Lewis Garfield

Dear Mr Shar

Re: Report regarding the case of Mr Lewis Aubrey GARFIELD deceased.

I am writing to you in response to the concerns that you highlighted to the Trust following the inquest hearing into the sad death of Lewis Aubrey Garfield that concluded on 27th October 2025.

Thank you for raising the concerns regarding the delays at the hospitals which is contributing to the Trust being able to respond to patients waiting in the community like Mr Garfield.

I am aware that you will share my response with Mr Garfield’s family, and I firstly wish to express my sincere condolences to them.

EMAS core purpose is to respond to patient needs in the right way, developing our organisation to become outstanding for patients and staff, and collaborating to improve wider healthcare. We will deliver safe, effective, compassionate care for patients, embedding a culture of compassion, continuous improvement.

East Midlands Ambulance Service (EMAS) acknowledges the concerns raised by HM Coroner and I offer the following clarifications and commitments.

The concerns highlighted in your report have been reviewed and discussed by the Trust’s Incident Review Group, which routinely considers issues raised through inquests and Prevention of Future Death reports. This process ensures that lessons are identified and appropriate actions are taken to address any systemic or procedural shortcomings.

Confidential Mr Hassan Shah, Assistant Coroner for the coroner area of Northamptonshire.

Matters of Concerns raised on 28 October 2025

a) I understand that nationally, the target time for handover from ambulance to hospital staff is 15 minutes. In the present case, the handover from ambulance to nursing staff at John Radcliffe Hospital took 25 minutes. However, at the same time, the longest handover time at Northampton General Hospital was 5 hours and at Kettering General Hospital it was 7 hours. The Trust lost 115 hours waiting to handover at Northampton over 121 hours at Kettering.

b) I heard evidence that steps are being taken to mitigate the impact of pressures in the healthcare system. University Hospitals of Northamptonshire have adopted the ‘45-minute handover’ approach. Despite this, on the day of the inquest on 27 October 2025, average handover times at Northampton General Hospital were 1 hour 11 minutes and I suspect that this will get worse during the full onset of winter pressures.

Persistent delays across the system have led to the introduction of an additional operational measure known as the 45-minute handover ceiling. This is also in this year’s 2025/26 planning guidance and Urgent Emergency Care recovery plan. Under this policy, if a patient has not been formally handed over within 45 minutes, ambulance crews are required to complete a safe transfer process and leave the patient in the care of hospital staff. This includes ensuring the patient is placed in an appropriate location (such as a trolley, chair, or designated waiting area) and that essential clinical information is communicated to ED personnel. The purpose of this measure is to prevent excessive delays that compromise ambulance availability and community response times for life-threatening incidents.

It is important to note that this policy does not permit abandonment of care, hospitals assume clinical responsibility for patients from the point of arrival or after 15 minutes, whichever is sooner. The 45-minute ceiling is therefore a pragmatic safeguard to balance patient safety with system resilience, though it can increase corridor care and crowding pressures within EDs.

These figures highlight a significant systemic issue affecting patient flow and ambulance availability, with extreme delays at some sites creating substantial operational pressures and potential risks to patient safety.

Kettering General Hospital and Northampton General Hospital now operate under the United Hospitals of Northamptonshire (UHN). The EMAS senior leadership team in Northamptonshire has established a strong collaborative relationship with the senior team at UHN and the Integrated Care Board (ICB).

This partnership ensures we work closely to manage risk across both acute sites, as well as for patients waiting in the community.

Within the Northamptonshire division, the Trust are now implementing dynamic strategic conveyance on a daily basis, directing patients to hospitals outside their usual catchment area when necessary. This approach helps mitigate the impact of excessive handover delays at pressured acute sites, reducing lost time and enabling crews to return promptly to attend patients in the community.

