Barbara Hollis

Dear Ms Lake Inquest into the death of Barbara Hollis am writing further to the inquest into the death of Barbara Hollis, which took place on 24 August 2022, andthe concerns You raised in relation to the in EEAST attending: understand that Chris Hewetson gave evidence in relation to the steps the Trust was to manage the current call demand and you have requested a further reviewto eakabliso { estal iffurther steps should be taken in respect ofthis. The Trust is working hard with our system partners across the region to ensure that our patients are safe during this challenging period: Like all other ambulance trusts; we are also working with the Healthcare Safety Investigation Branch HSIB) to continue to escalate our concerns_ Ihave attached our current action plan that has recently reviewed Ata local level; the Trust has a number of ongoing actions in Norfolk aimedat addressing the handover Daily system calls take place between EEAST, and other stakeholders, chaired by the ICB (Integrated Care Board) and respective hospitals and discuss any lengthy and interim measures that need to be put in place: The 'Category drop and go' and s avtagole : release' projects are also in place although these are not always atthe acute due to capacity_ Tohighlight the nature ofthe handover delays, last month we lost hours of ambulance time outside hospitals in Norfolk waiting to handover; after the 15-minute handover period (. not including that time). This does account forthe hours spent 'cohorting patients nor the lost mana time supporting this. As can be seen the effect on our Cz response time is hugely ragageann and correlates directly with delayed handovers. Escalations continue to take place regularly at executive levelto try and ease this situation, but the trend nevertheless is still currently worsening: Impact of Norfolk Hospital delays 7000
55.12 6000
40.48 5000
26.24 1200 1 4000
57.36 3 3000 43-12 2000
28.48 1000
14.24 00,00 "WHqer I 2 [ 28- 081 I # g3 1 ppit Wpeq 42 8 A-H>15 mins hours Iost delay delay been delays; delays rapid 6295 not
e.i

The initiative mentioned earlier relate to the 'Category 1 drop and go' process which means that if a Category 1 call is received and there is a crew waiting with a patient at hospital, the crew can their patient off immediately to attendto the Equally, the 'Category 2 rapid release means that if a Category 2 Pateegoyas Beerassegued over the phone by a Clinical Co-ordinator and revalidated as a valid Category call; the rapid release programme allows a crew to handover a patient at the hospital within 10 minutes to allow that crew to then attend to the Category 2 patient_ The aim ofthese schemes is to help improve the response time to patients who are suffering with chest pain or potentially having a stroke_ Furthermore; the Association of Ambulance Chief Executives (AACE) released a briefing for HM Coroners in relation to hospital handover and delayed ambulance responses to 999 calls and this was shared with your office on 30 August 2022_ have also attached a copy for your information: am for the delay that Barbara Hollis and her family experienced and would be grateful if you could pass a copy ofthis letter onto Barbara's family:

Dear Madam

Following the three inquests held earlier this ye~r in relation to the deaths ofl Barbara

I am writing to update you on actions taken in response to t he recommendations you made:
• Ensure all patients admitted to Spire Norwich Hospital are aware that the hospital does not have an on-site critical care unit
• In liaison with East of England Ambulance Service, agree a process to support timely ambulance transfers and early notification of when an ambulance is required In order to ensure.all patients are aware that Spire Norwich Hospital does not have a critical care unit, we have added the following wording to patient admission letters: In the unlikely event of an unforeseen emergency requiring specialist care or facilities not available at Spire Norwich Hospital, it may be necessary to transfer you to the Norfolk and Norwich University Hospital. If this is necessary, it will be as an NHS patient, as many services are simply not provided privately in these circumstances, and rapid emergency NHS treatment would be in your best interest. I met with , Patient Safety Officer (EEAST) and , Control Room Lead (EEAST) on the 1311' October 2022 to discuss options to improve ambulance response times fo r inter- provider transfers. We discussed the pressure facing the ambulance service at this time in great detail and took the time to explain that it would not be possible to provide any assurance regarding ambulance response times or to agree an early notification or booking service as you had suggested, due to t he req uirement to manage demand through the existing triage and prioritisation system. However, we did acknowledge that the ability to have a clinician to clinician discussion, where Spire senior nursing or medical staff can speak to a clinical lead within EEAST would enable detailed information to be provided regarding the rationale for transfer and patient condition. This would provide the ambulance service with more clinical information to assist with prioritisation of resources along with providing Spire statt more information in relation to wait ing times, thus assisting with patient care management plans whilst awaiting transfer. Therefore, we have agreed the following;
• On occasions where a delayed response to an IFT request is advised the caller may wish to speak to the EOC Clinical Co-ordinator direct ly, or request a clinical review, for consideration of a Priority Response, Rapid Release or Drop and Go to facilitate a more prompt response.

Details ot the request, including caller contact name and number, and a brief summary of any information pertinent to the request (such as treatment window or risk of deterioration) shoulci he recorded in CAD notes anrl escalated to the Clinical Co-ordinator throu~h normal esca lation channels.
• The EOC Clinical Co-ordinator is to review any such request as per normal process and decision making taking into account community risk and demand. Any decision must be communicated to the clinician making the IFT request and relevant dispatch team as required. We continue to consider other options to support timely transfer of patients, including liaison with private ambulance providers. The challenges with ambulance transfer delays have been reported to Spire Healthcare' s Executive committee and we are being supported to seek solutions to this challenge at a national level. Kind regards

Director of Clinical Services