South Western Ambulance Service NHS Foundation Trust
NHS / Health Body
Action Taken
South Western Ambulance Service NHS Foundation Trust has implemented a Standard Operating Procedure to address handover delays, which is being reviewed and updated against local agreements. They are involved in senior county-level meetings and have implemented initiatives such as the 'Timely Handover Process' and 'Hear and Treat' approach. (AI summary)
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Dear Ms McKinlay
Prevention of future deaths report touching on the death of Mr Graham Whiteley
I am writing on behalf of South Western Ambulance Service NHS Foundation Trust (thereafter referred to as the SWAST) in response to a Regulation 28 report to prevent future deaths, issued in relation to death of Mr Graham Whiteley. Our thoughts are with Mr Whiteley’s family, and we send them our sincere condolences.
Handover delays at hospital trusts have the biggest impact on SWAST’s ability to respond to patients. This articulated on the SWAST corporate risk register, where a risk related to system activity and flow sits at the highest level, with a risk score of 25. The challenge with impacts of handover delays is that SWAST alone cannot solve it. In August 2023, the Health Services Safety Investigation Body (HSSIB) published a final report ‘Harm caused by delays in transferring patients to the right place of care’. This report strengthens the findings of the SWAST system PSII report that was produced in July 2022, with a review and an addendum added in December 2023. It is recognised that a patient’s health may deteriorate while they are waiting to be seen by ED staff, or they may be harmed because they are not able to access timely and appropriate treatment.
At SWAST we are working to combat and reduce handover delays. This is a key priority to improve access to our services and to reduce harm to patients waiting in the community for an ambulance response.
To address handover delays, a Standard Operating Procedure (SOP) was introduced in late 2021. This has since been reviewed and updated, with a reassessment against locally agreed standards conducted in December 2023 and January 2024. The SOP facilitates the effective management of delays by employing four handover escalation levels. Local teams have collaborated with each hospital to determine the specific actions to be taken at each level. The triggers for escalation have also been locally established, enabling a more responsive and tailored approach. Additionally, the approach includes a designated area for immediate patient handover in situations where the Trust is unable to respond to a pending local Category 1 call within a reasonable timeframe.
SWAST remains committed to collaborating with hospitals to address this issue. In many instances, local operations teams hold daily meetings with their respective Emergency Departments. Resolving delays has been identified as a key priority by the regional NHS England (NHSE) team, and SWAST actively participated in the NHSE Ambulance Handovers task and finish group during the summer of 2024. Additionally, in 2024, a new tier of senior county-level meetings was established, bringing together hospitals, commissioners, NHSE, and SWAST. These meetings have provided SWAST with valuable opportunities to engage in Integrated Care System (ICS) discussions aimed at reducing delays.
Building on the aforementioned efforts, several initiatives are being implemented locally and across the South West by SWASFT. These include:
• Maintaining a robust ‘Hear and Treat’ approach, with referrals made, where suitable, to alternative services such as NHS 111 or self-care options.
• Maximising the use of ‘See and Treat’ to reduce the number of patients transferred to Emergency Departments (ED) unless absolutely necessary.
• Providing Hospital Ambulance Liaison Officer (HALO) support at acute hospitals when required to aid patient flow.
• Ensuring the Trust’s Operations Delivery Cell minimises resource unavailability as much as possible, increasing the capacity to respond effectively.
• Supporting the establishment of the Care Coordination Hub in Somerset, which launched on the 4th November 2024 and co-locating a specialist to further optimise appropriate patient conveyance to ED.
• Employing mutual aid solutions, including the use of Private Ambulance Providers, to bolster system support during periods of high demand.
These actions reflect a concerted effort to enhance patient care and system efficiency.
We have also collaborated with the Somerset system to implement the ‘Timely Handover Process,’ designed to initiate a rapid handover if it has not been completed within 90 minutes of arrival. This process was introduced in the area in November 2024 and following a challenging Christmas period we are now seeing early improvements in handover efficiency.
SWAST is dedicated to collaborating with system partners to mitigate handover delays and minimise their impact on our patients.
Prevention of future deaths report touching on the death of Mr Graham Whiteley
I am writing on behalf of South Western Ambulance Service NHS Foundation Trust (thereafter referred to as the SWAST) in response to a Regulation 28 report to prevent future deaths, issued in relation to death of Mr Graham Whiteley. Our thoughts are with Mr Whiteley’s family, and we send them our sincere condolences.
Handover delays at hospital trusts have the biggest impact on SWAST’s ability to respond to patients. This articulated on the SWAST corporate risk register, where a risk related to system activity and flow sits at the highest level, with a risk score of 25. The challenge with impacts of handover delays is that SWAST alone cannot solve it. In August 2023, the Health Services Safety Investigation Body (HSSIB) published a final report ‘Harm caused by delays in transferring patients to the right place of care’. This report strengthens the findings of the SWAST system PSII report that was produced in July 2022, with a review and an addendum added in December 2023. It is recognised that a patient’s health may deteriorate while they are waiting to be seen by ED staff, or they may be harmed because they are not able to access timely and appropriate treatment.
At SWAST we are working to combat and reduce handover delays. This is a key priority to improve access to our services and to reduce harm to patients waiting in the community for an ambulance response.
To address handover delays, a Standard Operating Procedure (SOP) was introduced in late 2021. This has since been reviewed and updated, with a reassessment against locally agreed standards conducted in December 2023 and January 2024. The SOP facilitates the effective management of delays by employing four handover escalation levels. Local teams have collaborated with each hospital to determine the specific actions to be taken at each level. The triggers for escalation have also been locally established, enabling a more responsive and tailored approach. Additionally, the approach includes a designated area for immediate patient handover in situations where the Trust is unable to respond to a pending local Category 1 call within a reasonable timeframe.
SWAST remains committed to collaborating with hospitals to address this issue. In many instances, local operations teams hold daily meetings with their respective Emergency Departments. Resolving delays has been identified as a key priority by the regional NHS England (NHSE) team, and SWAST actively participated in the NHSE Ambulance Handovers task and finish group during the summer of 2024. Additionally, in 2024, a new tier of senior county-level meetings was established, bringing together hospitals, commissioners, NHSE, and SWAST. These meetings have provided SWAST with valuable opportunities to engage in Integrated Care System (ICS) discussions aimed at reducing delays.
Building on the aforementioned efforts, several initiatives are being implemented locally and across the South West by SWASFT. These include:
• Maintaining a robust ‘Hear and Treat’ approach, with referrals made, where suitable, to alternative services such as NHS 111 or self-care options.
• Maximising the use of ‘See and Treat’ to reduce the number of patients transferred to Emergency Departments (ED) unless absolutely necessary.
• Providing Hospital Ambulance Liaison Officer (HALO) support at acute hospitals when required to aid patient flow.
• Ensuring the Trust’s Operations Delivery Cell minimises resource unavailability as much as possible, increasing the capacity to respond effectively.
• Supporting the establishment of the Care Coordination Hub in Somerset, which launched on the 4th November 2024 and co-locating a specialist to further optimise appropriate patient conveyance to ED.
• Employing mutual aid solutions, including the use of Private Ambulance Providers, to bolster system support during periods of high demand.
These actions reflect a concerted effort to enhance patient care and system efficiency.
We have also collaborated with the Somerset system to implement the ‘Timely Handover Process,’ designed to initiate a rapid handover if it has not been completed within 90 minutes of arrival. This process was introduced in the area in November 2024 and following a challenging Christmas period we are now seeing early improvements in handover efficiency.
SWAST is dedicated to collaborating with system partners to mitigate handover delays and minimise their impact on our patients.