron guide.
Is there a new feature that needs to be added to the docs or did we miss something? Everything seems to work except it doesnt.