Jean Frickel

PFD Report Historic (No Identified Response) Ref: 2023-0203
Date of Report 21 June 2023
Coroner Kate Sutherland
Response Deadline est. 16 August 2023
No published response · Over 2 years old
Response Status
Responses 0 of 3
56-Day Deadline 16 Aug 2023
Over 2 years old — no identified published response
About PFD responses

Organisations named in PFD reports must respond within 56 days explaining what actions they are taking.

Source: Courts and Tribunals Judiciary

Coroner’s Concerns
There was evidence from WAST and BCUHB that improvements had been made internally within their organisations. It seems that patient flow i.e. those patients who are ready to be discharged from hospital but are unable to be discharged due to insufficiencies in social care means that ambulances are unable to offload patients into the Emergency Department which then causes the community delays as ambulances are not readily available.

I have not been presented with any meaningful evidence on the involvement of Local Authorities in the considerations by WAST and BCUHB of lack of patient flow due to social care deficiencies.

I have previously issued Prevention of Future Death Reports to BCUHB and WAST pertaining to the length of time it is taking for ambulances to arrive to patients (as well as handover at hospitals).

I remain significantly concerned that delays are continuing and that deaths will continue to occur into the future.

Specifically, I require responses to the following:-

1. Extent of working relationship between WAST, BCU and North Wales Local Authorities to address the above issues; and
2. Extent of progress between WAST, BCU and North Wales Local Authorities in addressing the above issues; and
3. Extent of Strategic plan of action / improvement plan to address the above issues.
Report Sections
Investigation and Inquest
On 30 December 2022 an investigation was commenced into the death of Jean Frickel (DOB 4/2/43) who died on 20 December 2022. The investigation concluded at the end of the inquest on 20 June 2023. The conclusion of the inquest was a narrative conclusion as follows:- Jean Frickel died on 20/12/22 at her home address from a naturally occurring disease process. The time it took for the ambulance to arrive meant that she was denied the opportunity for possible life extending treatment at hospital.
Circumstances of the Death
The circumstances of the death are as follows :- Jean Frickel had required an ambulance on 19 December 2022 due to symptoms of shortness of breath and confusion following a GP home visit. She was in reasonably poor health. A call was made by her husband to WAST at 17:09 hours. At 08.07 hours the following morning a further call was made informing WAST that Jean Frickel was unresponsive and not breathing. Paramedics arrived at 08:12 and confirmed that she had died. It took 13 hours and 3 minutes from the initial call for paramedics to arrive. Cardiology evidence indicated that had Mrs Frickel received timely medical treatment then her life may have been prolonged by several weeks.
Inquest Conclusion
- Jean Frickel died on 20/12/22 at her home address from a naturally occurring disease process. The time it took for the ambulance to arrive meant that she was denied the opportunity for possible life extending treatment at hospital.
Related Inquiry Recommendations

Public inquiry recommendations addressing similar themes

Ambulance data on conveying deceased
Fuller Inquiry
Ambulance Handover Delays
Thalassaemia Society Support
Infected Blood Inquiry
Poor health and social care integration
Cross-Administration Patient Safety Coordination
Infected Blood Inquiry
Poor health and social care integration
Haemophilia Centre Resources
Infected Blood Inquiry
Poor health and social care integration
Central Delivery with Devolved Support
Infected Blood Inquiry
Poor health and social care integration
Reduce Organisational Silos
RHI Inquiry
Poor health and social care integration
Multi-Trust Mortality Meeting Engagement
Hyponatraemia Inquiry
Poor health and social care integration
Commissioner for Survivors of Institutional Childhood Abuse (COSICA)
HIA Inquiry
Poor health and social care integration
Specialist Care and Assistance Facilities
HIA Inquiry
Poor health and social care integration
Establish partner Trust buddying arrangement
Morecambe Bay Investigation
Poor health and social care integration

Data sourced from Courts and Tribunals Judiciary under the Open Government Licence.