Diana Fairweather-Purkis

Minister of State for Health (Secondary Care)  

39 Victoria Street  
London  
SW1H 0EU  

09 April 2025  

Our ref: PFD - 25-02-17 - FAIRWEATHER-PURKIS  

HM Assistant Coroner Paul Appleton  
The Coroner’s Service  
Middlesbrough Town Hall  
Albert Road  
Middlesbrough  
TS1 2QJ  

By email: t

Dear Mr Appleton,  

Thank you for the Regulation 28 report of 17 February sent to the Department of Health and Social 
Care about the death of Diana Fairweather-Purkis 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 Fairweather-Purkis' 
death,  and I offer  my sincere  condolences  to  her 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  ambulance  service  pressures,  the  long  waiting  times  for  an 
ambulance and handover delays experienced by patients.  

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

The Government is clear that patients should expect and receive the highest standard of service and 
care  from  the  NHS.    The  Government  also  accepts  that  the  NHS’s  urgent  and  emergency  care 
performance has been below the high standards that patients should expect in recent years.    

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.  

To start with, 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, to help deliver 40,000 extra appointments a 
week and cut NHS waiting times. 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.   

There  is  a  national  focus  to  improve  Category  2  response  time  performance  as  these  responses 
make up over half of all ambulance call outs and incidents within this category are of a high,  life-
threatening  nature.  Improving  Category  2  response  times  will  improve  ambulance  performance 
generally, as more resources will then be available to attend to lower acuity incidents.    

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.  

In Spring 2025, to accompany the additional investment in the NHS, the Government will publish its 
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, by this Spring we will also set out the lessons learned from the pressures on urgent and 
emergency  care  services  this  winter  and  the  improvements  that  we  will  put  in  place  to  improve 
services ahead of next winter.    

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

Yours sincerely,   

MINISTER OF STATE FOR HEALTH

Strictly Confidential
Mr Paul Appleton
HM Assistant Coroner
Teesside and Hartlepool
The Coroner's Service
Middlesbrough Town Hall
Albert Road
Middlesbrough
TS1 2QJ

Dear Mr Appleton

NENC ICB
Pemberton House
Colima Avenue
Sunderland
SR5 3XB

11th April 2025

Re: Diana Fairweather-Purkis, deceased (date of death 03/10/2022)

In relation to the matters of concern you identified following your investigation, please find the
following response from the North East and North Cumbria Integrated Care Board.

1.  There is insufficient ambulance service availability/resource to enable ambulances
to attend to patients in a timely manner and in accordance with relevant target attendance
times.

Since the creation of the North East and North Cumbria Integrated Care Board (NENC ICB) in July
2022  there  has  been  significant  investment  of  additional  resources  into  ambulances  services  to
increase capacity and availability. Over £40m of additional funding, made up of local ICB investment
and a share of nationally funded NHS England growth monies, has been made available to the North
East Ambulance Service (NEAS) since 2023/24 to increase the number of vehicles on the road and
also strengthen clinical advisory services.

NEAS  have  established  an  Integrated  Urgent  Care  Clinical  Assessment  Service  (IUCAS)  which
includes paramedics, nurses, advanced practitioners, pharmacists, GPs and clinical specialists who
provide enhanced clinical support to call handlers and patients ringing 111 and 999. Senior clinical
advisors  (clinicians)  provide  additional  clinical  assessment  via  telephone  triage,  improving  the
journey and experience for our patients by ensuring they can pass through to services quickly and
efficiently.  The  team  also  promotes  self-care,  provides  advice  and  support  for  patients  at  home,
facilitating onward referral where necessary to a range of primary and secondary care services. By
being able to increase the number of patients who are treated and discharged in the community, the
IUCAS  helps  to  reduce  pressures  on  ambulances,  emergency  departments,  and  other  NHS
services.

 With regard to ambulance performance and the target response times, NEAS are consistently the
highest  performing  ambulance  provider  in  England  across  all  4  response  time  categories  and
continue to implement system-wide improvement programmes in conjunction with ICB and our acute
hospital  providers  to  further  improve  response  times  throughout  2025/26  and  work  towards
achieving the NHS constitutional standards.

2.  There are excessive delays in ambulance crews being released following attendance
at hospital, due to delays in patients being handed over to hospital staff.

