Dear Mr Barkley Re: Regulation 28 relating to Inquest of Andrew Collins am writing in response to the Regulation 28 Report; to Prevent Future Deaths Issued to the Welsh Ambulance Services NHS Trust (the Trust) on 2 October 2018. This was issued following the conclusion of the inquest for Mr Andrew Collins: The Trust acknowledges your concers regarding our lack of resourcing; which meant thal there was a significant delay in attending to a critically unwell patient: The supporting information accompanying this letter, highlights the strategic and operational quality improvements in patient safety that have been completed or are underway: These are aimed at alleviating harm by improving our available resources to respond t0 patients within our communities. Continuous improvements are ongoing with our Health Board colleagues and we are working collaboratively t progress safety, effectiveness and a positive experience for patients and their carers The initiatives that the Trust are continuing t0 working on, to deliver and enable an improved resourcing picture include, the following; That planned resources are sufficient to meet overall demand That we align production against demand by local and time of That we reduce sickness absence That we reduce handover t0 clear duration Codand Dres Docher (Imerkn} Marn Wocdhrd Prt WetthedMICh { Enautwve Kllont "Dott Yadnodaitt N Cidutli [o1obuod My Gymnro Iut 5403mo Te Tnual wetonas Cotetnondun h Wiueh Enghh key day

That We Introduce safe alteratives to responding to scene where this is appropriate That we reduce conveyance where safe and appropriate and provide care in the patlents home utllising advanced practitioners The accompanying action plan will provlde you with the detail of this work, in addition to other quality improvement initiatives designed to safely release resources to respond t0 patients in greatest need. This includes the introduction of Falls Framework and increasing scope of practice for our Community First Responders. In addilion to the actions contained within the attached plan, the Trust has undertaken and completed a robust review of the "Explorer Project" _ The aim of this was the Introduction of "ring fencing" to stabilise resource capacity In the Cwm Taf area and to prevent the migration of emergency resources into busier adjacent Health Board areas. The Explorer Project was a joint programme of work between the Trust and the Cwm Taf University Health Board (CTUHB) designed to improve ambulance response times in the Cwm Taf area of Wales. would Ilike to reassure you that the Welsh Ambulance Services NHS Trust and Cwm Taf University Health Board, continue to work in collaboration t0 drive the improvements forward. We continue to strengthen the out of hospital alternative pathways to improve efficiency and effectiveness of care for our patlents and make best use of our resources_ We hope that we have been able to assure you that we remain focused t0 improve our services together and that actions taken to date have had an Impact in relation t0 all of the areas identified within thls Regulation 28 Report: would Iike to extend the offer t0 meet with you to discuss our response In more detail and to provide you with assurance of our commitment to the continuous improvement our service provision: