Nicola Owens

Minister of State for Health (Secondary Care) 

39 Victoria Street 
London 
SW1H 0EU 

24th March 2025 

Our ref: 

HM Coroner Anita Bhardwaj 
Liverpool and the Wirral Coroner’s Service 
Gerard Majella Courthouse 
Boundary Street 
Liverpool  
L5 2QD 

By email: 

Dear Ms Bhardwaj  

Thank you for the Regulation 28 report of 31 January 2025 sent to the Department of Health 
and Social Care about the death of Nicola Emma Owens. I am replying as the Minister with 
responsibility for urgent and emergency care. 

Firstly, I would like to say how saddened I was to read of the circumstances of  Ms Owens’ 
death and I offer my sincere condolences to their 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  regarding  prolonged  ambulance  response  times,  operational 
pressures  faced  by  the  North West  Ambulance  Service  and  the  impact  of  delayed  social 
care packages on hospital capacity and ambulance handover delays.  

In preparing this response, my officials have made enquiries with NHS England to ensure 
we adequately address your concerns. I understand that NHS England are also responding 
to your report. 

The Government is clear that patients should receive the highest standard of service and 
care  from  the  NHS.  We  acknowledge  that  urgent  and  emergency  care  performance  has 
failed to deliver that standard in recent years and we are committed to restoring ambulance 
response  times  to  the  standards  set  out  in  the  NHS  Constitution.  We  have  been  honest 
about the challenges facing the NHS and we are serious about tackling the issues; however, 
we must be clear that there are no quick fixes. 

As a first step, in the Autumn Budget, the Government announced an extra £22.6 billion in 
day-to-day  spending  in  2025/26  for the  NHS  compared to  2023/24.  An  additional £3.1bn 
further  capital  investment  over  2  years  will  provide  the  highest  real-terms  capital  budget 
since before 2010. 

 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
  
 
 
  
 
 We recognise that investment alone won’t be enough and are determined that it must go 
hand in hand with fundamental reform. On 5 December 2024, the Government published 
the Plan for Change (available here: https://www.gov.uk/government/publications/plan-for-
change),  that  set  the  mandate  for  the  direction  of  change  with  clear  milestones  in  five 
national missions, including building an NHS that is fit for the future. 

On 30 January 2025, the Government published ‘Road to recovery: the government's 2025 
mandate to NHS England’, that clearly set out delivery instructions for the NHS through the 
prioritisation of five key objectives aimed at driving reform within the NHS. Improving A&E 
and ambulance wait time was a prioritised objective in the mandate to specifically address 
the current challenges facing urgent and emergency care. On the same day NHS England 
published the 2025-26 planning guidance that contained the operational delivery detail for 
local NHS systems. The planning guidance included an implementation target for improving 
the  average  Category  2  ambulance  response  times  to  no  more  than  30  minutes  across 
2025-26, and practical actions focused on reducing avoidable ambulance dispatches and 
conveyances and ambulance handover delays. 

The  NHS  will  focus  on  delivering  the  following  range  of  practical  actions  to  improve 
performance in 2025/26:  

•  working towards delivering hospital handovers within 15 minutes, and implementing 
joint  working  arrangements  that  ensure  that  no  handover  takes  longer  than  45 
minutes,  
improving  ambulance  ‘hear  and  treat’  service  rates,  including  increasing  the 
proportion of Category 2 ambulance incidents where an ambulance clinician provides 
advice and treatment over the phone,   

• 

•  ensuring  all  999  ambulance  calls  classified  as  Category  3  and  4  are  clinically 
navigated, validated and where appropriate triaged in ambulance control centres, or 
in Single Points of Access.   

Regarding  the  concern  raised  about  delays  to  patient  discharge  from  hospitals,  this 
government will make sure that hospital departments are no longer blocked due to delayed 
discharges. By developing local partnership working between the NHS and social care, we 
will ensure we no longer have over 12,000 patients every day waiting to be discharged.  

We are reforming the Better Care Fund to ensure pooled NHS and local authority funding 
spent on social care contributes to wider efforts to reduce emergency admissions, delayed 
discharges, and care home admissions. We will continue to join up health and care services 
by supporting care workers to safely take on further duties to deliver delegated healthcare 
activities, such as blood pressure checks and other healthcare interventions, so that people 
can receive more routine checks and care at home without needing to travel to healthcare 
settings.  