The Trust continues to work in close partnership with the Acute Trust, the ICB, and NHS England to implement the 45-minute handover protocol. While an exact implementation date has not yet been confirmed with the Acute Trust, we are actively progressing toward a target of mid-December 2025. To support this, weekly implementation meetings facilitated by NHS England commenced on 27th November, ensuring collaborative oversight and alignment across Northamptonshire.

The Trust proactively initiates ‘rapid handover’ requests during periods of high demand, particularly when multiple hospital handover delays coincide with uncovered Category 2 emergency calls. These actions are guided by our ‘Managing Delays in the Safe Handover of Patients’ Standard Operating Procedure, which incorporates a series of triggers aligned with the NHSE Midlands Region agreed process.

Requests for rapid and immediate handover requests are recorded by our 24/7 on duty command teams, captured within our daily operational log. This supports the triggering of further escalation actions that may be required should these handover request be declined by the hospital.

Our priority is to provide safe, high-quality care for our patients. We’re working closely with system partners to reduce the impact of delays on patients and staff, including implementing the national 45-minute maximum ambulance handover time standard. I trust this response provides you with clear assurance of our unwavering commitment to reducing hospital handover delays and driving continuous improvement across our services.

Dear Mr Shah,

I am writing to you in response to the concerns that you highlighted to the Trust following the inquest hearing into the sad death of Lewis Aubrey Garfield that concluded on 27th October
2025. Thank you for providing us with the opportunity to respond to your concerns.

At the outset I would like to offer my personal condolences to Mr Garfield’s family and friends.

To confirm, your Regulation 28 report relates to six concerns labelled ‘a)’ – ‘f)’ in your report. The report has been written to four recipients and the concerns which relate to the involvement of South Central Ambulance Service (SCAS) are points ‘a)’ and ‘c)’:

a) It was not clear if information about the symptoms taken by SCAS was adequate or if it had been recorded or conveyed by them accurately/completely. It was odd that the call was upgraded to category 2, just 14 minutes after being designated a category 3, without any evidence that there had been a change or deterioration.

c) The family complained of not being given any guidance on how to deal with the patient pending the arrival of an ambulance e.g. not to move him given the fall down the stairs.

I understand from your report that the court had been made aware of concerns that had been raised by Mr Garfield’s family in advance of the hearing and it is regretful that evidence was not requested from the Trust in response to these concerns as would usually be the case. Moving forward, we would be grateful for the opportunity to address any concerns regarding our involvement in a patients care pathway and participate in the inquest hearing if a written response is not sufficient.

Actions taken when a 999 call is received

Before answering the concerns in detail, it may be helpful if I explain how the emergency ambulance service operates and interacts with other service providers by way of context. Patients and callers contacting the 999 service are assessed by a non clinical member of staff who has been trained to utilise a clinical decision support software system called NHS Pathways. This has been licensed by NHS England (NHSE) for use by UK ambulance and NHS 111 services. NHSE also own and manage the software system and are responsible for authoring the embedded algorithms used during the assessment.

When the assessment has been completed, the patient is signposted to the most appropriate care pathway for their clinical condition based on the information provided during the

2 assessment. This could be an ambulance response or could include for example referral to a GP out of hours services within a clinically safe timeframe, for that service to deliver onward care and / or advice. Additionally, patients’ symptoms can also be managed by the caller receiving advice on accessing an alternative care pathway such as seeing their GP, attending a walk-in centre or minor injury/illness unit or self-care.

If the assessment has identified that an emergency ambulance response is required, the national ambulance response standards determined by NHSE are in the table below:

