Dear Coroner, Re: Regulation 28 Report to Prevent Future Deaths – Ryan James Richard Campbell

Thank you for your Report to Prevent Future Deaths (hereafter “Report”) dated 1 October 2024 concerning the death of Ryan James Richard Campbell. The circumstances of death section in your Report appears incomplete, and the date of death has not been specified.

In advance of responding to the specific concerns raised in your Report, I would like to express my deep condolences to Ryan’s family and loved ones. NHS England are keen to assure the family and the Coroner that the concerns raised about Ryan’s care have been listened to and reflected upon.

Your Report raised the concern that there was an absence of a full suite of cardiac diagnostic imaging equipment at Stepping Hill Hospital, particularly CT or MR angiograms, which contributes to delays in diagnosis for patients.

My response to your Report has been informed by engagement with NHS Greater Manchester Integrated Care Board, who are the responsible commissioner for the cardiac services delivered within Stockport NHS Foundation Trust where Stepping Hill Hospital sits. Stockport NHS Foundation Trust are commissioned for the following diagnostics/services:
• Plain Echocardiogram
• Stress Echocardiogram
• Contrast Echocardiogram
• Transoesophageal Echocardiogram (TOE)
• Valve surveillance
• Electrocardiogram (ECG)
• 24 hour ECG
• 72 hour ECG
• 7 day ECG National Director of Patient Safety NHS England Wellington House 133-155 Waterloo Road London SE1 8UG

25 November 2024 A1

• 24 hour blood pressure
• Implantable loop recorder
• Myocardial Perfusion Scan (Radiology)
• Tilt Table Test Stockport NHS Foundation Trust are not commissioned for CT or MR angiograms. In Ryan’s case, the CT Coronary Angiogram (CTCA) scan that was requested following his admission to the Acute Medical unit (AMU) in December 2023 is delivered at Wythenshawe Hospital (part of Manchester University NHS Foundation Trust). Manchester University NHS Foundation Trust (MFT) have always been the regional provider for this. Some other NHS hospitals in the region do have their own CTCA service (for example, Salford Royal Hospital) but do not accept external referrals. The waiting times for CTCA at Wythenshawe Hospital have unfortunately been increasing for some time. Previously, the turnaround time for a CTCA would have been around 6-12 weeks. However, in the last year this has become around a 6 month turnaround time. Stockport NHS Foundation Trust is not an outlier in terms of being a district general hospital with a cardiology service that does not include a full suite of cardiac diagnostic imaging equipment, particularly CT or MR angiograms. The centralisation of specialist services like this is longstanding and is not unique to Stockport NHS Foundation Trust or the North West region. The Trust’s cardiology service would like to expand the diagnostics/services offered on site at Stepping Hill Hospital in the future and CT Coronary Angiogram service provision is on the Division of Medicine and Urgent Care’s service development programme for review next year. Within this review, the specific areas of focus will be equipment required and cost, radiology and other staffing requirements and availability, and the predicted demand for the service. The Trust has no plans to develop an MR angiogram service at this stage. In Ryan’s case, he had a 6 week wait for an urgent Stress Echocardiogram, which was requested by his GP on 22nd February 2024. An appointment was booked for Ryan for 3rd April 2024. This was the earliest appointment available. The waiting list at this time was 5 months. The Trust has made significant progress in relation to Stress Echocardiogram waiting times, with an additional 20 lists now planned over weekends which will cover 140 patients and should clear the backlog that the Trust is experiencing. This will bring the waiting time for Stress Echocardiograms back to 6 weeks; it is hoped this will be achieved by 31st January 2025. The service will then be achieving the 6 week standard for all patients and urgent referrals will be prioritised and booked from 2 weeks. In terms of plain echocardiograms, the community diagnostic centre (CDC) opened in September 2024, providing the Trust with an additional 74 echocardiogram slots per week, which has had a direct impact on the waiting times. Patients are now being seen within the expected 6-week timeframe for a plain echocardiogram. A2

