West Yorkshire Integrated Care Board
Integrated Care Board
Action Planned
The ICB is working to implement the Better Ambulatory Record Sharing (BaRS) system, which would allow EDs to access NHS 111 Online assessment data, with a target date of March 2026. They are also promoting access to medical histories through the Yorkshire and Humber Care Record. (AI summary)
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Dear Mr Longstaff, Thank you for your letter of 13th June 2025 in relation to the Regulation 28 report to prevent future deaths following the inquest into the death of Chloe Ellis. This was issued to the West Yorkshire Integrated Care Board (WYICB), White Rose House, West Parade, Wakefield, WF1 1LT. I would like to offer my sincere condolences to Chloe’s family on behalf of the NHS West Yorkshire Integrated Care Board. I am sorry for their loss and for the circumstances surrounding Chloe’s death. You raised the following Matters of Concern:
• The inquest was told that it is possible for the outcomes of NHS 111 online assessments to be made accessible to Emergency Department (ED) clinicians, and that the decision whether or not to commission that accessibility in a particular hospital rests with the relevant Integrated Care Board.
• The inquest was told that the WYICB has not commissioned accessibility to NHS 111 online assessments for the Mid Yorkshire Teaching NHS Trust (MYTT).
• If the NHS online assessment completed by Ms Ellis had been available to the relevant clinicians at Dewsbury District Hospital, her history of oral contraceptive use and the suspicion of a pulmonary embolism would have been visible to them.
• The availability of NHS 111 online assessments to clinicians in EDs may assist in the obtaining of a full history and may act as a failsafe against inadequate history taking in EDs.
I will respond to these points and hope to provide assurance around actions that WYICB is taking as a result.
111 Online Assessments and Data Sharing Timely access to comprehensive medical records — including NHS 111 online assessments — is an important contributor to supporting effective and safe clinical assessments within Emergency Departments (EDs). At the time of the case involving Chloe, no Emergency Departments across West Yorkshire had access to NHS 111 Online assessment data. This meant that the assessment information could not be shared with Emergency Department clinicians. At present, NHS 111 Online is commissioned nationally by NHS England (NHSE) and not directly by the West Yorkshire Integrated Care Board (WYICB). When a patient completes an NHS 111 Online assessment, the system advises them on the most appropriate local service to attend. We have been considering options for the development of “interoperable” systems locally that can routinely share data, including these assessments, between NHS111 and EDs. However, there is now a national solution in development which is designed to enable the safe, structured transfer of such information across systems. This is called the Booking and Referral Standard (BaRS). Our approach will be to use the BaRS in West Yorkshire. Implementation of the Booking and Referral Standard (BaRS) BaRS is a national interoperability standard that enables the secure sharing of patient information, supporting both clinical care and operational processes. It is expected to enhance patient safety, especially within urgent and emergency care, by ensuring essential clinical information is available to clinicians in real-time. The national development and implementation of BaRS was first signalled in the 2022 Plan for Digital Health and Social Care. NHS England has recently confirmed that BaRS is now being rolled out to support urgent and emergency care pathways. Adoption of BaRS is the responsibility of individual NHS trusts and their suppliers. However, compatibility with many existing NHS IT systems — such as Symphony, currently used within Mid Yorkshire Teaching Trust (MYTT) — is not yet in place and still under development. WYICB is working actively with national and local partners to facilitate this integration. It is anticipated that NHS 111 Online assessment data could be available to EDs in West Yorkshire by March 2026. Broader Efforts to Improve Access to Clinical Information In addition to supporting BaRS implementation, WYICB is also promoting access to medical histories through the Yorkshire and Humber Care Record, which offers clinicians improved visibility of a patient’s broader health information. This is another important step towards more joined-up and informed care. Medical history information is shared via the Yorkshire and Humber Care Record, providing
clinicians with a holistic view of a patient’s health. This comprehensive information enables clinicians to make a more informed assessment. We are aware that the inquest into the death of Chloe was informed of actions being taken by Mid Yorkshire Teaching Trust to improve the assessment of patients presenting at the Emergency Department. WYICB is committed to working in close partnership with MYTT to further support these improvements. I hope this letter provides reassurance of our commitment to improving both patient safety and interoperability between services. We will continue to engage with colleagues from both MYTT and NHSE to support continued improved interoperability and transfer a critical patient information. Should you have any further questions, or need for clarification please do not hesitate to contact me again.
