Ronald Spencer

8th Floor  
Alpha Tower  
Suffolk Street 
Queensway 
Birmingham  
B1 1TT 

14th June 2024  

Mr A Hodson 
Assistant Coroner for Birmingham and Solihull 
The Birmingham and Solihull Coroner’s Court 
Steelhouse Lane 
Birmingham 
B4 6BJ 

Dear Mr Hodson 

Re: Prevention of Future Deaths – Ronald Henry Spencer 

I am writing in response to your Prevention of Future Deaths report dated 23rd April 2024, in relation to 
the  recent  investigation  into  the  circumstances  surrounding  the  death  of  Ronald  Henry  Spencer.  NHS 
Birmingham and Solihull (BSol ICB) and University Hospitals Birmingham (UHB) would like to take this 
opportunity  to offer sincere condolences to Mr Spencer’s family at this time and offer assurances that we 
have carefully considered the issues that arose during the inquest and will use this time to ensure that 
lessons are learned for patients and the public in the future. 

In response to matters of concern in relation to staff shortages at UHB, it is noted that the Inquest found 
no evidence to suggest that the standard of clinical care provided to Mr Spencer contributed to his death.   
However, we recognise that at the time of his death there was an unprecedented strain on the  general 
surgical consultant workforce at UHB as a result of unanticipated sickness absence of three surgeons.   
Steps  had  been  taken  to  mitigate  the  impact  of  the  exceptional  workforce  pressures  which  included             
arranging for two senior fellows, both of whom had completed registrar training,  to "act up" and cover any 
identified  gaps  on  the  consultant  rota.    Both  fellows  were  considered  to  be  sufficiently  skilled  and                  
experienced and consultant support was also put in place so that there was oversight of their temporary 
roles.     

Since  the  time  of  Mr  Spencer’s  admission  in  December  2023,  three  locum  consultants  in  emergency        
surgery have been appointed as well as an academic colorectal consultant. As a result, there is increased 
resilience in the emergency surgery rota than was the case when Mr Spencer was admitted.  

It  has  also  been  recognised  that  the  current  staffing  model  in  place,  which  includes  four  dedicated       
esophago-gastric consultants running the specialist upper GI on-call service for the region, may represent 
an additional vulnerability within the service, particularly at times of increased demand. The UHB upper GI 
service  has  recently  undergone  an  independent  invited  review  which  has  been  conducted  by  the  East 
Midlands Clinical Senate.  The review encompassed all aspects of elective and emergency upper GI care 
at  the  QEH.  The  final  report  is  awaited,  but  it  is  anticipated  that  recommendations  will  likely  include              
reviewing the current esophago-gastric service configuration and increasing the number of consultants  

 
 
 
        
 
 
      
 
 
 
 
 
 
 
 
 covering  the  upper  GI  on-call  rota.    All  recommendations  will  be  considered  and  implemented,  where      
appropriate, which will further support service resilience. 

In addition to the above and recognising the impact of increased urgent and emergency admissions on 
our  healthcare  system,  there  are  also  plans  underway  to  open  the  refurbished  elective  surgical  hub  at 
Solihull Hospital in September 2024. There has been significant investment in the hub which includes six 
new  operating  theatres  and  will  enable  an  additional  11,500  procedures  a  year  for  patients  from                   
Birmingham and Solihull, thereby alleviating pressure on bed occupancy and treatment capacity across 
the Trust. 

BSol ICB recognises the need for a workforce that is sufficient in numbers and skills to care for patients 
throughout the calendar year and works with all system partners to ensure this. We are also committed to 
the introduction of the NHS Long Term Workforce Plan.  

In June 2023, BSol ICB carried out a high-level diagnostic of the current and future workforce looking at 
both  demand  and  supply  drawing  upon  BSol  strategy  and  operational  documents.  It  identified  that           
workforce is an immediate and urgent priority for the ICB and supports the system in responding to the 
NHS  Long Term Workforce Plan and Framework 15.  

