Dear Mr Sullivan am writing further to your letter dated November 2016_ enclosing Regulation 28 Report to Prevent Future Deaths. This report was made by you following the inquest into the death of Brian Douglas Mills_ which concluded on 16th November 2017 . You were concerned about the high levels of outstanding emergency calls that exceeded the NHS Response Times targets and recommended that action be taken to resolve this_ All calls are triaged using an Advanced Medical Priority Dispatch System (AMPDS) , which codes and then categorises the call This standardised system ensures priority patients receive a response first understand that the Trust's Quality Improvement and Professional Standards Lead will be delivering some training to Coroner's Officers around the country this year in relation to the coding and resourcing of 999 calls_ All ambulance services, and the wider NHS system, are seeing a year-year rise in demand. To take the recent weeks as an example, activity has been 31% higher than previous four weeks and in one 24 hour period we received more than 4,000 calls_ We also experienced exceptional increases in the number of hours lost through handover delays at hospitals, at one point we had 60 ambulances queued at hospitals across the region_ If our community teams are waiting at a hospital or attending other calls_ it leads to a stack of Red calls and, depending on number waiting, call handlers are instructed to provide most calls categorised as Green with a predicted response time_ These are not response times that we would want or expect but are part of the increasing pressure on our system. A number of mitigating initiatives have been introduced led by the Trust Medical Director to protect patient safety during these periods of pressure when responses to Green patients are delayed; These include increasing the number of clinicians in the Emergency Operations Centres (EOC) to increase the number of patients treated over the phone and referred to appropriate pathways. Following consultation with hospital colleagues we have introduced process which instigates the release of ambulance crews from queues in A and E departments to attend to patients in the community with life threatening conditions. However; the good news is that the number of responses to our most seriously ill patients the Red category within eight minutes is on a constant upward trend and we continue to respond to more patients more quickly than ever before Chief Executive: Robert Morton 17th the the

In the context of ever growing demand, we also need to be clear that while we are taking every possible step we can, we do not have the capacity available to deliver national NHS Response Times Targets_ In line with the Trust's strategic objective to improve service delivery t0 our patients, we are negotiating with regulators and commissioners on the funding required to meet the acknowledged capacity gap at EEAST. We continue to recruit hundreds of patient tacing staff within the financial envelope provided which in the environment of increasing activity is the only sustainable solution to delayed responses to patients_ Our Quality Strategy has recently been showcased and the Trust is in the process of implementing revised operating model, which includes the introduction of a new clinical career pathway for our staff. This will help to develop our dedicated workforce and improve the clinical care we provide_ hope this information assures you that the Trust is taking action following the inquest into the death of Brian Mills that we are continuing to seek improvement in the way we manage and respond t0 999 calls_