Vera Spencer

The Council House, 
 First Floor, 
 Corporation Street, 
 Derby, 
 DE1 2FS       

E: 

www.derbyandderbyshireicb.nhs.uk  

Date 17 January 2025 

Dear Sophie Lomas, 

Subject: Regulation 28 with respect to the death of Mrs Vera Spencer 

Thank you for raising your concerns with us on this important matter. 

Derby & Derbyshire ICB extend our sympathies to the family and friends of Mrs Vera Spencer over 
their loss. Secondly, we have examined the issues you raised in the regulation 28 notice. 

The Regulation 28 Notice identified: 

At times when the ambulance service is under extreme pressure, individuals who have fallen 
at  home  can  wait  many  hours  on  the  floor  before  paramedics  can  attend.  This  is  usually 
because falls are given a lower categorisation by the ambulance service because it is not a 
life-threatening situation. Resultant long lies can increase the risk of pneumonia, pressure 
damage  and  Rhabdomyolysis.  The  court  heard  evidence  that  other  than  the  ambulance 
service, there is no local falls service or team operating out of hours to assess patients and 
assist them off the floor following a fall. 

Derby & Derbyshire ICB response: 

At the time of Vera's fall, the Team Up falls service was resourced to support non-injurious falls, so 
an individual with a fractured hip would not have been suitable for that type of response. 

We are aware that some areas have since progressed into supporting injurious falls, and the plan 
is for all others to follow suit.  

Action 1: Derby & Derbyshire ICB will seek to accelerate the development and roll out of a 
falls prevention service that is available to all residents in Derby & Derbyshire that includes 
consideration of an injurious falls service.  This will be considered through in the local NHS 
planning & prioritisation process for 2025/26. 

Long  lies  are  variable  in  their  effect  on  an  individual,  this  is  usually  based  on  their  co-
morbidities/frailty prior to the fall.  If an individual is not able to be retrieved from the floor, then the 
main concerns are hypothermia, dehydration, immobility, severity of pain and acute kidney injury. 

Head office address: The Council House, First Floor, Corporation Street, Derby, DE1 2FS       

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 In  exceptional  circumstances,  next  of  kin  or  responders  from  the  above  options  could  attend  on 
scene and support to confirm the need for ambulance, or recover if able, and manage symptoms 
and risks e.g. pain relief, temperature regulation, hydration, safe movement/pressure care, if a long 
wait for an ambulance is incurred. However, we are aware that in periods of severe strain upon acute 
& ambulance services that this approach may not always be successful in mitigating the risk of harm 
to patients. Therefore, the ICB recognises the need to look at further actions that may be put in place 
to mitigate the risk of harm. 

Further options that the ICB will consider for alternative ambulance response out of hours: 

Option A: DHU have staff trained in falls recovery as they provide some cover for the Team Up / 
UCR provision. Their falls response provision could be extended to cover 20:00-08:00, and Team 
Up and step-up virtual wards would provide the continuation of clinical support next day.  If this was 
in situ, this individual could have been responded to by a team, observations completed, ambulance 
need confirmed through on-screen head to toe assessment, perhaps an urgent visit arranged from 
DHU medic for pain relief. It is likely that with a hip fracture suspected, the responders would not be 
able to safely lift the individual off the floor (teams only have seated lifted equipment). This option 
would  offer  the  person  in  person  support,  confirmation  of  need  and  pain  and  other  symptom 
management, but not remove the need for ambulance attendance in this case. 

Option B: EMAS have a community first responder network who are volunteers and trained in falls 
recover, deployed exclusively by EMAS EOC. The provision can be variable in the hours available, 
and  geographies  covered  However  we  can  explore  the  possible  extension  of  this  service  for  the 
people  of  Derby  &  Derbyshire.    Again,  these  teams  would  be  limited  to  providing  on  scene 
support/monitoring but would likely not be able to recover the individual as they only have access to 
seated lifting equipment.  

Option  C:  ICB  to  consult  with  technology  enabled  care  providers  to  ensure  they  consider  the 
provision of community-based response as an integral part of their services. Where TEC services 
do  not  provide  in  person  response,  there  is  an  increased  dependence/reliance  on  ambulance 
services for attendance to pendant alarm alerts. However, like the above option, if the TEC provider 
had attended in person, and confirmed the individual was significantly injured, the team would not 
recover, keep the individual safe, and escalate to the ambulance service to attend. 

Option D: The district and borough technology enabled care providers that we have commissioned 
as part of the Team Up Enhanced falls response; all operate as 24/7 responding services for their 
main service provision (fee paying TEC services). Therefore, they could be commissioned by the 
ICB to extend this enhanced offer to cover 24/7, maintaining similar processes we have in place now 
for  UCR.  The  provision  offered  by  these  providers  is  limited  to  Derby  City,  High  Peak  (excluding 
Glossop  currently),  Chesterfield,  South  Derbyshire,  Bolsover,  and  parts  of  NE  Derbyshire  and 
therefore DHU would potentially offer a solution for the remainder. 

Action 2:  Derby & Derbyshire ICB will seek to implement options that further mitigate the risk 
of a long lie following a fall that is available to all residents in Derby & Derbyshire. 

Derby & Derbyshire ICB recognise that there are times when the East Midlands Ambulance Service 
(EMAS)  is  under  extreme  pressure.  These  situations  lead  to  unacceptable  response  times  for 
severely  ill  and  injured  people  within  our  community.  Indeed  we  have  just  come  out  of  an 
unprecedented EMAS critical incident due to such pressures. 

Head office address: The Council House, First Floor, Corporation Street, Derby, DE1 2FS       

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 In  this  critical  incident  the  local  NHS  worked  together  with  the  local  authorities  and  the  voluntary 
sector to reduce the response times for patients in the community. In the short term we will continue 
to work as a multi-agency group to try and minimise response times by EMAS. In the medium term 
we recognise that we will need to identify ways in which the demand for healthcare and healthcare 
beds can be reduced. This will require a blended approach that looks at: 

1.   Reducing the flow of people into our urgent & emergency care services through prevention  
2.  Improving flow through our acute sector and reducing length of stay in hospital beds. In the 
short term we have the local roll out of a technology known as Optica that has a proven ability 
to reduce length of stay in hospital settings  

3.  Continued working with social and voluntary care services to improve the speed of discharge 

of people when they are well back to their usual home setting. 

Yours sincerely, 

Chief Medical Officer  

Head office address: The Council House, First Floor, Corporation Street, Derby, DE1 2FS       

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