Valerie Hill

Prif Weinidog Cymru/First Minister of Wales 

Graeme Hughes 
Senior Coroner  
South Wales Central Coroner Area 
The Old Courthouse 
Courthouse Street 
Pontypridd 
CF37 1JW 

Dear Mr Hughes, 

     24 July 2025 

I am writing in response to your letter and Regulation 28 Prevention of Future Deaths report 
on 13 June following the conclusion of the inquest into the death of Valerie Hill. Please pass 
on my condolences to Ms Hill’s family. 

Your report raises concerns about the impact of ambulance patient handover delays at Cwm 
Taf  Morgannwg  University  Health  Board,  in  particular,  on  patient  outcomes  and  on 
ambulance responsiveness to 999 calls in the community.   

The Welsh Government expects the NHS to provide a high standard of care to everyone 
who seeks treatment. I am saddened when care falls below that standard, especially when 
it results in harm. I am grateful to you for providing this Regulation 28 report  – this is an 
opportunity for the NHS and the Welsh Government to further learn from what went wrong 
in  Ms  Hill’s  case  and  to  work  together  to  put  in  place  changes  to  prevent  more  people 
experiencing the same issues and failings.    

I will set out the roles and responsibilities in relation to the health service and address your 
concerns. 

Governance: roles and responsibilities 

Welsh Ministers set the strategic expectations for health and care services and hold health 
bodies accountable for fulfilling their statutory duties. Welsh Ministers are not responsible 
for the delivery of health services.  

Health boards and NHS trusts are responsible for planning, commissioning and delivering 
services for the population of their respective areas within the national policy framework set 
by Welsh Ministers.  

The Welsh Ambulance Services National Health Service Trust (Establishment) Order 1998 
established  the  Welsh  Ambulance  Services  University  National  Health  Service  Trust 

Bae Caerdydd • Cardiff Bay 
Caerdydd • Cardiff 
CF99 1SN 

Canolfan Cyswllt Cyntaf / First Point of Contact Centre:  
0300 0604400 

Rydym yn croesawu derbyn gohebiaeth yn Gymraeg.  Byddwn yn ateb gohebiaeth a dderbynnir yn Gymraeg yn Gymraeg ac ni fydd 
gohebu yn Gymraeg yn arwain at oedi.  

We welcome receiving correspondence in Welsh. Any correspondence received in Welsh will be answered in Welsh and corresponding 
in Welsh will not lead to a delay in responding.   

 
 
 
                                  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 (WAST). Article 3 delegates the function of managing the ambulance service to WAST. It is 
responsible for delivering emergency ambulance services, in line with the commissioning 
intentions set by the NHS Wales Joint Commissioning Committee (JCC). The JCC is a joint 
committee  of  health  boards  established  to  jointly  exercise  the  functions  of  planning, 
securing, and commissioning of emergency ambulance services.  

The Welsh Government’s clear expectation is that when someone is conveyed to hospital 
by ambulance, care must be handed over to the receiving hospital team as soon as possible, 
in order of clinical priority and within 15 minutes. Health boards are responsible for ensuring 
this happens reliably and that there is sufficient available capacity throughout the receiving 
hospital. This is set out in the Ambulance Patient Handover Guidance.  

Our  policy  expectation,  and  the  commissioning  intent  of  the  NHS  JCC,  is  that  WAST 
prioritises response to those in most need and aims to provide the right response, first time 
to optimise outcomes and experience.  

The  Cabinet  Secretary  for  Health  and  Social  Care  holds  the  chairs  of  health  boards  and 
WAST  to  account  for  oversight  of  the  delivery  of  those  expectations  through  regular 
meetings.  

Welsh Government officials maintain oversight of the delivery of services via Joint Executive 
Team  meetings  held  biannually  and  through  bimonthly  integrated  quality  planning  and 
delivery  (IQPD)  meetings  where  progress  against  key  performance  targets  is  scrutinised 
and assurance on the quality and safety of services is sought.  

Ambulance patient handover performance 

I  remain  concerned  about  the  level  of  ambulance  patient  handover  delays  at  emergency 
departments and the impact of these delays on  people’s outcomes; on NHS staff morale 
and on the Welsh Ambulance Service’s ability to respond to people in the community. 

Until recent months, I have been disappointed with the slow progress in reducing ambulance 
patient handover delays. As your report notes, addressing this requires co-ordinated action 
across  the  entire  health  and  social  care  system,  with  strong  clinical  leadership  and 
executive-level commitment from health boards. 

The Cabinet Secretary for Health and Social Care has been clear with health boards about 
his expectation for improvement in the timeliness of ambulance patient handovers. All health 
boards are expected to deliver the Ambulance Patient Handover Guidance, which has been 
established as one of five priorities (‘enabling actions’) for urgent and emergency care in the 
NHS  planning  framework for 2025-26.  It also  features as  part of  the  health board  chairs’ 
objectives as a marker of performance.  

A  review  of  health  board  compliance  was  commissioned  in  quarter  four  of  2024-25  and 
completed  in  March  2025  by  NHS  Performance  and  Improvement.  A  report  containing 
learning and key themes for health boards to consider was shared by Welsh Government 
on 18 June 2025. A copy is attached at annex A. 

Welsh Government officials have sought urgent assurance from each health board about 
how they will deliver specific actions against the eight aspects from the report to support 
compliance with the handover guidance and work towards delivery of no delays in excess 
of 45 minutes by quarter three of 2025-26. Progress will be followed up by officials and NHS 
Performance and Improvement at Integrated Quality Planning and Delivery meetings with 
health boards. 