National Ambulance Call Categories Response Timeframe CATEGORY 1 - LIFE-THREATENING CONDITIONS Time critical life-threatening event needing immediate intervention and/or resuscitation
e.g. cardiac or respiratory arrest, airway obstruction, ineffective breathing, unconscious with abnormal or noisy breathing. We are required to respond within an average time of 7 minutes and at least 9 out of 10 occasions within 15 minutes CATEGORY 2 - EMERGENCY CALL Potentially serious conditions that may require rapid assessment, urgent on-scene intervention and/or urgent transport e.g. probable heart attacks, strokes, and major burns. We are required to respond within an average time of 18 minutes and at least 9 out of 10 occasions within 40 minutes CATEGORY 3 - URGENT CALL Urgent problems that are not immediately life-threatening which need treatment to relieve suffering (e.g. pain control) and transport, or assessment and management at scene with referral where needed. In some instances, ambulance personnel may treat patients in their own home or refer patients onward to an appropriate Health Care Professional. We are required to respond to calls of this nature at least 9 out of 10 occasions within 120 minutes CATEGORY 4 - NON-URGENT CALL Problems that are not urgent but need clinical assessment (face-to-face or telephone) and possibly transport within a clinically appropriate timeframe. We are required to provide clinical assessment at least 9 out of 10 occasions within 180 minutes

Review undertaken in June 2025.

On 5th June 2025 the Head of Patient Safety at East Midlands Ambulance Service wrote to the Trust and asked us to review our involvement in Mr Garfield’s care pathway. Requests like this are common within the NHS where a patient has died or had a poor outcome. The patient safety culture within the NHS prompts Trusts to work together to review care episodes so that any areas where service delivery and / or patient safety could be enhanced are identified and acted upon.

A copy of the response that we sent to East Midlands Ambulance Service, which answers point ‘a)’ of your concern, is enclosed with this letter. Had the court sought evidence from the Trust for the inquest hearing, a copy of the response would have been provided along with a bespoke statement detailing a full review of the interactions we had with the family.

A full summary of the calls we took is detailed below which includes details regarding the content and categorisation of the 999 calls. This section also covers point ‘c)’ of your concerns.

Call one

SCAS received the first 999 call from Mrs Garfield at 00:30:57 on 4th December 2024. Mrs Garfield was using a mobile telephone and unfortunately due to poor reception, the line

3 became disconnected before the triage could begin. Our Emergency Call Taker confirmed the telephone number with the BT Operator and telephoned Mrs Garfield back. Mrs Garfield explained that approximately 10 minutes earlier, she had found her husband on the floor at the bottom of the stairs. When asked, Mr Garfield said that he had not fallen down the stairs, but Mrs Garfield advised this may not be correct because he had dementia. It was reported by Mrs Garfield that she thought her husband had injured his head and back, and with the assistance of their neighbour, they had ‘got him up’.

The Emergency Call Taker was unable to fully triage the call because Mr and Mrs Garfield were unable to answer the triage questions with any accuracy. Their neighbour came onto the call and was able to confirm that Mr Garfield was not bleeding heavily.

NHS Pathways provides you with three options to answer the questions asked, ‘yes’, ‘no’ and ‘not sure’. When an Emergency Call Taker receives more than two ‘not sure’ answers, the call is classed as complex, and they need to seek advice. The Emergency Call Taker did so on this occasion and was advised to select ‘triage not possible’ within the NHS Pathways system to reach an ambulance response disposition. Where there are no confirmed reports of major trauma or heavy bleeding, the default category of ambulance response is a Category 3.

In relation to worsening advice, our Emergency Call Taker correctly advised that Mrs Garfield and her neighbour keep a close eye on Mr Garfield and they should apply pressure to his head wound if it begins to bleed again and should not remove any objects from the wound. In addition to this, the Emergency Call Taker advised them to redial 999 if his condition changed, worsened or they had any other concerns.

This call was audited by our Audit and Investigation team and was found to meet the standards expected by NHS Pathways and the Trust.

Call two

This second call was received by SCAS at 00:50:27. Mrs Garfield was calling for a second time because Mr Garfield had fallen again whilst they were trying to help him to the toilet. She explained that his condition had become worse since this second fall and she reported that he had injured his shoulder, back and head. Mrs Garfield explained that his head was not bleeding heavily, and she had placed a dry dressing on it. When asked whether Mr Garfield was breathless, his wife replied that he was, but he was not struggling desperately for every breath. Mrs Garfield passed the telephone to her neighbour so they could provide additional information to the Emergency Call Taker. Their neighbour confirmed that he had got Mr Garfield off the floor, and he was now sat in a chair.

