Bobilya Mulonge
PFD Report
All Responded
Ref: 2024-0250
All 1 response received
· Deadline: 3 Jul 2024
Coroner's Concerns (AI summary)
Persistent delays in paramedics attending Category 2 calls are caused by ambulances being unable to clear Accident and Emergency departments promptly.
View full coroner's concerns
Despite a number of measures being undertaken by the North West Ambulance Service, the delay in paramedics attending Category 2 calls has not been resolved to within target ranges. This is because resources available in the North West Ambulance Service cannot be fully utilised as a result of the delays in ambulances clearing Accident and Emergency departments.
Responses
Action Taken
The Department of Health and Social Care outlines actions being taken nationally to improve ambulance response times and patient flow, including additional funding and targets for faster ambulance response times and hospital handover. They highlight the reduction in average Category 2 ambulance response times in the North West Ambulance Service region in 2023/24. (AI summary)
The Department of Health and Social Care outlines actions being taken nationally to improve ambulance response times and patient flow, including additional funding and targets for faster ambulance response times and hospital handover. They highlight the reduction in average Category 2 ambulance response times in the North West Ambulance Service region in 2023/24. (AI summary)
View full response
Dear Ms Costello,
Thank you for your letter of 8 May to the Secretary of State for Health and Social Care regarding the death of Bobilya Mulonge. I am replying as Minister with responsibility for urgent and emergency care.
Firstly, I would like to say how deeply sorry I was to read the circumstances of Ms Mulonge’s death and I offer my sincere condolences to her family and loved ones. It is vital that where Regulation 28 reports raise matters of concern these are looked at carefully so that NHS care can be improved. I am grateful to you for bringing these matters to my attention.
Your report raised concerns about ambulance response times at North West Ambulance Service NHS Trust (NWAS) and that, despite a number actions being taken by the trust, response times are still being impacted by long patient handover times at A&E. In preparing this response, my officials have made enquiries with NHS England (NHSE) who have in turn liaised with Greater Manchester Integrated Care Board and NWAS.
I am advised that NHS organisations locally are continuing work to support reductions in handover delays. A Hospital Handover Improvement Working Group continues to provide focus on this issue across Greater Manchester. Learning from the best performing trusts is shared across the region and a hospital handover Operational Improvement Plan has been developed with NWAS colleagues. This focusses on key areas including alternative options for conveyance, in particular direct referrals to Same Day Emergency Care, expanding and formalising Greater Manchester Falls response services and Urgent Community Response services to support further reduction in conveyance, and strengthening governance to improve risk reporting and escalation practices.
As the Minister responsible for urgent and emergency care services, I recognise the significant pressure the NHS is facing and the impact of waiting times for patients. In January 2023, NHSE published a two year ‘Delivery plan for recovering urgent and emergency care services’ which aims to deliver sustained improvements in waiting times with targets for this year for a minimum of 78% of patients being admitted, transferred, or discharged within four hours by March 2025, and to reduce Category 2 ambulance response times to 30 minutes on average. An update to this plan has now been published, to build on learnings from the first year and to
2 continue to support systems to improve performance and reduce waiting times. The plan is available at:
recovering-urgent-and-emergency-care-progress-update-and-next-steps-May-2024.pdf
Your report highlights that NWAS were under high demand at the time of the incident. Ambulance services received £200 million of additional funding in 2023/24 to expand capacity and improve response times.
To improve patient flow and bed capacity within hospitals £1 billion of dedicated funding was provided to increase staffed core hospital beds by 5,000 compared to 2022/23 plans. £1.6 billion of funding was also made available over two years to support the NHS and local authorities to ensure timely and effective discharge from hospital, helping to free up beds and reduce long waits for admission from A&E.
At a national level, we have seen 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%. NWAS average Category 2 response times were over 13 minutes faster in 2023/24 compared to the previous year, a 32% reduction. In May 2024, average patient handover times in the NWAS region were 31 minutes 30 seconds, over 7 minutes faster than January 2024.
Thank you once again for bringing these concerns to my attention.
Yours,
HELEN WHATELY
Thank you for your letter of 8 May to the Secretary of State for Health and Social Care regarding the death of Bobilya Mulonge. I am replying as Minister with responsibility for urgent and emergency care.
Firstly, I would like to say how deeply sorry I was to read the circumstances of Ms Mulonge’s death and I offer my sincere condolences to her family and loved ones. It is vital that where Regulation 28 reports raise matters of concern these are looked at carefully so that NHS care can be improved. I am grateful to you for bringing these matters to my attention.
Your report raised concerns about ambulance response times at North West Ambulance Service NHS Trust (NWAS) and that, despite a number actions being taken by the trust, response times are still being impacted by long patient handover times at A&E. In preparing this response, my officials have made enquiries with NHS England (NHSE) who have in turn liaised with Greater Manchester Integrated Care Board and NWAS.
