Emergency services related deaths

Noted (AI summary) The Welsh Ambulance Services University NHS Trust acknowledges concerns about ambulance delays and the MPDS system but states it is not the primary authority to take action, offering to meet to discuss the response in more detail and welcomes suggestions for actions they might take with partners.

Noted (AI summary) The Trust details existing processes for prioritising calls and rapid handover of patients, and offers a meeting to discuss their response and commitment to improvement. Swansea Bay University Health Board outlined existing plans to reduce delays within acute unscheduled care pathways, including reducing bed numbers and improving flow, implementation of a frailty assessment unit and SDEC, and providing alternative pathways for patients presenting to the Emergency Department. The Welsh Government notes that the Health Board and Ambulance Service will respond separately and summarises pressures on urgent and emergency care services in Wales, as well as the actions being taken to address them including '50 day challenge' and escalation of Swansea Bay University Health Board to level 4.

Noted (AI summary) NHS England is working with the Association of Ambulance Chief Executives (AACE) to ensure patients inform 999 call handlers or healthcare professionals if they are steroid dependent; NHS England's National Primary Care Team will consider GP awareness of alerting ambulance services to specific conditions; the ICB will take the circumstances surrounding Margaret’s death to their GP learning sessions and consider a system-wide safety alert. AACE expresses condolences and explains its role in supporting ambulance services with national policy and guidelines. They highlight existing JRCALC guidance and raise concerns about the validity of flagging patient addresses. NEAS has taken several actions including reviewing and updating clinical practice guidelines to highlight steroid dependency and adrenal insufficiency, updating the NHS Pathways system to improve recognition of steroid dependency, and accepting care plans and flags from providers until an automated solution is available. They have also established an ICB-wide group to improve flagging challenges.

Noted (AI summary) The Welsh Ambulance Service explains why it carries naloxone but not flumazenil, stating that flumazenil is not safe for widespread use and that ambulance personnel are trained in more appropriate techniques for benzodiazepine overdose.

Noted (AI summary) NHS England explains the NHS Pathways triage system and how it handles repeat calls, noting that ambulance services have local procedures for managing duplicate callers, including a geofence and other differentiating factors. They also highlight the use of the 'what3words' function to support location identification. West Midlands Ambulance Service explains their call taking protocols, addressing how they manage duplicate/repeat calls and clarifies the circumstances surrounding the delayed ambulance response, attributing it to significant hospital handover delays. They state the ambulance crew initially went to the kidney treatment center because they were unaware Mr. Fray had returned home.

Noted (AI summary) NHS England expresses condolences and states that concerns have been listened to and reflected upon. They highlight the remit of other organisations (NWAS and Tameside and Glossop Integrated Care NHS Foundation Trust) regarding some of the concerns, and reference workstreams to increase ambulance capacity and improvements to Tameside's ED. They also note the discussion of PFD reports by their Regulation 28 Working Group to share learnings.

Noted (AI summary) NHS England outlines actions taken to improve ambulance performance, including implementing the Delivery plan for recovering urgent and emergency care services, engaging with West Yorkshire ICB, and publishing the NHS Long Term Workforce Plan. These actions include joint escalation processes, investment in resources, and workforce enhancements. West Yorkshire ICB describes actions taken to reduce ambulance response times and handover delays, including funding for additional resource in call centres. The ICB also highlights the development of a System Coordination Centre (SCC) to enable a proactive system response to operational pressures. The DHSC acknowledges the concerns regarding ambulance response times and hospital handover delays, notes that West Yorkshire ICB and NHS England will respond directly on specific actions, and highlights national initiatives to improve urgent and emergency care performance.

Noted (AI summary) NHS England outlines key actions from their Delivery plan for recovering urgent and emergency care services, including improving ambulance response times, increasing ambulance capacity, improving hospital flow, speeding up discharges, and expanding community services. They also mention the Regulation 28 Working Group which shares learnings from preventable deaths across the NHS. The DHSC acknowledges concerns about ambulance response times and hospital handover delays, directing the coroner to NHS England and Birmingham Integrated Care Board for specific actions. They highlight the 'Delivery plan for recovering urgent and emergency care services' and funding allocated to boost ambulance capacity and improve patient flow. NHS Birmingham and Solihull outline several actions to address ambulance delays, including the implementation of a medical push model, improvement activities to reduce length of stay, and a single transfer of care hub. These measures aim to improve patient flow out of acute hospitals.

Noted (AI summary) NWAS has reviewed the use of NHS Pathways for overdose calls, implementing an automatic prompt for an advanced questionnaire if 'risk of suicide' or 'accidental poisoning' is recognised, leading to an automatic upgrade to Category 2 for patients who have taken higher-risk medications. Clinicians in the Clinical Navigation, CSD, and CCD teams have undergone extended training and will use TOXBASE to support decision-making. The Minister acknowledges the concerns raised and explains that national guidance is in place for ambulance services regarding overdose calls, including clinical intervention within 30 minutes or automatic upgrade to Category 2. NWAS is best placed to respond on specific local actions.