Dear Coroner, Re: Regulation 28 Report to Prevent Future Deaths – Elizabeth Jane Brown who died on 23 January 2023.

Thank you for your Report to Prevent Future Deaths (hereafter “Report”) dated 12 March 2024 concerning the death of Elizabeth Jane Brown on 23 January 2023. In advance of responding to the specific concerns raised in your Report, I would like to express my deep condolences to Elizabeth’s family and loved ones. NHS England are keen to assure the family and the Coroner that the concerns raised about Elizabeth’s care have been listened to and reflected upon. 

Your Report raises the concern that there are long waits and delays to see immunologists in specialist clinics and that these delays were caused by a significant shortage of qualified/trained staff nationally which had led to services across the country being run with a high level of vacancies.

Information received from the Immunology Specialty Advisory Committee at the Royal College of Pathologists indicates that there are approximately 10-15 Immunology Consultant vacancies across England at present, on a background of a reported Consultant workforce of 89 whole-time equivalents (WTE) (data from December
2023). At higher level training posts, recruitment is very competitive, with 100% fill rates for the last few rounds. There is a planned workforce distribution review, which is intended to consider whether the posts need to be distributed differently, although it is unlikely that there will be an increase as a result. NHS England have been informed that The Royal College of Pathologists is planning to focus on workforce as one its key priorities over the next few years, having already made written submissions to Parliament in 2022.

The issue highlighted in this case appears to relate to follow up waiting times rather than new outpatient waiting times and as such this would normally be for local monitoring. However, the national Outpatient Transformation Team are exploring ways to reduce long waiting times for patients who need monitoring by implementing reviews of those on the waiting list for repeat appointments to which continue to be clinically necessary. This work is planned for 2024/25.

National Medical Director NHS England Wellington House 133-155 Waterloo Road London SE1 8UG

09 May 2024

NHS England is also working at a national level to deliver the Long-Term Workforce Plan. This is a robust and effective strategy to ensure we have the right number of people, with the right skills and support in place to be able to deliver the kind of care people need. It heralds the start of the biggest recruitment drive in health service history, but also of an ongoing programme of strategic workforce planning. It includes ambitious commitments to grow the workforce by significantly expanding domestic education, training, and recruitment, as well as actions aimed at improving culture, leadership and wellbeing so that more staff are retained in NHS employment over the next 15 years. These actions will aim to close anticipated staffing shortfalls in the NHS in the long term, however Trusts have a responsibility to ensure safe staffing levels at local level in the current day to day operation of their hospitals. This is in line with Care Quality Commission (CQC) Regulation 18 which states that providers must deploy enough suitably qualified, competent and experienced staff to enable them to meet all other regulatory requirements. I would also like to provide further assurances on national NHS England work taking place around the Reports to Prevent Future Deaths. All reports received are discussed by the Regulation 28 Working Group, comprising Regional Medical Directors, and other clinical and quality colleagues from across the regions. This ensures that key learnings and insights around preventable deaths are shared across the NHS at both a national and regional level and helps us pay close attention to any emerging trends that may require further review and action.

Thank you for bringing these important patient safety issues to my attention and please do not hesitate to contact me should you need any further information.