Ambulance  handover  delays  are  a  priority  area  of  focus  for  the  ICB,  NEAS,  and  acute  provider
Foundation Trusts across NENC Integrated Care System (ICS). The multi-agency NENC Strategic
Urgent  &  Emergency  Care  Network  and  Local  A&E  Delivery  Boards  provide  leadership  and
oversight of a range of transformation initiatives that are being taken to improve patient handover
times. There has been a significant programme of work taking place in the second half of 2024/25
to bring together colleagues from across the system (ICB, FT, ambulance trust) to look at ambulance
handover improvement and transformation. This programme was externally facilitated and has led
to a number of revised and standardised policies and procedures being agreed for elements of the
ambulance  handover  process  (e.g.,  immediate  release,  cohorting,  diverts  and  deflections  etc.).
Alongside  the  wider  ICS  programme  there  have  also  been  individual  improvement  programmes
taking place across Foundation Trusts to reduce handover delays. A strong example of this is the
work  that  has  taken  place  at  South  Tees  FT  to  make  tangible  improvements  to  their  internal
processes  resulting  in  increased  flow  through  the  Emergency  Department  and  reduced  average
handover times.

Average ambulance handover times are improving after a difficult and challenging winter period and
in the last 3 weeks the average handover time has been less than 20 minutes across NENC, just
above the constitutional standard of 15 minutes and significantly below the target of 45 minutes in
the 2025/26 NHS operational planning guidance. There have also been significant reductions in the
number of ambulance handovers  in  excess of  60 minutes,  the  threshold beyond  which  we  know
patients are at an increased risk of experiencing harm. These improvements have been delivered
whilst the demand for ambulances has continued to rise, and general & acute bed occupancy has
remained above 92% across NENC. There continues to be a strong focus on reducing handover
delays so that ambulance crews can be released back onto the road as quickly and efficiently as
possible  to  respond  to  patient  demand  in  the  community.  This  is  evidenced  by  the  consistently
strong performance of NEAS across the four categories of ambulance response times compared to
other ambulance services in England.

I hope that this answers your queries. Please do not hesitate to contact me if you require any further
information on this.

Yours sincerely

Chief Contracting and Procurement Officer

Mr Paul Appleton 
HM Assistant Coroner  
Teesside and Hartlepool Coroner’s Service 
Middlesbrough Town Hall  
Albert Road 
Middlesbrough 
TS1 2QJ 

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

16 April 2025 

Dear Coroner, 

Re: Regulation 28 Report to Prevent Future Deaths – Diana Fairweather-Purkis 
who died on 3 October 2022.  

Thank  you  for  your  Report  to  Prevent  Future  Deaths  (hereafter  “Report”)  dated  17 
February 2025 concerning the death of Diana Fairweather-Purkis on 3 October 2022. 
In advance of responding to the specific concerns raised in your Report, I would like 
to express my deep condolences to Diana’s family and loved ones. NHS England are 
keen to assure the family and the Coroner that the concerns raised about Diana’s care 
have been listened to and reflected upon.   

I am grateful for the further time granted to respond to your Report, and I apologise for 
any  anguish  this  delay  may  have  caused  Diana’s  family  or  friends.  I  realise  that 
responses to Coroners’ Reports can form part of the important process of family and 
friends coming to terms with what has happened to their loved ones, and I appreciate 
this will have been an incredibly difficult time for them. 

Your Report raised concerns that there is insufficient ambulance service availability / 
resource  to  enable  ambulances  to  attend  to  patients  in  a  timely  manner  and  in 
accordance with relevant target attendance times, and that there are excessive delays 
in patient handovers between ambulance crews and hospital staff. In Diana’s case, I 
note that the initial target response time for the Category 3 ambulance was 2 hours 
before it was upgraded to Category 2, but unfortunately an ambulance did not attend 
until 9 hours and 56 minutes after the initial call to NHS 111.  

Ambulance availability and response times 

NHS  England  recognises  the  significant  pressures  on  all  NHS  services,  including 
ambulance services, and has been prioritising improvements to Category 2 response 
times and urgent and emergency care (UEC) services. Improvements to Category 2 
response times will have a positive impact across ambulance performance generally, 
including Category 3 responses.  

NHS  England  also  recognises  the  need  to  increase  ambulance  capacity  through 
growing the workforce, improving flow through hospitals, reducing handover delays, 
speeding up discharges from hospital and expanding new services in the community; 

                                                                                                                       
 
 
 
 
 
 
 
  
 
 
 
  
 all of which support improved patient flow and ambulance response times. The NHS 
is  working  more  closely  with  local  authorities  to  improve  the  timely  discharge  of 
patients and has developed discharge metrics to monitor performance improvements. 
Response  times  for  Category  2  ambulance  calls  have  improved;  over  the  2023/24 
year, the average response time was over 13 minutes faster compared to the previous 
year.   

