Dear Coroner,

Re: Regulation 28 Report to Prevent Future Deaths – Lee Dryden who died on 12 January 2022.

Thank you for your Report to Prevent Future Deaths (hereafter “Report”) dated 2 August 2023 concerning the death of Lee Dryden on 12 January 2022. In advance of responding to the specific concerns raised in your Report, I would like to express my deep condolences to Lee’s family and loved ones. NHS England are keen to assure the family and the coroner that the concerns raised about Lee’s care have been listened to and reflected upon.

In your Report you raised the concern that Royal College Guidance as to how external organisations should be reporting images to NHS Trusts was not understood or embedded by NHS Trusts. NHS England has undertaken or been involved in several initiatives and activities around imaging reports to improve processes across Trusts and stakeholder organisations. These include:

• Alerts and Notification of Imaging Reports Recommendations was published in October 2022 and was supported by a Royal College of Radiology (RCR) hosted webinar:

and-notification-imaging-reports
• NHS England hosted a national webinar on 7th March 2023 with the inclusion of the above delivered by the RCR for NHS services. This guidance is also available on the NHS England Futures website, a virtual collaboration platform for NHS staff members to make change, improve and transform health and social care.
• The RCR have also indicated they will review the Standards for the Provision of Teleradiology within the United Kingdom Guidance which was first published in 2016. This will potentially take place next year.
• The Academy of Medical Royal Colleges (AoMRC) published a report on ‘Alerts and notification of imaging reports – Recommendations’ which include recommendations on fail-safe notification systems. This was highlighted by NHS England in the January 2023 national Patient Safety bulletin and followed a report from the Healthcare Safety Investigation Branch (HSIB): Failures in communication or follow-up of unexpected significant radiological findings.
• The NHS England National Imaging Board has developed new standards for imaging reporting turnaround times which was published on 9th August 2023. National Medical Director NHS England Wellington House 133-155 Waterloo Road London SE1 8UG

england.coronersr28@nhs.net 20 September 2023

This Radiology Reporting Turnaround Guidance cab be viewed here: . NHS England » Diagnostic imaging reporting turnaround times. To help embed this new guidance, a national webinar will be hosted by NHS England on Thursday 28 September and communications will be cascaded across the NHS as well as to Independent Sector Providers. This will include an update in the national Patient Safety bulletin.
• NHS England is also investing in digital infrastructure to support Imaging network development to enable radiology reporting infrastructure across constituent providers and the independent sector and should link into this infrastructure for any outsourced Radiology Reporting services.

I acknowledge that the above activities have occurred following Lee’s death in January 2022, but I hope they provide assurances that actions have been taken or are underway to clarify guidance around imaging reports and how they should be shared between NHS Trusts and independent sector providers.

My North East & Yorkshire (NEY) regional colleagues have also advised that they have gone out to all NEY systems for assurance that national guidance is being followed around image reporting. Systems bring together Nhs organisations, local authorities and others to take collective responsibility for health and care planning services across geographical areas.

Your second concern focused on the delay in the Yorkshire Ambulance Service response time to the ambulance call made by Lee’s mother, which was categorised as a Category 2 call.

NHS England recognises the significant pressure on ambulance services since the Covid-19 pandemic, which has seen longer response times across all categories than before the pandemic. That is why NHS England are focusing on improving ambulance performance for 2023/24, supported by the Delivery plan for recovering urgent and emergency care services, published in January 2023. The plan outlines the actions and steps that we are taking across England to recover and improve urgent and emergency care services, including improving ambulance response times for Category 2 incidents, increasing ambulance capacity through growing the workforce, speeding up discharges from hospitals, expanding new services in the community, and taking steps to tackle unwarranted variation in performance in the most challenged local systems. In July 2023, we also published a letter to Integrated Care Boards, NHS Trusts and Primary Care Networks title Delivering operational resilience across the NHS this winter. This included focusing on improvements around Accident & Emergency handover and ambulance handover times. 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.

Dear Ms Combes,  

Thank you for your letter of 2 August 2023 to the Secretary of State for Health and Social Care regarding the death of Lee Dryden. I am replying as Minister with responsibility for urgent and emergency services. Please accept my sincere apologies for the delay in responding to this matter. I would like to assure you that the Department is mindful of the statutory responsibilities in relation to prevention of future deaths reports and we are prioritising responses as a matter of urgency.

Firstly, I would like to say how deeply sorry I was to read the circumstances Mr Dryden’s death and I offer my sincere condolences to his family. It is vital that we learn from incidents, where they are identified, to improve NHS care. I am grateful to you for bringing these matters to my attention.

Your report raised a concern that Royal College guidance on how external providers should report images to NHS trusts was not understood or embedded by NHS trusts. I understand that NHS England, after also receiving your report, has written to you on the specific actions that have been taken or are underway to clarify guidance around imaging reports and how they should be shared between NHS trusts and independent sector providers. In addition, all North East & Yorkshire systems have been asked for assurance that national guidance is being followed. I hope this has provided reassurance on the action being taken on this issue.

Your report also raised concerns about response times by Yorkshire Ambulance Service NHS trust (YAS) including the impacts of handover delays. I note NHS England also responded on the action they are taken in relation to this concern. As the Minister responsible for urgent and emergency case services, I recognise the significant pressure the urgent and emergency care system is facing. That is why we published our ‘Delivery plan for recovering urgent and emergency care services’ which aims to deliver sustained improvements in waiting times. Our ambitions for this year are to reduce Category 2 ambulance response times to 30 minutes on average. The plan is available at B2034-delivery-plan-for-recovering-urgent-and-emergency- care-services.pdf (england.nhs.uk)

Your report highlights that YAS were under high demand at the time of the incident. A primary aim of our delivery plan is to boost ambulance capacity. Ambulance services received £200 million of additional funding in 2023/24 to expand capacity and improve response times, and we are maintaining this additional capacity in 2024/25. This is alongside the delivery of new

ambulances and specialist mental health vehicles. With more ambulances on the road, patients will receive the treatment they need more swiftly.   

I recognise that ambulance trusts work within a health and care system and issues such as delayed patient handovers to hospitals can impact on capacity and response times. That is why a key part of the delivery plan is about improving patient flow and bed capacity within hospitals. We achieved our 2023/24 ambition of delivering 5,000 more staffed, permanent hospital beds this year compared to 2022/23 plans, backed by £1 billion of dedicated funding, and we will maintain this capacity uplift in 2024/25. Further, we also achieved our target of scaling up virtual ward bed capacity to over 10,000 ahead of winter 2023/24, and there are now over 11,000 beds available nationally. We also have provided £1.6 billion of funding over two years to support the NHS and local authorities to ensure timely and effective discharge from hospital. These measures are helping improve patient flow through hospitals, reducing delays in patient handovers so ambulances can swiftly get back on the roads.   

Since publication of the plan, we have already seen significant improvements in performance. In 2023/24, average Category 2 ambulance response times (including for serious conditions such as heart attacks and strokes) were over 13 minutes faster compared to the previous year, a reduction of 27%. In the Yorkshire region, average Category 2 response times were over 9 minutes faster over the same time period, a 27% reduction.

However, I recognise there is still more to do to reduce response times further, and the Government will continue to work with NHS England to achieve this.

Thank you once again for bringing these concerns to my attention.