The workforce diagnostic recommended system-wide action in four areas using trend breaking action to 
help achieve in-year operational plans in terms of activity, finance and workforce. The actions fall into four 
workstreams (4R’s), these are: 

•  Reconnecting with our staff. 

•  Recruit, Retain and Train. 

•  Resilience - reduce reliance on contingent workforce actions including temporary staffing. 

•  Reform – redistributing skills and resources to deliver redesigned future services. 

In October  2023,  the  BSol  ICS  Workforce  Programme  Board  was established to  provide  oversight  and 
support delivery of the 4R’s Workforce Delivery Framework, this group reports directly into the BSol ICS 
People Committee. 

The 4R’s Workforce Delivery Framework is now operational and significant resource has been allocated 
to support implementation over the next two years.  This investment will be used to sustain the delivery of 
existing  programmes  where  they  have  been  identified  as  supporting  the  4R’s  as  well  as  a  range  of             
additional priorities identified as part of the Workforce Diagnostic. 

The investment received will be used to: 

• 

Implement the ‘new staff offer’.  

•  Deliver  key  programmes  of  work  that  have  been  identified  as  critical  to  address  the  risks  and              

challenges identified within the workforce diagnostics which will enable: 

o  moving to a more sustainable workforce model with reduced reliance on temporary staffing. 
o 
investment in the retention of health and care workforce. 
o  support system-wide training and development programmes. 
o  setting the foundations for implementation of the NHS Long Term Workforce Plan. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 The BSol ICB Finance and Performance Committee and People Committee receive detailed workforce 
data reports at their meetings. The reports focus on a range of workforce indicators including staff in post, 
vacancies,  sickness absence and turnover with focused discussion on the actions to support organisations 
being  taken  at  a  system  level  including  the  4R’s  Workforce  Delivery  Framework.  Where  appropriate       
workforce, training  and education  issues  are also  discussed and reported via the  BSol  System Quality 
Group. 

If we can be of any further assistance at this time, please do contact me. 

Yours sincerely   

Chief Executive

From Minister Andrew Stephenson 
Minister of State for Health 

39 Victoria Street 
London 
SW1H 0EU 

Mr Adam Hodson 
The Birmingham and Solihull Coroner’s Court 
Steelhouse Lane 
Birmingham 
B4 6BJ 

19 June 2024 

Dear Mr Hodson, 

Thank you for your Regulation 28 report to prevent future deaths dated 23 April 2024 about 
the  death  of  Ronald  Henry  Spencer.  I  am  replying  as  Minister  with  responsibility  for  NHS 
workforce planning. 

Firstly, I would like to say how saddened I was to read of the circumstances of Ronald Henry 
Spencer, and I offer my sincere condolences to his family and loved ones. The circumstances 
your report describes are concerning and I am grateful to you for bringing these matters to my 
attention.  

The report raises concerns over winter pressures in the hospital where Ronald received care, 
wider  staffing  pressures  in  the  local  area  and  planning  to  find  longer  term  solutions  to 
workforce shortages.  

In preparing this response, Departmental officials have made enquiries with NHS England. 

We recognise winter pressures are having a significant impact on UEC services. That is why, 
in January 2023, NHS England published a two year 'Delivery plan for recovering urgent and 
emergency care services’ which aims to deliver sustained improvements in waiting times, with 
a  target  for  this  year  to  reduce  Category  2  ambulance  response  times  to  30  minutes  on 
average. An update to this plan has now been published, to build on learnings from the first 
year and to continue to support systems to improve performance and reduce waiting times. 
The plan is available at: 
https://www.england.nhs.uk/wp-content/uploads/2024/05/PRN01288_ii_Delivery-plan-
for-recovering-urgent-and-emergency-care-progress-update-and-next-steps-May-
2024.pdf  

To support ambulance services, ambulance trusts received £200 million of additional funding 
in 2023/24 to expand  capacity  and  improve response times.  In  addition, to improve  patient 
flow and bed capacity within hospitals £1 billion of dedicated funding was provided to increase 
staffed core hospital beds by 5,000 compared to 2022/23 plans. 

