Dear Ms Costello, Thank you for your letter of 28 April 2022 to the then Secretary of State Sajid Javid, about the death of John Scott Murphy. I am replying as Minister with responsibility for Health and Secondary Care and thank you for the additional time allowed. Firstly, I would like to say how saddened I was to read of the circumstances of Mr Murphy's death, and I offer my sincere condolences to his family and loved ones. The circumstances your report describes are very concerning and I am grateful to you for bringing these matters to my attention. · In preparing this response, Departmental officials have made enquiries with NHS England, as well as the relevant regulator, the Care Quality Commission (CQC). There is work ongoing to address the concerns outlined in your report. The North West Ambulance Service (NWAS) lead commissioners, representatives from the local health system and NHS England have developed a 6-point winter improvement plan concentrating on key actions to assist in improving performance levels for 999 and Urgent and Emergency Care. Ambulance handover times are also a major part of the Greater Manchester Urgent and Emergency Care Improvement Plan for 2022/23. The government is committed to supporting the ambulance service to manage the pressures it is facing, ensuring that people receive the treatment that they need when they need it. Ambulance trusts receive continuous central monitoring and support from the NHS England funded National Ambulance Coordination Centre, and there is a range of support in place to improve performance. In addition, NHS England has allocated £150 million of additional system funding for ambulance service pressures in 2022/23, supporting improvements to response times through additional call handler recruitment, retention and other funding pressures. You may wish to know that we have also made significant investments in the ambulance workforce. The number of NHS ambulance and support staff has increased by 40% since February 2010, and Health Education England has a mandated target to train 3,000 paramedic graduates nationally per annum from 2021-2024, further increasing the domestic paramedic workforce to meet future demands on the service. The number of national 999 call handlers has also been boosted to over 2,300 at the start of May 2022, about 400 more than September 2021, with potential for services to increase capacity further during 2022/23. Additionally, a £1.3 million national campaign for the 999 call handlers was initiated in March to support trusts. This is alongside a £50 million national investment across NHS 111 in England for 2022/23 to support additional NHS 111 capacity to ensure people get the care they need when they need it and avoid unnecessary demand on ambulances. This builds on additional investment from last year.

Finally, ambulance services across the country have been working closely with their local systems to reduce avoidable conveyance and support patients to get the care they need outside of hospital. Conveyance rates to Emergency Department are the lowest ever outside periods of national lockdown. To drive further progress and support regional and local system arrangements, we have established a national discharge taskforce with membership from local government, the NHS and national government. Local health and social care partners are already standing up the use of additional action to support discharge and improve patient flow. We will continue exploring options that minimise delays to hospital discharge, including identifying capacity to accommodate people who no longer need acute hospital care while continuing to need other forms of support. I hope this response is helpful. Thank you for bringing these concerns to my attention.