I would also like to provide further assurances on the 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 events, such as the sad death of Ryan, are shared across the NHS at both a national and regional level and helps us to 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 Mr Murray, Further to the inquest you held on 20 September 2024 into the death of the late Mr Ryan Campbell, I am writing to you at your request for further information in relation to the matter of concern you have raised. I have asked (Associate Medical Director for Medicine and Urgent Care), (Consultant Cardiologist) and (Interim Directorate Manager for Cardiology) to review your concerns. Your concern related to:
1) The absence of a full suite of cardiac diagnostic imaging equipment at Stepping Hill Hospital, particularly CT or MR angiograms, contributes to delays in diagnosis for patients and the risk of delays is heightened by having to switch treatment centres. This lack of a range of equipment is inconsistent with providing a full cardiology service to patients. Stockport NHS Foundation Trust are commissioned for the following diagnostics/services:
• Plain Echocardiogram
• Stress Echocardiogram
• Contrast Echocardiogram
• Transoesophageal Echocardiogram (TOE)
• Valve surveillance
• Electrocardiogram (ECG)
• 24hr ECG
• 72hr ECG
• 7 day ECG
• 24hr blood pressure
• Implantable loop recorder
• Myocardial Perfusion Scan (Radiology)
• Tilt Table Test A4

Stockport NHS Foundation Trust are not commissioned for CT or MR angiograms. In Mr Ryan’s case, the CT Coronary Angiogram (CTCA) scan that was requested following his admission to AMU in December 2023 is delivered at Wythenshawe Hospital (Manchester University NHS Foundation Trust). Manchester University NHS Foundation Trust (MFT) have always been the regional provider for this. Some other NHS hospitals in the region do have their own CTCA service (for example, Salford Royal NHS Foundation Trust), but do not accept external referrals.

The waiting times for CTCA at Wythenshawe Hospital have unfortunately been increasing for some time. Prior to last year the turnaround time for a CTCA would have been around 6- 12 weeks. However, in the last year this has become around a 6 months turnaround time.

Stockport NHS Foundation Trust is not an outlier in terms of being a district general hospital with a cardiology service that does not include a full suite of cardiac diagnostic imaging equipment, particularly CT or MR angiograms. This centralisation of specialist services like this is fairly longstanding and is not unique to Stockport NHS Foundation Trust or the North West Region.

The cardiology service would like to expand the services offered on site at Stockport NHS Foundation Trust in the future and CT Coronary Angiogram service provision is on the Division of Medicine and Urgent Care’s service development programme for review next year. Within this review specific areas of focus will be equipment required and cost, radiology and other staffing requirements and availability, and the predicted demand for the service.

In Mr Ryan’s case, he had a 6 week wait for an urgent Stress Echocardiogram; which was requested by his GP on 22nd February 2024. An appointment was booked for Mr Ryan for a Stress Echo for 3rd April 2024. This was the earliest appointment available. The waiting list at this time was 5 months. The Trust has made significant progress in relation to Stress Echo waiting times, with an additional 20 lists now planned over weekends which will cover 140 patients and should clear the backlog that the Trust is experiencing. This will bring the waiting time for Stress Echo back to 6 weeks; it is hoped this will be achieved by 31st January 2025. The service will then be achieving the 6-week standard for all patients and urgent referrals will be prioritised and booked from 2 weeks. In terms of plain echocardiogram, the community diagnostic centre (CDC) opened in September 2024 providing the Trust with an additional 74 ECHO slots per week, which has had a direct impact on the waiting times. Patients are now being seen within the expected 6 week timeframe for echos.

I would like to express my apologies to Mr Ryan’s family in relation to the delays in diagnostic tests, and offer my sincere condolences for their loss. A5

I trust that the above addresses your concerns. Please do not hesitate to contact the Trust if you require any further information.

Dear Sirs,

Our case reference: 35964868

Please find attached a Regulation 28 Report for your attention.

Kind regards,

Business Support Assistant

NOTE: Please do not edit the subject line when replying to this email. A7