This call reached a Category 2 ambulance response due to the reported breathlessness. Mrs Garfield was advised not to move Mr Garfield unless he was in immediate danger where he was and informed that she should redial 999 if his condition changed, worsened or she had any further concerns.

This call was also audited and was regrettably found to be non complaint with expected standards. The triage had reached the correct category of response, but the Emergency Call Taker did not pass on location information to East Midlands Ambulance Service and answered one of the questions incorrectly. Although the answer she received was that Mr Garfield would not be able to get himself off the floor unaided, because he was already sitting in a chair, the Emergency Call Taker should have selected the ‘yes’ answer stem within the NHS Pathways system.

The Emergency Call Taker had a face to face meeting with the auditor and her line manager to discuss the audit outcome on 11th June 2025. They had the opportunity to listen to the call

4 and were provided with training material to ensure that they understood the errors they had made and so that their future practice improved moving forwards.

Call three

A third 999 call was received by SCAS from Mr Garfield’s neighbour at 01:38:31. His neighbour confirmed that Mr Garfield’s condition remained the same and he was just calling to request an update regarding when an ambulance would arrive. The Emergency Call Taker explained to the caller that she was unable to provide him with an estimated time of arrival because he was not talking to the ambulance service that would be sending a crew to Mr Garfield. The Emergency Call Taker advised the caller to apply pressure to Mr Garfield’s head wound with a clean dry cloth if his head was still bleeding and to call again if his condition changed or worsened. East Midlands Ambulance Service were advised that a third call had been received.

An audit of this call confirmed that it was triaged correctly and in line with expectations and processes.

Call four

At 02:29:18 a fourth 999 call was received from Mrs Garfield. She explained that they had been waiting for 2 hours, and Mr Garfield kept asking when an ambulance would arrive. The Emergency Call Taker asked whether his condition had changed, and Mrs Garfield explained that his speech was now very confused. She confirmed that Mr Garfield had been ‘got up’, was propped up on a sofa in the hallway and was being kept warm with blankets and coats placed over him. Because of the reported change in his condition, a further triage took place. Mrs Garfield confirmed that the bleeding from his head wound had stopped but he was still breathless. She said that she was now the only person who was with Mr Garfield. The triage resulted in a Category 2 ambulance response which was passed to East Midlands Ambulance Service.

The Emergency Call Taker advised Mrs Garfield not to move her husband further unless he was in immediate danger and explained Mr Garfield should be allowed to adopt a position that is comfortable for him. She was further advised not to remove any false teeth and to roll Mr Garfield onto his side if he became unconscious before redialling 999. Mrs Garfield was informed that she should call 999 again if Mr Garfield’s changed worsened or she had any further concerns.

This call was also found to be compliant with expected standards and reached a safe and appropriate outcome based on Mr Garfield’s presentation at the time of the call.

Call from a clinician

Because the clinician who made the call to Mrs Garfield referred to within your Regulation 28 report works for East Midlands Ambulance Service SCAS are unable to comment on the call or their rationale for upgrading the call to a Category 1 ambulance response. We are also unable to comment on the time that passed before a clinician reviewed the call. East Midlands Ambulance Service will need to respond to both of these points.

Response to concerns

I have asked the SCAS legal team to provide you with copies of call recordings for the calls that were taken so that you can be satisfied that the information captured during the call triage was accurate. It is evident from the second 999 call that there had been a change and deterioration in Mr Garfield’s condition, and he had unfortunately fallen again after the first 999 call was made. The Emergency Call Taker was also able to obtain answers to the questions

5 asked during the assessment in the second 999 call. The symptoms Mr Garfield was suffering from since his second fall and the ability to obtain accurate answers during the triage is the reason why the outcome of the second 999 call was different to the first call.

