Ronald Bennett

Brighton and Sussex
University Hospitals
RECEIVED
26 JUN 2017

The Royal Sussex County Hospital
Eastern Road

Brighton

BN2 5BE

21 June 2017

Miss Gilva Tisshaw
Assistant Coroner
The Coroner's Office
Woodvale

Lewes Road
BRIGHTON

BN2 3QB

Tel: 01273 696955

Dear Miss Tisshaw
The late Mr Ronald Bennett, DOB: 05/05/1935

Thank you for your letter of 4 April 2017 addressed o Trust Managing Director.
You may be aware that Marianne Griffiths has since become Chief Executive of Brighton and
Sussex University Hospitals NHS Trust (BSUH) and | am replying on behalf of Ms Griffiths.

lam very sorry to read about the sad circumstances of Mr Bennett’s death and the concerns
which you have highlighted about the Trust's Emergency Department and lack of availability of
inpatient beds. These issues have been reviewed by the Clinical Lead for the Emergency
Department, the Clinical Director for the Acute Floor and by our Interim Chief Operating
Officer.

We recognise that since February 2016, the Trust, in common with NHS services in the rest of
the country, has had difficulty in complying with a range of emergency care performance
measures and national standards. Specifically, the problem of delays in ambulance staff being
able to hand over patients to the Emergency Department at the Royal Sussex County Hospital
(RSCH) has been caused by overcrowding in the Department. This has been compounded by
lack of bed availability for patients who need to be admitted. Bed availability is in turn linked to
delayed transfer of patients medically ready for discharge, who are waiting for packages of
care in the community or a residential setting.

Since January 2017, there have been significant efforts to work more closely with South East
Coast Ambulance Service NHS Foundation Trust (SECAMB) and this has been reflected in
improved ambulance handover performance. In March 2017 the ambulance handover
performance was the best for two years.

The following actions are also ongoing in order to improve patient flow and reduce
overcrowding in the Emergency Department:

(1) Local Authorities in England have been granted a budget increase of £1bn for 2017-
18. The details of how this will be deployed locally are still being worked out but we

anticipate this will have a significant impact on improving delayed transfers of
inpatients.

With our partner
¢ brighton and sussex
> medical school

(2) We are working with NHS 111 on our Directory of services to ensure patients are
directed to appropriate services other than the Emergency Department.

(3) We now have a £31m capital scheme in development to expand the emergency floor,
including an expanded Urgent Care Centre at the Royal Sussex County Hospital, more
GP input to the Emergency Department and an ambulatory emergency care facility in
advance of next winter.

(4) The Trust’s Clinical Transformation Programme includes the following measures:

i, A review of service provision at Princess Royal Hospital, Haywards Heath, to
further relieve pressure on bed capacity at the RSCH

ii. Implementation of the SAFER care bundle (this is a range of interventions
aimed at improving patient flow and discharging patients earlier in the day)

iii. Creating more discharge capacity by expansion of Newhaven Downs
Community Hospital and extending the scale of the Hospital at Home scheme
(where patients discharged home received extended nursing and medical
input)

As part of the development of closer working relations with SECAMB, the two organisations
have agreed and implemented a new clinical handover protocol and escalation triggers at 15,
30 and 60 minutes from arrival of a patient to ensure more timely handover. The Trust is also
funding the joint appointment of a Hospital Ambulance Liaison Officer and we have
commissioned an observational audit of the handover process to identify any further
improvements that can be made.

| hope that the above information is helpful and thank you again for raising your concerns with
the Trust.

| would also be grateful if you could pass on my condolences to Mrs Bennett for her sad loss. |
hope my letter will provide assurance to Mrs Bennett that the Trust is committed to doing
everything possible to address the issues identified during the inquest.

Yours sincerely

Chief Medical Officer & Deputy Chief Executive

South East Coast Ambulance Service NHS |

NHS Foundation Trust

Nexus House
Gatwick Road

26 June 2017 anion
RECEIVED

www.secamb.nhs.uk
Miss Gilva Tisshaw
Assistant Coroner
The Coroner's Office
Woodvale

Lewes Road
Brighton

BN2 3QB

ae ae oe tm ED am eH

Dear Miss Tisshaw
Re: The late Mr Ronald Bennett

| am writing further to your report, written under Paragraph 7, Schedule 5 of the Coroners & Justice
Act 2009 and Regulations 28 and 20 of the Coroner’s (investigations) Regulations 2013.This was in
relation to the sad death of Mr Ronald Bennett.

The concern you raise about hospital handover delays is a high priority, not just from the ambulance
service but the whole healthcare system, as each component part has a role in resolving the
problem. | will focus here specifically on Brighton & Hove, but the issues | highlight are consistent
across Sussex, Surrey and Kent; indeed, across most of the country.

In recent years, the delays at hospitals for ambulance crews has continually increased, to the point
where they are impacting on the Trust's ability to respond to emergency calls in the community.
During 2015, in response to this ever growing problem, we introduced an Immediate Handover
Policy. However, due to the challenges at the Royal Sussex County Hospital this was difficult to
implement. A special Handover Workshop was facilitated last year in Brighton by Professor
Matthew Cooke who had previously been National Clinical Director for Emergency & Urgent Care
for the NHS. This was organised by Emergency Care Improvement Programme to seek solutions as
the delays at Brighton & Sussex University Hospitals NHS Trust had been rising.

Towards the end of 2016, NHS England and NHS Improvement organised a number of strategic
region-wide meetings There was a resultant understanding at a strategic level of the need to think
differently about how to address this problem. It has become a standing agenda item at both the
Local Accident & Emergency Delivery Board and the two Urgent Care Operational Resilience
Groups.

In March 2017, a new joint Standard Operating Procedure was developed in partnership with BSUH
providing more clarity around the process and responsibilities, including how and when to escalate.
Since its implementation, there has been a marked improvement in overall performance in handover
delays, although it is still the case that many hours continue to be lost.
+
Your ene

Chair. Richard Foster: CBE... Chief Executive: Daren Mochrie QAM
_ Chair F ene your call

There is a commitment from system partners to ensure continual improvement and | have attached
the improvement plan for your information.

Although | cannot give you assurance that this complex and multi-factorial problem is fixed, | am
confident that the matter is now being given sufficient priority by our acute, community and primary
care partners. Its impact on our services is significant, and we are doing all we reasonably can to
ensure improvement is sustained.

| hope this information is helpful and | can confirm that the Trust would be content should the Chief
Coroner wish to publish a copy of this response.

Yours sincerely

Daren Mochrie QAM
Chief Executive