Lina Piroli

Dear Coroner, Re: Regulation 28 Report to Prevent Future Deaths – Lina Piroli who died on 20th February 2025.

Thank you for your Report to Prevent Future Deaths (hereafter “Report”) dated 4th December 2025 concerning the death of Lina Piroli on 20th February 2025. In advance of responding to the specific concerns raised in your Report, I would like to express my deep condolences to Lina’s family and loved ones. NHS England is keen to assure the family and yourself that the concerns raised about Lina’s care have been listened to and reflected upon.

Your Report raised concerns around the lack of available beds on the elderly care ward at the time Lina re-presented to the Emergency Department (ED), and the delay in transferring her to a ward. The busy and overcrowded ED meant that the guidance on treating patients with dementia was unachievable. You raised that this is a problem across all hospitals nationally and the ED is not set up to deliver care to elderly and complex patients.

Emergency Department capacity and bed availability on wards

NHS England recognises the significant pressures on all NHS services and, in January 2023, published a two-year Urgent & Emergency Care (UEC) Recovery Plan. The plan prioritised improvements to the 4-hour standard – a constitutional standard aiming for 95% of patients to be admitted, transferred, or discharged within four hours of arrival. The plan outlined key actions to recover and improve urgent and emergency care services. Despite significant challenges, including high demand for services, there was an improvement in the headline ambition between 2023 and 2025.

Recognising that there is further work to be done, in June 2025, NHS England published the Urgent and Emergency Care Plan for 2025/26 which included an ambition to ‘improve flow through hospitals with a particular focus on patients waiting over 12 hours and making progress on eliminating corridor care’. NHS England is National Medical Director NHS England Wellington House 133-155 Waterloo Road London SE1 8UG

22nd January 2026

working with the regions to support Acute Trusts to eliminate crowding in EDs in the longer term. Improvements are being progressed through NHS England’s operational planning guidance, where Integrated Care Boards (ICBs) were asked to focus on delivering improved patient flow. This has included increasing the productivity of acute and non-acute healthcare services, improving flow and length of stay, as well as clinical outcomes. In addition to this, we are continuing to develop services that shift activity from acute hospital settings to settings outside of an acute hospital for patients with unplanned urgent needs, supporting proactive care, alternatives to admission and improving hospital discharge.

NHS England also undertook a bed occupancy reduction sprint to manage demand nationally, which commenced in October 2025 and concluded on 24th December 2025. This has enabled a reduced bed occupancy and enabled providers to respond to surges in demand that the NHS traditionally experiences during winter, enabling patients to move in a more timely manner to ward beds.

NHS England’s London regional team has liaised with the Whittington Hospital in relation to this case. The Trust (Whittington Health NHS Trust) has advised that on 2nd February 2025, when Lina presented to hospital, they were in a high Opel 3 (red alert) status with 16 patients waiting for beds. An Opel 3 score signifies major operational pressures, compromising patient flow. The Trust has a standard operating procedure to support the care of patients waiting for beds, which sets out expected standards of care.

Unfortunately, Lina’s stay in the ED was prolonged as she required neurosurgical advice from the Royal London Hospital (RLH) and additional MRI imaging was requested to identify the stability of her spine.

We are advised that the Trust recognises that caring for patients in the ED, particularly those with dementia, is far from ideal. The Trust is committed to continuing to work on patient flow initiatives which include supporting safe and timely discharges from the wards, home treatment via virtual wards and Same Day Care to improve the flow of patients throughout the Trust and reduce the time that patients spend in the ED once a decision to admit has been made.

Review by the Geriatric Team The Trust has advised NHS England that their geriatric team does not currently provide a direct in‑reach service into the ED. However, they do have a dedicated frailty team and are actively developing this service further. As part of this work, they are creating a dedicated frailty area within their Same Day Emergency Care unit to offer a more suitable environment for this patient group. They are also focusing on ensuring that, from the moment patients arrive in the ED, their frailty score is used to guide placement and prioritisation. Their aim is to minimise the amount of time that frail and vulnerable patients spend in the ED and ensure they receive timely, appropriate care in the most suitable setting.

I would also like to provide further assurances on the national NHS England work taking place around the Reports to Prevent Future Deaths. All reports received are discussed by the Regulation 28 Working Group, comprising Regional Medical Directors, and other clinical and quality colleagues from across the regions. This ensures that key learnings and insights around events, such as the sad death of Lina, are shared across the NHS at both a national and regional level and helps us to pay close attention to any emerging trends that may require further review and action.

Thank you for bringing these important patient safety issues to my attention and please do not hesitate to contact me should you need any further information.

Dear Ms Lee,

Thank you for the Regulation 28 report of 4 December 2025 sent to the Secretary of State regarding the death of Lina Piroli. I am replying as the Minister with responsibility for urgent and emergency care.

Firstly, I would like to say how saddened I was to read of the circumstances of Ms Piroli’s death and I offer my sincere condolences to their 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. Please accept my sincere apologies for the delay in responding to this matter.

The report raises concerns over A&E waiting times, hospital bed availability, and specialist care for the elderly. In preparing this response, my officials have made enquiries with NHS England and I understand they will be responding to your concerns in full.

The Government acknowledges that urgent and emergency care (UEC) performance has not consistently met expectations in recent years. However, we are committed to ensuring patients receive the highest standard of service and care from the NHS. That is why our 10- Year Health Plan set out commitments to restoring waiting standards to those set out in the NHS Constitution by the end of this Parliament.

We are taking serious steps to achieve this. Our Urgent and Emergency Care Plan for 2025/26 focuses on improvements to deliver better UEC performance both daily and during winter pressures, ensuring more patients receive timely and clinically appropriate care. We are aiming for 78% of patients to be seen in in 4 hours this year, meaning over 800,000 people will receive more timely care. Key actions to help achieve this include:
• Investing £250 million into expanding same day and urgent care services, helping avoid unnecessary admissions to hospital and supporting faster diagnosis, treatment and discharge for patients.
• Increasing the number of patients receiving urgent care in primary, community and mental health settings.

• Introducing new clinical operational standards for the first 72 hours of care to support better hospital flow. These set minimum expectations for timely review, availability of advice, and coordinated care when multiple specialist teams are involved.
• In the longer-term, our 10 Year Health Plan will increase the urgent care capacity outside hospital through new neighbourhood health services, reducing demand pressures on A&E.
• Improve hospital flow, with a focus on reducing the number of patients waiting more than 12 hours and making progress towards eliminating corridor care.
• Increasing bed capacity by reducing the average length of stay for patients requiring an overnight emergency admission by at least 0.4 days returning closer to pre- pandemic levels.

Despite increasing demand, A&E 4-hour performance has improved, showing the measures we are taking are already having a positive impact. In England, the latest NHS figures show that in November 2025, 4-hour A&E performance improved to 74.2%, up from 72.2% in November last year. Regarding specialist care for the elderly, we recognise that older people are particularly vulnerable to long waits and delayed discharges. We are therefore investing in specialist frailty pathways, expanding the community workforce, and embedding elderly care expertise throughout urgent and emergency care. Initiatives such as frailty Same Day Emergency Care units, rapid front-door frailty team input, and integrated neighbourhood teams are designed to ensure older people receive timely, specialist assessment and support. We are also working to increase the number of geriatricians and frailty specialists, and to strengthen collaboration between hospital and community services, so that discharge planning starts earlier and transitions are safer. These actions are part of our wider commitment to transform care for older people and to ensure that the NHS meets the needs of an ageing population. I hope this response provides reassurance that the Government is taking meaningful action to improve urgent and emergency care services. Thank you once again for bringing these concerns to my attention.