In relation to advice provided regarding moving Mr Garfield, it is clear from the call recordings that Mr Garfield had already been moved from the floor onto a sofa following each fall before 999 was called. Our Emergency Call Takers correctly advised his wife and neighbour not to move him any further unless he was in immediate danger. This advice is provided to prevent the possibility of further injury being caused before a physical examination can rule out any injuries caused by the fall which could be worsened on movement.

I hope that this letter has adequately addressed the concerns that you have raised. Should you wish to discuss these matters further, please contact Jennifer Saunders, Head of Legal Services at SCAS who will be able to facilitate this.

Yours sincerely,

Chief Executive

Enc

Response to East Midlands Ambulance Service Call recordings

Southern House Sparrowgrove Otterbourne Winchester SO21 2RU

Registered Headquarters: 7 and 8 Talisman Business Centre, Talisman Road, Bicester 0X26 6HR

PRIVATE & CONFIDENTIAL

Claire Kelman

3rd July 2025 Dear Ms Kelman

I am writing further to your email to our Patient Experience Team on the 6th June 2025, in which you raised a concern regarding our Emergency 999 service, specifically the incident involving Lewis Garfield on 4th December 2024. I am now able to respond following a full review by the Collation of Facts Manager, Amy Harman, Senior Emergency Call Taker.

Firstly, I would like to offer my sincere apologies for any upset and distress caused as a result of this incident involving Mr Garfield.

Before answering your concern in detail, it may be helpful to explain how the emergency ambulance service operates and interacts with other service providers. Patients and callers contacting the service are assessed by an Emergency Call Taker (ECT) who is not clinically trained utilising a Clinical Decision Support Software system called NHS Pathways. This has been licensed by NHS England (NHSE) for use by UK ambulance services.

Please find below the information requested in relation to the concerns raised regarding the call activity involving Mr Lewis Garfield on Wednesday, 4th December 2024.

Included is a detailed timeline of the patient’s journey through our Emergency Operations Centre (EOC), the outcomes of all relevant call audits, and responses to your specific queries.

Timeline and Call Overview

00:30:57 – Amy can confirm this was the first 999 call received by South Central Ambulance Service (SCAS). This call was triaged by an ECT. The caller reported the patient had been found at the bottom of the stairs with injuries to his head and back. The patient, who had dementia, denied falling down the stairs. Due to the caller being unable to provide enough clinical detail to support a full triage, the call was coded as "triage not possible" per NHS Pathways protocol.

00:44:49 – A Category 3 ambulance request was sent to EMAS via ITK . Audit Outcome: Compliant with NHS Pathways standards.

2 00:50:27 – Second 999 call received. The patient’s condition was reported to have worsened, with mention of a potential shoulder injury and increased breathlessness. A neighbour, identified as a GP, had assisted the patient into a chair.

00:58:34 – A Category 2 ambulance request was sent to EMAS via ITK

Audit Outcome: Non-compliant due to the factors listed below.  The ECT incorrectly recorded the patient as unable to get off the floor.  Additional location information that could assist the attending crew was not relayed. Despite these learning points, the audit found that the overall triage category and response priority were unaffected and a safe an appropriate outcome was reached, based on the Mr Garfield’s presentation at the time of the call.

The learning points from the audit were addressed through a face-to-face debrief with the ECT, supported by a Call Review Plan and Reflective Practice Exercise. Further support has been offered to ensure learning is embedded.

01:38:31 – Third call received from the patient’s neighbour requesting an ETA. No change in clinical condition was reported.

01:48:06 – ETA request was manually passed to EMAS. Audit Outcome: This call was compliant with the expected standards and processes.

02:29:18 – Fourth call received. The patient’s wife reported new confusion and increasing breathlessness, though the head wound had ceased bleeding.

02:33:10 – A further Category 2 ambulance request was made via ITK to EMAS (reference:
19152499). Audit Outcome: This call was also compliant with the expected standards and processes. A safe and appropriate outcome was reached based on the patient’s presentation at the time of the call.