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 
operational  planning  guidance  sets  out  that  the  NHS  should  improve  ambulance 
response  times  and  Accident  and  Emergency  (A&E)  waiting  times  compared  to 
2024/25,  and  that  Category  2  ambulance  response  times  should  average  no  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.   

NHS England has also engaged with North East and North Cumbria Integrated Care 
Board (NENC ICB), who I note your Report was also addressed to, on the concerns 
raised in your Report.  

They advise that since the creation NENC ICB in July 2022, there has been significant 
investment of additional resources into ambulance services to increase capacity and 
availability. Over £40 million of additional funding, made up of local ICB investment 
and  a  share  of  nationally  funded  NHS  England  growth  monies,  has  been  made 
available to the North East Ambulance Service (NEAS) since 2023/24 to increase the 
number of vehicles on the road and also strengthen clinical advisory services. 

NEAS  have  established  an  Integrated  Urgent  Care  Clinical  Assessment  Service 
(IUCAS)  which  includes  paramedics,  nurses,  advanced  practitioners,  pharmacists, 
GPs and clinical specialists who provide enhanced clinical support to call handlers and 
patients  ringing  111  and  999.  Senior  clinical  advisors  (clinicians)  provide  additional 
clinical assessment via telephone triage, improving the journey and experience for our 
patients  by  ensuring  they  can  pass  through  to  services  quickly  and  efficiently.  The 
team also promotes self-care and provides advice and support for patients at home, 
facilitating onward referral where necessary to a range of primary and secondary care 
services.  By  being  able  to  increase  the  number  of  patients  who  are  treated  and 
discharged in the community, the IUCAS helps to reduce pressures on ambulances, 
emergency departments and other NHS services. 

With  regard  to  ambulance  performance  and  the  target  response  times,  NEAS  are 
consistently  the  highest  performing  ambulance  provider  in  England  across  all  4 
response time categories, and they continue to implement system-wide improvement 
programmes  in  conjunction  with  NENC  ICB  and  acute  hospital  providers  to  further 
improve  response  times  throughout  2025/26  and  work  towards  achieving  the  NHS 
constitutional standards. 

Handover delays in hospital 

 Ambulance handover delays are a priority area of focus for NENC ICB, NEAS, and 
acute  provider  NHS  Foundation  Trusts  across  the  NENC  Integrated  Care  System 
(ICS).  The  multi-agency  NENC  Strategic  Urgent  &  Emergency  Care  Network  and 
Local  A&E  Delivery  Boards  provide  leadership  and  oversight  of  a  range  of 
transformation  initiatives  that  are  being  taken  to  improve  patient  handover  times. 
There has been a significant programme of work taking place in the second half of 
2024/25 to bring together colleagues from across the system (ICB, Foundation Trust, 
Ambulance Trust) to look at ambulance handover improvement and transformation. 
This  programme  was  externally  facilitated  and  has  led  to  a  number  of  revised  and 
standardised  policies  and  procedures  being  agreed  for  elements  of  the  ambulance 
handover  process  (e.g.,  immediate  release,  cohorting,  diverts  and  deflections  etc.). 
Alongside  the  wider  ICS  programme,  there  have  also  been  individual  improvement 
programmes  taking  place  across  Foundation  Trusts  to  reduce  handover  delays.  A 
strong example of this is the work that has taken place at South Tees Hospitals NHS 
Foundation Trust to make tangible improvements to their internal processes, resulting 
in increased flow through the Emergency Department and reduced average handover 
times.  

Average  ambulance  handover  times  are  improving  after  a  difficult  and  challenging 
winter period and, in the last 3 weeks, the average handover time has been less than 
20  minutes  across  the  NENC  area,  just  above  the  constitutional  standard  of  15 
minutes  and  significantly  below  the  target  of  45  minutes  in  the  2025/26  NHS 
operational  planning  guidance.  There  have  also  been  significant  reductions  in  the 
number of ambulance handovers in excess of 60 minutes, the threshold beyond which 
we know patients are at an increased risk of experiencing harm. These improvements 
have  been  delivered  whilst  the  demand  for  ambulances  has  continued  to  rise,  and 
general  &  acute  bed  occupancy  has  remained  above  92%  across  NENC.  There 
continues to be a strong focus on reducing handover delays, so that ambulance crews 
can be released back onto the road as quickly and efficiently as possible to respond 
to  patient  demand  in  the  community.  This  is  evidenced  by  the  consistently  strong 
performance  of  NEAS  across  the  four  categories  of  ambulance  response  times 
compared to other ambulance services in England. 

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 Diana, 
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