£1 billion was invested this year through the Discharge Fund in commissioning packages of 
care for people being discharged and improving discharge processes. A £40 million fund was 

1 

 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
  
 also launched in September 2023 for local authorities in areas with the greatest challenges on 
urgent and emergency care. Local authorities used this funding for social care provision and 
strengthening admissions avoidance and discharge services over the past winter. The number 
of  people  discharged  from  hospital  with  packages  of  health  and  social  care  support  has 
increased by 9% from the end of March 2023 to the end of March 2024.  

Since  publication  of  the  recovery  plan  in  January  2023,  there  have  been  improvements  in 
performance. Nationally in 2023/24, average Category 2 ambulance response times (including 
for  serious  conditions  such  as  heart  attacks  and  strokes)  were  over  13  minutes  faster 
compared to the previous year, a reduction of over 27%. 

As  of  January  2024,  there  are  21,531  full-time  equivalent  (FTE)  staff  working  in  University 
Hospital  Birmingham  NHS  Foundation  Trust,  which  is  1,636  (8%)  more  than  in  2023.  This 
includes 2,882 FTE doctors and 5,289 FTE nurses which is 214 (8%) more doctors and 448 
(9%) more nurses than in 2023. 

The Surgical Specialty Group within the Trust has 38 (6%) more FTE doctors, and 260 (6%) 
more consultants in January 2024 than in 2023.  

In addition, as of January 2024 there are 45,024 FTE staff working within NHS Birmingham 
and Solihull ICB, which is 3,127 (7%) more than in 2023. This includes 5,058 FTE doctors and 
11,379 FTE nurses which is 313 (7%) more doctors and 649 (6%) more nurses than in 2023. 

There are 1,033 FTE doctors working in the Surgical Specialty Group within the ICB, which is 
52 (5%) more than in 2023. This includes 444 FTE Consultants, which is 24 (6%) more than 
in 2023. 

The NHS Long Term Workforce Plan (LTWP) sets out the steps the NHS and its partners 
need to take to deliver an NHS workforce that meets the changing needs of the population 
over the next 15 years.  

NHS England is working at a national level to deliver the LTWP. This is a robust and effective 
strategy to ensure we have the right number of people, with the right skills and support in place 
to be able to deliver the kind of care people need. It includes ambitions to grow the workforce 
by  significantly  expanding  domestic  education,  training  and  recruitment,  as  well  as  actions 
aimed at improving culture, leadership and wellbeing so that more staff are retained in NHS 
employment over the next 15 years.  

These  actions  will  aim  to  close  anticipated  staffing  shortfalls  in  the  NHS  in  the  long  term, 
however Trusts have a responsibility to ensure safe staffing levels in the current day to day 
operation of their hospitals. This is in line with Care Quality Commission (CQC) Regulation 18 
which states that providers must deploy enough suitably qualified, competent and experienced 
staff to enable them to meet all other regulatory requirements. 

I hope this response is helpful. Thank you for bringing these concerns to my attention.  

Yours sincerely,  

 
 
 
 
 
 
 
 
 
 THE RT HON ANDREW STEPHENSON CBE  
MINISTER OF STATE

Adam Hodson 
The Birmingham and Solihull Coroner’s Court  
Steelhouse Lane  
Birmingham 
B4 6BJ 

National Medical Director  
NHS England  
Wellington House 
133-155 Waterloo Road  
London 
SE1 8UG 

17 June 2024  

Dear Coroner, 

Re: Regulation 28 Report to Prevent Future Deaths – Ronald Henry Spencer 
who died on 2 December 2023.   