Later in the Spring, to accompany the additional investment in the NHS, the Government 
will publish a 10-Year Health Plan which will set out the radical reforms for the NHS. The 
health  plan  will  focus  on  ensuring  three  big  reform  shifts  in  the  way  our  health  services 
deliver care. First, from ‘hospital to community’ to bring care closer to where people live. 
Second,  from  ‘analogue  to  digital’  with  new  technologies  and  digital  approaches  to 

 
 
 
 
 
 
 
 
 
 
 
 
 modernise the NHS, and third from ‘sickness to prevention’ so people spend less time with 
ill-health by preventing illnesses before they happen. The reforms will support putting the 
NHS on a sustainable footing so it can tackle the problems of today and the future. 

In  addition,  we  will  shortly  set  out  further  actions  to  be  taken  during  2025-26  to  support 
improvements to urgent and emergency care performance this year.    

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

Yours sincerely,  

MINISTER OF STATE FOR HEALTH

Ms Anita Bhardwaj 
Area Coroner  
Liverpool and Wirral Coroner’s Service 
Majella Courthouse 
Boundary Street  
Liverpool  
L5 2QD 

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

24 March 2025  

Dear Coroner, 

Re: Regulation 28 Report to Prevent Future Deaths – Nicola Emma Owens who 
died on 5 October 2024.  

Thank  you  for  your  Report  to  Prevent  Future  Deaths  (hereafter  “Report”)  dated  31 
January 2025 concerning the death of  Nicola Emma Owens on  5 October 2024. In 
advance of responding to the specific concerns raised in your Report, I would like to 
express my deep condolences to Nicola’s family and loved ones. NHS England are 
keen to assure the family and the Coroner that the concerns raised about Nicola’s care 
have been listened to and reflected upon.   

Your Report raises concerns over delays in ambulance attendance due to ambulance 
unavailability, with this delay being significantly contributed to by handover delays in 
hospitals.  This,  in  turn,  is  contributed  to  by  backlogs  of  patients  who  are  fit  for 
discharge but are awaiting social care packages. I was very sorry to read the Coroner’s 
conclusion  that  Nicola’s  death  was  preventable,  and  that  the  unavailability  of  an 
ambulance to convey Nicola to hospital for necessary emergency treatment sooner 
resulted in the terminal cardiac event. 

Ambulance response times and handovers  

NHS  England  recognises  the  significant  pressure  on  all  NHS  services,  including 
ambulance services, and has been prioritising improvements to Category 2 response 
times and urgent and emergency care (UEC) services. NHS England also recognises 
that in order to support improved patient flow, there is the need to improve ambulance 
capacity  through  growing  the  workforce,  reducing  handover  delays,  speeding  up 
discharges from hospital and expanding new services in the community.  

NHS  England’s  regional  teams  are  continuing  to  work  closely  with  commissioners, 
Integrated  Care  Boards  (ICBs),  acute  NHS  providers  and  ambulance  services  to 
implement plans to continue to improve patient handovers. The 2025/26 Priorities and 
Operation  Planning  Guidance  sets  out  that  the  NHS  should  improve  ambulance 
response times and Accident and Emergency waiting times compared to 2024/25, and 
that Category 2 ambulance response times should not average more than 30 minutes 
across  2025/26.  The  guidance  also  sets  out  some  immediate  tasks  for  2025/26, 

                                                                                                                       
 
 
 
 
 
 
 
 
  
 
 
 
  
 including  to  reduce  avoidable  ambulance  dispatches  and  conveyances  and  reduce 
handover delays.  

The NHS is working more closely with local authorities to improve timely discharge of 
patients and has developed discharge metrics to monitor performance improvements.  

Patients being rehabilitated into the community 

NHS England recognises that delayed discharges have a significant impact on hospital 
flow, capacity and ambulance handovers. In order to address this, NHS England is 
strengthening the use of Discharge Ready Date (DRD) data in order to gain a clearer 
understanding of discharge delays and their key contributing factors.  

The aim of embedding DRD in operational decision-making is to:  

• 

• 

Identify  and  quantify  delays  at  local,  regional  and  national  levels,  enabling 
targeted interventions. 
Improve  coordination  across  NHS  teams  by  providing  real-time  insights, 
supporting better planning and resource allocation. 

•  Enhance system-wide decision-making through improved forecasting, ensuring 

capacity is optimised to facilitate timely discharges. 

The use of this data-driven approach is helping to improve patient flow, reduce hospital 
pressures,  and  ensure  that  patients  who  are  medically  ready  for  discharge  can 
transition safely and efficiently.  