Call Audit Summary  Three of the four calls were triaged in accordance with NHS Pathways protocols and SCAS procedures.  One call (second) was found to be non-compliant due to errors in documentation and omission of supplementary information. However, this did not alter the disposition or call category.  Corrective action has been taken and learning has been shared directly with the call handler.

Call Cycle Summary

Each contact received by the EOC was appropriately escalated via ITK to EMAS. Calls were handled in line with NHS Pathways guidance and SCAS policy, with the exception of the isolated deviation outlined above.

The investigation of complaints and feedback form an important part of organisational learning and service development which contributes to the aim of providing a consistently high quality of service to patients, so I would like to thank you for supporting this process.

I would also like to thank you for providing us with the opportunity to address your concerns and I hope that you are reassured and satisfied with the response given. If you have any further queries, please do not hesitate to contact the Patient Experience Team.

Dear Mr Shah

Regulation 28: Report to prevent future deaths re Mr Lewis Aubrey Garfield

I write in response to the above report issued on 28th October 2025 to University Hospitals of Northamptonshire NHS Group (UHN).

I would like to firstly express my sincere condolences to the family of the late Mr Garfield and to acknowledge and apologise for the delayed ambulance handover times noted at the inquest on 27th October 2025.

This response to the Regulation 28 Report builds on the previous information provided on actions being taken to mitigate the impact of pressures in the healthcare system and our adoption of the “45 minute handover” approach.

Ambulance Handover Improvement Planning Update 4th Dec 2025 It is recognised 2024/25 was one of the most challenging years for delivery of urgent and emergency care within Northamptonshire and its hospitals. Long ambulance delays impacted both delivery of urgent care across the Emergency Department with average handovers of 84mins in Dec-24 and impact on Cat2 ambulance response with up to an average response time of 111mins in Dec-24. Since January 2025 University of Northamptonshire Hospitals (UHN) have worked through a UEC improvement programme in collaboration with support from NHS England and Getting it Right First Time (GIRFT) team to improve delivery of the UEC pathway and reduce ambulance handover delays. This included a Trust and system partner commitment across ICB, Local Authorities, EMAS and NHFT to winter preparedness commencing much earlier in the year following lessons learnt. Key winter schemes developed in the UHN Winter Plan were approved through Trust Board on 1st August 2025. UEC improvements have focused on safety within the Emergency Department(s), utilising alternative strengthened pathways to ED and improvement in admitted patient flow through reduction in length of stay.

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Ambulance Handover Performance

Overcrowding in the Emergency Department is well recognised as impacting on quality and safety, increasing risk of harm to patients if unable to handover from ambulances. This risk is actively monitored through the Trust Accountability Framework with performance and actions reviewed through Divisional Accountability meetings, Clinical Quality and Safety Committee in Common, Trust Board and ICB UEC Board. In line with this year’s 2025/26 planning guidance and Urgent and Emergency Care Recovery plan a 45min handover ceiling has been worked towards in close collaboration with EMAS colleagues both at Directorate and Director level. Ambulance handover performance both in terms of average handover times and compliance against max 45min handovers has improved throughout the year, see figure 1. Figure 1. Data source: Ambulance and NHS111 Commissioning Team, Derby ICB

It is also important to reflect on the Nov-25 against Nov-24 position, particularly in the context of a YTD position of 5% increase in conveyances against plan.

Performance Metric Nov-24 Nov-25 Variance Northampton Average handover time 82mins 28mins
-54mins % Handovers achieved in <45 mins 47% 88% 41% Kettering Average handover time 86mins 32mins
-54mins % Handovers achieved in <45 mins 49% 87% 38% Data source: Ambulance and NHS111 Commissioning Team, Derby ICB

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Summary of Key Actions Taken

Transformation and Strategic Developments

As of Monday 3rd November at NGH, a new purpose built Rapid Assessment Unit (RAU) was commissioned providing 8 additional trolley spaces aimed at handover within 15mins into a dedicated space for primary assessment of patients. This forms a key part of strategic planning that will see a new Urgent Treatment Centre open from July 2026 with works already having commenced.