Thank you for your Report to Prevent Future Deaths (hereafter “Report”) dated 23 April 
2024 concerning the death of Ronald Henry Spencer on 2 December 2023. In advance 
of responding to the specific concerns raised in your Report, I would like to express 
my deep condolences to Ronald’s family and loved ones. NHS England are keen to 
assure the family and the coroner that the concerns raised about Ronald’s care have 
been listened to and reflected upon.   

Your Report raised concerns over staffing issues being experienced across the NHS 
and the challenges these cause nationally.  

NHS England is working at a national level to deliver the Long-Term Workforce Plan. 
This is a robust and effective strategy to ensure we have the right number of people, 
with the right skills and support in place to be able to deliver the kind of care people 
need. It heralds the start of the biggest recruitment drive in health service history, but 
also of an ongoing programme of strategic workforce planning. It includes ambitious 
commitments  to  grow  the  workforce  by  significantly  expanding  domestic  education, 
training and recruitment, as well as actions aimed at improving culture, leadership and 
wellbeing so that more staff are retained in NHS employment over the next 15 years. 
These actions will aim to close anticipated staffing shortfalls in the NHS in the long 
term. 

Your Report also raises the impact of delays to patient care being caused by ‘winter 
pressures’  and  that  there  is  ‘inadequate  cohesive  forward  thinking  or  planning’  to 
short-term pressures such as these.  

NHS England continues to plan for and provide support to systems ahead of winter 
pressures. Further information and links to historic plans and letters to our systems 
can be found on our winter resilience website pages.  For the most recent winter period 
(2023/24), we sent out a letter to our Integrated Care Boards and Trusts, setting out 
our national approach to winter planning and our four areas of focus:  

1.  Continuing  to  deliver  on  the  Urgent  &  Emergency  Care  Recovery  Plan  by 

ensuring that high-impact interventions are in place.  

                                                                                                                       
 
 
 
 
 
 
 
 
  
 
 
 
  
 2.  Competing  operational  and  surge  planning  to  prepare  for  different  winter 

scenarios. 

3.  Ensuring that there is an effective system working across all parts of a health 
system, including acute trusts and community care, elective care, children and 
young people, mental health, primary, community, intermediate, social care and 
the voluntary, charitable and social enterprise sector.  

4.  Supporting the workforce to deliver over winter.  

This followed the publication of our ongoing delivery plans for recovering Urgent and 
Emergency (UEC) Care services, Primary Care Recovery Plan and Elective Recovery 
Plan, all of which provide a strong basis for winter preparedness.   

Trusts do have a responsibility to ensure safe staffing levels in the current day to day 
operation of their hospitals. This is in line with the Care Quality Commission (CQC) 
Regulation  18  which  states  that  providers  must  deploy  enough  suitably  qualified, 
competent  and  experienced  staff  to  enable  them  to  meet  all  other  regulatory 
requirements. 

I  would  therefore  refer you to  NHS Birmingham  and  Solihull  Integrated Care  Board 
and  University  Hospitals  Birmingham  NHS  Foundation  Trust  for  more  local 
arrangements  on  staffing  and  workforce.  However,  NHS  England  understands  that 
there  have  been  several  appointments  since  Ronald’s  death  and  that  there  is  now 
increased  resilience  in  the  emergency  surgery  rota  and  that  recommendations  are 
expected to  be made  regarding  their  oesophago-gastric  service configuration.  NHS 
England have been asked to be sighted on their final responses to the coroner.  

I would also like to provide further assurances on national NHS England work taking 
place around the Reports to Prevent Future Deaths. All reports received are discussed 
by  the  Regulation  28  Working  Group,  comprising  Regional  Medical  Directors,  and 
other clinical and quality colleagues from across the regions. This ensures that key 
learnings and insights around preventable deaths are shared across the NHS at both 
a national and regional level and helps us pay close attention to any emerging trends 
that may require further review and action.   

Thank you for bringing these important patient safety issues to my attention and please 
do not hesitate to contact me should you need any further information.  

Yours sincerely,  

National Medical Director