Department of Health and Social Care
Central Government
Action Taken
EEAST is working with the integrated care system to reduce arrival to handover times, has implemented unscheduled care coordination, and has increased referrals into community teams. The government delivered over 5,000 more staffed, permanent hospital beds this year compared to 2022-23 plans, scaled up virtual ward bed capacity to over 10,000 ahead of winter 2023/24, and provided £1.6 billion to support timely and effective discharge from hospital. (AI summary)
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Dear Jacqueline,
Thank you for the Regulation 28 report to prevent future deaths of 29/09/23 about the death of John Winsworth. I am replying as Minister with responsibility for urgent and emergency case services.
Firstly, I would like to say how saddened I was to read of the circumstances of John Winsworth’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 significant delay in responding to this matter. Your report raised concerns about ambulance response times, handover delays, and A&E waiting times. In preparing this response, Departmental officials have made enquiries with NHS England and the Care Quality Commission. I am also aware you have written directly to the East of England Ambulance Service Trust (EEAST).
My officials have advised me that the EEAST have taken the following actions taking to work with the integrated care system to reduce the impact of delays and reduce patient harm, including but not limited to:
EEAST are a member of the “Front Door Group” looking to improve arrival to handover times. This is chaired by the Deputy Director for Intensive Support from the NHSE/I team. EEAST have shared good practice from West Suffolk and Colchester Hospitals within the group, which is attended by all Acutes in the area. EEAST have also approached each Acute to review the current process and suggested changes to allow quicker offloads.
EEAST have implemented the unscheduled care coordination with the Integrated Care Board, Integrated Care 24 and community teams and have increased referrals into these teams through enhanced triage. This has also supported crews on scene, and this will
strengthen their conveyance rate across Norfolk and Waveney as being consistently the lowest in the trust.
• EEAST has also been involved in an ‘Improvement Week’ from 9 – 13 October 2023 in Norfolk and Waveney. The medical teams have been working alongside crews, dispatchers, and call handlers to better understand the issues behind delays for patients and helping identify ways to resolve them. This week will be run as a continuous improvement exercise and will use quality improvement approaches to capture real time information and potential solutions to the challenges they face.
As the Minister responsible for urgent and emergency case services, I recognise the significant pressure the urgent and emergency care system is facing. That is why we published our ‘Delivery plan for recovering urgent and emergency care services’ which aims to deliver sustained improvements in waiting times. Our ambitions for this year are to improve A&E waiting times to 78% of patients to be admitted, transferred, or discharged from A&E within four hours by March 2025, and to reduce Category 2 ambulance response times to 30 minutes across this fiscal year. The plan is available at https://www.england.nhs.uk/wp- content/uploads/2023/01/B2034-delivery-plan-for-recovering-urgent-and-emergency-care- services.pdf.
Your report highlights that EEAST were under high demand at the time of the incident. Alongside the local actions outlined above, a primary aim of our delivery plan is to boost ambulance capacity. Ambulance services received £200 million of additional funding in 2023/24 to expand capacity and improve response times, and we are maintaining this additional capacity in 2024/25. This is alongside the delivery of new ambulances and specialist mental health vehicles. With more ambulances on the road, patients will receive the treatment they need more swiftly.
I recognise that ambulance trusts work within a health and care system and issues such as delayed patient handovers to hospitals can impact on capacity and response times. That is why a key part of the delivery plan is about improving patient flow and bed capacity within hospitals. We achieved our 2023/24 ambition of delivering 5,000 more staffed, permanent hospital beds this year compared to 2022-23 plans, backed by £1 billion of dedicated funding, and we will maintain this capacity uplift in 2024/25. Further, we also achieved our target of scaling up virtual ward bed capacity to over 10,000 ahead of winter 2023/24, and there are now over 11,000 beds available nationally. We also have provided £1.6 billion of funding over two years to support the NHS and local authorities to ensure timely and effective discharge from hospital. These measures are helping improve patient flow through hospitals, reducing delays in patient handovers so ambulances can swiftly get back on the roads.
At a national level, we have seen significant improvements in performance this year compared to last year. In 2023-24, year-to-date average Category 2 ambulance response times (including for serious conditions such as heart attacks and strokes) were almost 15 minutes faster compared to the same period last year, a reduction of over 27%. EEAST average Category 2 response times were over 23 minutes faster compared to the same time period last year, 34% faster.
