O’Shea Dover

Dear Mr Straker

O’SHEA MEDAD DOVER (DECEASED)

I am writing in response to the preventing future deaths report that was sent to , Clinical Support Manager for Association of Ambulance Chief Executives and I respond as our Director of Operational Development and Quality Improvement on behalf of AACE.

Firstly, on behalf of AACE, I would like to extend our sincere condolences to the family of O’Shea Dover.

It may be helpful for us to explain that AACE is a private company owned by the English and Welsh NHS ambulance services. Its purpose is to support its members, UK NHS ambulance services, in the implementation of national agreed policy and to act as an interface, where appropriate at a national level, between them and their stakeholders. It is a company owned by NHS organisations and possesses the intellectual property rights of the Joint Royal Colleges Ambulance Liaison Committee UK ambulance service clinical practice guidelines (the “JRCALC guidelines”). AACE is not constituted to mandate or instruct ambulance services however it has national influence via the regular meetings of ambulance chief executives and chairs along with a network of national specialist sub-groups.

It is important to note that the JRCALC guidelines are advisory and have been developed to assist healthcare professionals inform patients and to make decisions about the management of the patient’s health, including treatments. This advice is intended to support the decision making process and is not a substitute for sound clinical judgement. The guidelines cannot always contain all the information necessary for determining appropriate care and cannot address all individual situations; therefore, individuals using these guidelines must personally ensure they have the appropriate knowledge and skills to enable suitable interpretation.

We respond in relation to your matter of concern:

Consideration to be given for the national JRCALC guidance to include the London Ambulance Service’s JRCALC Plus recommendation that where delivery is not progressing the patient should be conveyed to an obstetric unit.

We have liaised with our lead maternity and consultant paramedic colleagues at London Ambulance Service to understand more about the decisions made by the attending ambulance clinicians and midwives that attended the address, and around whether to move the patient to hospital immediately or not. We have also taken time to understand the learning and changes that have been made in London in relation to this case.

We are consulting with our expert advisors for our JRCALC guidance, obstetricians and midwives and the NHS England National Maternity team.

All our JRCALC guidance is updated on a frequent basis. The guidance is available to all UK ambulance paramedics and is used on an App. We regularly respond to learning from incidents and issues or

concerns raised so that we can continue to improve the guidance towards improving patient care. We currently have JRCALC guidance for a range of maternal emergencies, and we have guidance called ‘Maternal care (including obstetric emergencies overview)’ and ‘Birth Imminent -normal birth and birth complications’. These guidelines detail the appropriate destination for conveyance, including whether the patient should be conveyed to an obstetric unit, birth/birthing centres (or 'standalone' maternity units) or in some cases to the emergency department.

As a result of the learning from this incident two guidelines are now under review and will take into account the matters of concern you have raised about conveying the patient if delivery is not progressing. The decision whether to move the patient may differ in every individual situation and would continue to be made by the attending clinicians.

The guidance will be updated following the review we have commenced, and this is expected to take around three months. When the guidance is updated it will be issued as a clinical update onto the App following our usual process which involves approvals from JRCALC and our National Ambulance Medical Directors group (NASMeD).

If you have any further questions please do not hesitate to get in touch.