• The inquest was told that it is possible for the outcomes of NHS 111 online assessments to be made accessible to Emergency Department (ED) clinicians, and that the decision whether or not to commission that accessibility in a particular hospital rests with the relevant Integrated Care Board.
• The inquest was told that the WYICB has not commissioned accessibility to NHS 111 online assessments for the Mid Yorkshire Teaching NHS Trust (MYTT).
• If the NHS online assessment completed by Ms Ellis had been available to the relevant clinicians at Dewsbury District Hospital, her history of oral contraceptive use and the suspicion of a pulmonary embolism would have been visible to them.
• The availability of NHS 111 online assessments to clinicians in EDs may assist in the obtaining of a full history and may act as a failsafe against inadequate history taking in EDs.
I will respond to these points and hope to provide assurance around actions that WYICB is taking as a result.
111 Online Assessments and Data Sharing Timely access to comprehensive medical records — including NHS 111 online assessments — is an important contributor to supporting effective and safe clinical assessments within Emergency Departments (EDs). At the time of the case involving Chloe, no Emergency Departments across West Yorkshire had access to NHS 111 Online assessment data. This meant that the assessment information could not be shared with Emergency Department clinicians. At present, NHS 111 Online is commissioned nationally by NHS England (NHSE) and not directly by the West Yorkshire Integrated Care Board (WYICB). When a patient completes an NHS 111 Online assessment, the system advises them on the most appropriate local service to attend. We have been considering options for the development of “interoperable” systems locally that can routinely share data, including these assessments, between NHS111 and EDs. However, there is now a national solution in development which is designed to enable the safe, structured transfer of such information across systems. This is called the Booking and Referral Standard (BaRS). Our approach will be to use the BaRS in West Yorkshire. Implementation of the Booking and Referral Standard (BaRS) BaRS is a national interoperability standard that enables the secure sharing of patient information, supporting both clinical care and operational processes. It is expected to enhance patient safety, especially within urgent and emergency care, by ensuring essential clinical information is available to clinicians in real-time. The national development and implementation of BaRS was first signalled in the 2022 Plan for Digital Health and Social Care. NHS England has recently confirmed that BaRS is now being rolled out to support urgent and emergency care pathways. Adoption of BaRS is the responsibility of individual NHS trusts and their suppliers. However, compatibility with many existing NHS IT systems — such as Symphony, currently used within Mid Yorkshire Teaching Trust (MYTT) — is not yet in place and still under development. WYICB is working actively with national and local partners to facilitate this integration. It is anticipated that NHS 111 Online assessment data could be available to EDs in West Yorkshire by March 2026. Broader Efforts to Improve Access to Clinical Information In addition to supporting BaRS implementation, WYICB is also promoting access to medical histories through the Yorkshire and Humber Care Record, which offers clinicians improved visibility of a patient’s broader health information. This is another important step towards more joined-up and informed care. Medical history information is shared via the Yorkshire and Humber Care Record, providing
clinicians with a holistic view of a patient’s health. This comprehensive information enables clinicians to make a more informed assessment. We are aware that the inquest into the death of Chloe was informed of actions being taken by Mid Yorkshire Teaching Trust to improve the assessment of patients presenting at the Emergency Department. WYICB is committed to working in close partnership with MYTT to further support these improvements. I hope this letter provides reassurance of our commitment to improving both patient safety and interoperability between services. We will continue to engage with colleagues from both MYTT and NHSE to support continued improved interoperability and transfer a critical patient information. Should you have any further questions, or need for clarification please do not hesitate to contact me again.