However, I recognise there is still more to do to reduce response times further, and the Government will continue to work with NHS England to achieve this.
Thank you once again for bringing these concerns to my attention.
Yours,
HELEN WHATELY
Thank you for the Regulation 28 report to prevent future deaths of 29/09/23 about the death of John Winsworth. I am replying as Minister with responsibility for urgent and emergency case services.
Firstly, I would like to say how saddened I was to read of the circumstances of John Winsworth’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 significant delay in responding to this matter. Your report raised concerns about ambulance response times, handover delays, and A&E waiting times. In preparing this response, Departmental officials have made enquiries with NHS England and the Care Quality Commission. I am also aware you have written directly to the East of England Ambulance Service Trust (EEAST).
My officials have advised me that the EEAST have taken the following actions taking to work with the integrated care system to reduce the impact of delays and reduce patient harm, including but not limited to:
EEAST are a member of the “Front Door Group” looking to improve arrival to handover times. This is chaired by the Deputy Director for Intensive Support from the NHSE/I team. EEAST have shared good practice from West Suffolk and Colchester Hospitals within the group, which is attended by all Acutes in the area. EEAST have also approached each Acute to review the current process and suggested changes to allow quicker offloads.
EEAST have implemented the unscheduled care coordination with the Integrated Care Board, Integrated Care 24 and community teams and have increased referrals into these teams through enhanced triage. This has also supported crews on scene, and this will
strengthen their conveyance rate across Norfolk and Waveney as being consistently the lowest in the trust.
• EEAST has also been involved in an ‘Improvement Week’ from 9 – 13 October 2023 in Norfolk and Waveney. The medical teams have been working alongside crews, dispatchers, and call handlers to better understand the issues behind delays for patients and helping identify ways to resolve them. This week will be run as a continuous improvement exercise and will use quality improvement approaches to capture real time information and potential solutions to the challenges they face.
As the Minister responsible for urgent and emergency case services, I recognise the significant pressure the urgent and emergency care system is facing. That is why we published our ‘Delivery plan for recovering urgent and emergency care services’ which aims to deliver sustained improvements in waiting times. Our ambitions for this year are to improve A&E waiting times to 78% of patients to be admitted, transferred, or discharged from A&E within four hours by March 2025, and to reduce Category 2 ambulance response times to 30 minutes across this fiscal year. The plan is available at https://www.england.nhs.uk/wp- content/uploads/2023/01/B2034-delivery-plan-for-recovering-urgent-and-emergency-care- services.pdf.
Your report highlights that EEAST were under high demand at the time of the incident. Alongside the local actions outlined above, a primary aim of our delivery plan is to boost ambulance capacity. Ambulance services received £200 million of additional funding in 2023/24 to expand capacity and improve response times, and we are maintaining this additional capacity in 2024/25. This is alongside the delivery of new ambulances and specialist mental health vehicles. With more ambulances on the road, patients will receive the treatment they need more swiftly.
I recognise that ambulance trusts work within a health and care system and issues such as delayed patient handovers to hospitals can impact on capacity and response times. That is why a key part of the delivery plan is about improving patient flow and bed capacity within hospitals. We achieved our 2023/24 ambition of delivering 5,000 more staffed, permanent hospital beds this year compared to 2022-23 plans, backed by £1 billion of dedicated funding, and we will maintain this capacity uplift in 2024/25. Further, we also achieved our target of scaling up virtual ward bed capacity to over 10,000 ahead of winter 2023/24, and there are now over 11,000 beds available nationally. We also have provided £1.6 billion of funding over two years to support the NHS and local authorities to ensure timely and effective discharge from hospital. These measures are helping improve patient flow through hospitals, reducing delays in patient handovers so ambulances can swiftly get back on the roads.
At a national level, we have seen significant improvements in performance this year compared to last year. In 2023-24, year-to-date average Category 2 ambulance response times (including for serious conditions such as heart attacks and strokes) were almost 15 minutes faster compared to the same period last year, a reduction of over 27%. EEAST average Category 2 response times were over 23 minutes faster compared to the same time period last year, 34% faster.
However, I recognise there is still more to do to reduce response times further, and the Government will continue to work with NHS England to achieve this.
Thank you once again for bringing these concerns to my attention.
Yours,
HELEN WHATELY