Dear Ms Lake,

Thank you for the Regulation 28 report of 17th July 2024 sent to the Secretary of State about the death of Pauline Spedding. I am replying as Minister with responsibility for urgent and emergency care.

Firstly, I would like to say how saddened I was to read of the circumstances of Mrs Spedding’s death, and I offer my sincere condolences to her family and loved ones. The circumstances your report describes are concerning and I am grateful to you for bringing these matters to my attention. Thank you for the additional time provided to the department to provide a response to the concerns raised in the report.

The report raises concerns over the continuity of care for Mrs Spedding, who had a complex medical history, and bed capacity issues at Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH).

In preparing this response, my officials have made enquiries with NHS England to ensure we adequately address your concerns.

Your report raised concerns regarding the continuity of care provided in this case following the movement between wards as a result of bed capacity pressures. I am informed that NNUH has undertaken focused work on this issue which has reduced the number of moves for patients during their inpatient stay. Patients are assessed prior to moving and moves are only undertaken if the clinical priority of another patient requiring that bed space is higher. The number of moves per patient is monitored and reviewed weekly to confirm if they were appropriate or to identify improvements to reduce the number of moves. A nursing assessment booklet has been fully implemented across the trust and the trust’s audits show that there have been improvements.

In relation to escalation bed processes, I am also advised that the trust has reviewed and strengthened processes for the use of escalation beds and the plans for de-escalation, which has reduced the number of escalation beds used since July to date. NNUH will continue to review internal processes to minimise risk to patients. The trust will continue to work with stakeholders and partner providers across the system to reduce the need for escalation beds.

In relation to delays to patient discharge, it is vital that people are discharged safely from hospital when they are medically ready. Enabling people to be discharged from hospital more quickly with the right care and support in place contributes to speedier recovery and better outcomes for patients. NNUH has advised that finding suitable placements for patients unable to return to their own homes remains a priority as part of their transfer of care. Those with a length of stay of over 21 days are reviewed weekly by appropriate nursing teams.

At a national level, this government is committed to supporting the NHS to recover back to the level of service patients rightly should expect. In doing so we will be honest about the challenges facing the health service and serious about tackling them. The Health Secretary ordered an independent investigation of NHS performance to provide an assessment of the issues and challenges it faces. This reported on 12th September 2024 and the investigation’s findings will feed into the government’s work on a 10-year plan to radically reform the NHS and build a health service that is fit for the future.

I hope this response is helpful. Thank you for bringing these concerns to my attention.