The UTC facility will provide a consolidated single front door for walk in patients seeking emergency care with rapid assessment and triage of patients with the ability to take direct ambulance referrals from co-located facilities.

In commitment of reducing handover delays the identify of Nye Bevan wards have been formalised with a new dedicated Acute Assessment Unit (AAU) on Walter Tull with Esther White ward being 72hr medical short stay. This key improvement in patient pathway has enabled suitable patients to be identified within the RAU and streamed directly into the AAU reducing the demand into the ED further reducing handover delays. This is a key improvement in the way patient care is being delivered to improve the patient experience through reducing delays in ED and seeing medical patients in the right location at the right Date Action Implemented Impact Mar 2025 Implementation of a standardised Transfer of Care (TOC) form across UHN. Improve quality and reduce delays associated with TOC referrals into the discharge hub. Mar 2025 Frailty SDEC go live KGH. Dedicated capacity for Frailty SDEC service. Mar 2025 Agreement of Internal Professional Standards across UHN. Expectations on timeliness of speciality support and escalation. Apr 2025 Sir Thomas Moore Ward (KGH) reopened to adult patients for 24/7 discharge lounge. 14 additional bed spaces and 8 chairs for patients planned discharge to reduce length of stay. Apr 2025 Formalised direct to SDEC pathways for EMAS and extended operating hours. 15% increase in SDEC activity to reduce ED attendance and overcrowding. Apr-May 2025 Boardround test for change and Boardround SOP (NGH). Improved discharge planning and boardround documentation. May 2025 Release to Respond Go live NGH. Implement release to respond model with key escalation triggers to balance clinical risk across the organisation. June 2025 NyeBevan move to medicine speciality only and address backflow of patients with GIRFT. Reduced LoS on NyeBevan with reduced medical outliers in surgical wards. July 2025 Use of Siren to review patient identifiable information from EMAS pre arrival. Reduce delays associated with registration of patients into EPR. Sept 2025 Twice weekly system partner escalation calls for complex discharge support. Improvement in super stranded position across UHN. Oct 2025 Cardiology Virtual Ward launched at NGH. Reduce length of stay through virtual monitoring of heart failure patients who would otherwise meet criteria to reside. Oct 2025 Frailty SDEC go live NGH. Frailty team based in medical SDEC for speciality assessment. Oct 2025 Trusted Assessor introduced at NGH. Reduce discharge delays for patients returning to care homes. Nov 2025 Rapid Assessment Unit (RAU) and Acute Assessment Unit (AAU) go live. Increase in capacity of ambulance handover space and medical pathway directly into AAU reducing ED demand. Dec 2025 Introduction of nerve centre pre arrivals screen

Improvement in <15min handovers as EMAS Siren clinical history added as pre arrival ready for handover once ambulance arrives to site.

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time. This has provided a step change of ~3% improvement in 12hr performance within the ED and reducing overcrowding alongside a reduced requirement to use ED temporary escalation capacity.

Digital Enabler

Since July 2025, both sites have actively engaged in access and review of patient information documented by EMAS crews for patients who are inbound (Siren EPR).

Through the development of NerveCentre at NGH site - a pre arrivals screen is now available from 1st December. This has been a key digital enabler for the ED team to input clinical history directly into NerveCentre ahead of the crew arriving to site, rather than having to book in when the crew arrive. This will further improve <15mins handover time.

Our priority is to provide safe, high-quality care for our patients. We are working closely with our system partners across the ICB, Local Authorities, EMAS and community partners from Northamptonshire Healthcare NHS Foundation Trust, to further reduce the impact of delays on patients and staff, including implementation of the national 45-minute maximum ambulance handover time standard.

I trust that the above information details our commitment to improve patient safety by continuously working to meet and maintain the national standard.