NHS  England  has  also  published  the  2025/26  Better  Care  Fund  (BCF)  policy 
framework and planning requirements, working alongside the Department of Health 
and  Social  Care  (DHSC)  and  Ministry  of  Housing,  Communities  and  Local 
Government. The BCF framework supports local systems to jointly agree plans across 
health and care, including supporting the flow of patients through UEC.  

For 2025/2026, changes in funding include:  

•  The  NHS  minimum  contribution  to  Adult  Social  Care,  which  is  one  of  the 

mandatory funding streams within the BCF, will increase by 3.9%.  

•  The  Discharge  Fund,  which is £1 billion for  2024/2025,  has been embedded 
within the NHS minimum contributions to allow systems greater local flexibility 
in how they utilise this funding to address flow issues.  

NHS England will be working with local areas to support them to maximise the impact 
of this investment over the coming year, by providing additional or enhanced support 
to  those  areas  which  face  particular  challenges,  and  working  with  partners  in  local 
government  and  social  care  including  Local  Government  Associations,  Directors  of 
Social Services, and Care and Health Improvement advisors to support local systems 
to improve timely discharge of patients.  

My regional colleagues from the North West were also asked to review your Report. 
They have advised that the Integrated Health and Social Care Programme  in North 
Mersey is focusing on three main workstreams, to improve UEC services. These are 
outlined below.    

 
 
 
 
 
 
 
 
 
 
 1.  Admission and Attendance Avoidance 

There is specific focus in the workstream  to reduce the need for North West 
Ambulance Services (NWAS) to convey patients to hospital, by increasing the 
use  of  services  in  the  community,  NHS  111  and  other  dispositions.  NWAS, 
Mersey  Care  NHS  Foundation  Trust  (MCFT),  the  local  authority  and  the 
University Hospitals of Liverpool Group are working collaboratively to embed a 
Single  Point  of  Access  using  NHS  England’s  framework.  A  Single  Point  of 
Access is intended to simplify access to services by offering clinicians advice 
and guidance to support onward referral, ensuring patients get the right care 
for their needs quickly and safely, and to improve patient outcomes regardless 
of where they present. 

There  is  also  work  underway  to  reduce  ambulance  handover  times  and 
increase  the  number  of  streaming  options  away  from  the  emergency 
department and into services across acute hospitals. There has been difficulty 
consistently utilising Frailty Units, Same Day Emergency Care Services as well 
as other services due, to operational pressures. Work supported by Emergency 
Care  Improvement  Support  (ECIST)  and  the  Advancing  Quality  Alliance 
(AQuA) with the acute trust will help to improve access to services and reduce 
ambulance  turnaround  times.  There  have  been  significant  improvements  in 
recent ambulance turnaround times, partly due to additional corridor and surge 
capacity being made available on the two sites.  

The revised Frailty Plan forms part of Volume 2 of the North Mersey Urgent and 
Emergency  Care  Programme.  This  plan  focuses  on  using  falls  and  frailty 
services in the community to reduce the need to convey patients to hospital and 
to contribute to greater availability of NWAS emergency vehicles when needed.  

2. Acute Length of Stay 

There is a focus on ward processes to help reduce internal delays, reducing the 
length of time patients stay in hospital and creating capacity and flow out of the 
emergency department, which all contribute to reducing ambulance delays.  

3. Acute Discharge 

This is focusing on operational issues such as long length of stay or no criteria 
to  reside  issues  relating  to  patients  needing  onward  care,  and  is  working  to 
improve  the  utilisation  of  different  discharge  pathways,  decreasing  the  over-
reliance of pathway 3 bed capacity in community care (for those with the highest 
level of complex needs, who require discharge to a care home placement). 

Each of the above workstreams have had an impact on increasing flow through the 
Emergency  Department  for  patients  who  require  a  hospital  admission,  and  the 
programme is currently being revised with a greater emphasis on prevention, in line 
with national policy. This will be presented to the UEC Programme Board for sign off. 
NHS  England  have  asked  regional  colleagues  for  the  date  in  which  this  sign  off  is 
expected  to  happen  and  are  awaiting  a  response.  NHS  England  can  undertake  to 
update the Coroner on this in due course.   

 
 
 
 
 
 
 
 
 I  would  also  like  to  provide  further  assurances  on  the  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  events,  such  as  the  sad  death  of 
Nicola, are shared across the NHS at both a national and regional level and helps us 
to  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