I am advised that NHS organisations locally are continuing work to support reductions in handover delays. A Hospital Handover Improvement Working Group continues to provide focus on this issue across Greater Manchester. Learning from the best performing trusts is shared across the region and a hospital handover Operational Improvement Plan has been developed with NWAS colleagues. This focusses on key areas including alternative options for conveyance, in particular direct referrals to Same Day Emergency Care, expanding and formalising Greater Manchester Falls response services and Urgent Community Response services to support further reduction in conveyance, and strengthening governance to improve risk reporting and escalation practices.
As the Minister responsible for urgent and emergency care services, I recognise the significant pressure the NHS is facing and the impact of waiting times for patients. In January 2023, NHSE published a two year ‘Delivery plan for recovering urgent and emergency care services’ which aims to deliver sustained improvements in waiting times with targets for this year for a minimum of 78% of patients being admitted, transferred, or discharged within four hours by March 2025, and to reduce Category 2 ambulance response times to 30 minutes on average. An update to this plan has now been published, to build on learnings from the first year and to
2 continue to support systems to improve performance and reduce waiting times. The plan is available at:
recovering-urgent-and-emergency-care-progress-update-and-next-steps-May-2024.pdf
Your report highlights that NWAS were under high demand at the time of the incident. Ambulance services received £200 million of additional funding in 2023/24 to expand capacity and improve response times.
To improve patient flow and bed capacity within hospitals £1 billion of dedicated funding was provided to increase staffed core hospital beds by 5,000 compared to 2022/23 plans. £1.6 billion of funding was also made available over two years to support the NHS and local authorities to ensure timely and effective discharge from hospital, helping to free up beds and reduce long waits for admission from A&E.
At a national level, we have seen 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%. NWAS average Category 2 response times were over 13 minutes faster in 2023/24 compared to the previous year, a 32% reduction. In May 2024, average patient handover times in the NWAS region were 31 minutes 30 seconds, over 7 minutes faster than January 2024.
Thank you once again for bringing these concerns to my attention.
Yours,
HELEN WHATELY
Sent To
- Department of Health and Social Care
Response Status
Linked responses
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56-Day Deadline
3 Jul 2024
All responses received
About PFD responses
Organisations named in PFD reports must respond within 56 days explaining what actions they are taking.
Source: Courts and Tribunals Judiciary
Report Sections
Investigation and Inquest
On 24th May 2023 an investigation was commenced into the death of Bobilya Mulonge then aged 62 years. The investigation concluded at the end of the inquest on 19th April 2024. The conclusion of the inquest was a narrative conclusion that Mrs Mulonge died as a result of congestive cardiac failure against a background of hypertensive heart disease. Ambulance response times probably contributed to her death. The medical cause of death being: 1 (a) Congestive Cardiac Failure (b) Hypertensive Heart Disease II) Chronic Kidney disease and Type II diabetes mellitus
Circumstances of the Death
Mrs Mulonge had multiple co-morbidities including hypertension with a history of hypertensive crisis, stroke, diabetes and she had multiple hospital admissions in 2022. On 24 November 2022 at 06:09 an ambulance was called because her breathing was laboured, and her consciousness was reducing. During the call she became unconscious. When an ambulance arrived 72 minutes later, at 07:24, she was in cardiac arrest. Her heart was restarted but despite appropriate treatment she continued to deteriorate and died at 10:45 on 24 November 2022 at Tameside General Hospital, as a result of congestive cardiac failure against a background of hypertensive heart disease, chronic kidney disease and type II diabetes mellitus. The Inquest heard that the North West Ambulance Service was unable to meet average response standards at the time of the 999 call mainly due to the fact that ambulances were unable to clear the region’s hospitals because of the long waiting times there. In addition, there were high call volumes. A level 4 incident plan was commenced as a result. A number of measures have been undertaken by the North West Ambulance Service to address emergency response times including: Regular meetings take place between the North West Ambulance Service and NHS Trusts in the region to discuss the delays at a regional level. There are faster communications between senior leaders in the North West Ambulance Service and NHS Trusts when there is a period of high demand or delay. North West Ambulance Service managers are deployed to struggling Accident and Emergency departments. A delayed handover checklist is in place. Patients are triaged to assess if they can wait in a waiting room to release ambulances – this is called Fit to Sit. Patients who can be safely grouped with other patients and looked after by one ambulance crew rather than in individual ambulances are placed together to release ambulances. The North West Ambulance Service now has an option to remove crews with 15 minutes notice to the hospital. Batch Divert is in place which allows the North West Ambulance Service to send an ambulance to another hospital. The inquest heard that waiting times across the North West region are still impacted by problems clearing the regions hospitals despite the above measures.
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Data sourced from Courts and Tribunals Judiciary under the Open Government Licence.