 The independent Getting it Right First Time (GIRFT) and Ministerial Advisory Group on NHS 
Performance and Productivity report also underscored the need for change.  The Cabinet 
Secretary for Health and Social Care has announced a National Handover-45 Taskforce to 
support  health  boards  and  WAST  to  deliver  system-wide  improvements  to  improve 
ambulance handover. 

The  taskforce  will  develop  and  support  delivery  of  high-impact  clinical  pathways  in  the 
community;  support  the  delivery  of  effective  evidence-based  emergency  department 
processes  and  support  the  delivery  of  evidence-based  processes  to  improve  the  flow  of 
patients from emergency departments to wards and optimise discharge. 

It will play a key role in assessing and supporting the readiness of NHS Wales to deliver 
every ambulance patient handover within 15 minutes as far as possible, but always within 
45 minutes. 

The taskforce will be led by: 

• 

• 

• 

• 

• 

, executive director of nursing at Aneurin Bevan University Health 

Board. 

, executive director of allied health professions and health science at 

Hywel Dda University Health Board. 

director at Cardiff and Vale University Health Board. 

,  executive  director  of  precision  medicine  and  executive  medical 

,  executive  director  of  paramedicine,  Welsh  Ambulance  Services 

University NHS Trust. 

, executive director of quality and nursing, Welsh Ambulance Services 

University NHS Trust.  

They will be supported by NHS Wales Performance and Improvement and the NHS Wales 
Joint Commissioning Committee. 

The taskforce will use the NHS Performance and Improvement review as a foundation and 
compile comprehensive evidence about effective strategies for improving ambulance patient 
handover. This will inform the development of an improvement programme and a readiness 
assessment.  

The taskforce will support health boards and WAST through a series of rapid improvement 
events  over  a  30,  60  and  90-day  period.  These  will  bring  together  senior  clinical  and 
operational leaders at a health board level with a focus on high-impact pathways, emergency 
department processes, improving patient flow and encouraging clinical ownership of actions.  

There have been some encouraging signs of improvement because of local strategies, the 
work  of  the  Six  Goals  for  Urgent  and  Emergency  Care  programme,  and  the  Wales-wide 
focus  on  reduced  delayed  hospital  discharges.  These  approaches  will  be  shared  with  all 
health boards and the taskforce will also draw on other successful cultures, processes and 
models from across the UK. 

In June 2025, across all emergency departments in Wales there were 31% fewer ambulance 
hours lost caused by ambulance patient handover delays and 24% fewer delays in excess 
of one hour when compared to June 2024. In the Cwm Taf Morgannwg University Health 
Board area, there were 33% fewer ambulance hours lost, and 69% fewer patients delayed 
more than an hour when compared to June 2024. The 15-minute performance was 47% and 
we expect to see this improve. 

 
 Planning for winter 2025-26 

As the winter period traditionally presents greater challenges for emergency care services, 
the  process  of  learning  lessons from  last  winter and  developing  plans for  winter  2025-26 
started at the earliest possible stage on 31 March 2025. The Cabinet Secretary for Health 
and Social Care chaired a Winter Summit meeting with NHS chief executives, directors of 
social services and the Association of Directors of Social Services (ADSS) Cymru.  

The outputs from the summit have been co-ordinated by Welsh Government officials and 
expectations of health and social care partners, with guidance and good practice was issued 
to NHS organisations and local authorities on 14 July 2025. 

Escalation and Intervention 

Escalation is used to hold health boards to account for delivering the services the people of 
Wales require. It enables us to offer appropriate support so that they get the help they need 
to make the desired improvements.  

Our  approach  to  oversight,  escalation  and  intervention  is  set  out  in  the  NHS  Oversight, 
Assurance, Escalation and Intervention Framework. The framework sets out six escalation 
domains against which all health organisations are assessed. 

In  line  with  the  processes  described  within  the  document,  Welsh  Government  officials 
undertake an assessment of each health organisation against each of the domains at least 
twice a year. These assessments draw in a variety of evidence and are used in conjunction 
with evidence and intelligence from statutory organisations by Welsh Government officials 
to inform the recommendations made to the Cabinet Secretary, on the escalation levels of 
NHS  organisations  in  Wales.  The  latest  escalation  levels  for  each  organisation  were 
published in July and are available at NHS Wales escalation and intervention arrangements 
| GOV.WALES.  

All health boards in Wales, are in escalation for urgent and emergency care, which includes 
ambulance  handovers.  Cwm  Taf  Morgannwg  University  Health  Board  is  in  level  four 
escalation (the second highest level) for urgent and emergency care.  

Decisions  about  escalation  levels  are  taken  at  least  twice  a  year,  and  more  frequently  if 
serious concerns persist. This process involves the analysis of data, outcomes, and patient 
experiences  amongst  others.  Views  are  taken  from  statutory  bodies  and  others.  Welsh 
Government officials use this collective information to assess escalation levels and make 
recommendations to the Cabinet Secretary for Health and Social Care. When considering 
whether an increase in escalation level or special measures is necessary a clear rationale 
is  required  including  analysis  of  what  improvements  and  support  can  be  offered  via 
escalation or intervention before that recommendation can be made.  

All  organisations  in  escalation  have  an  agreed  escalation  framework,  this  sets  out  very 
clearly the criteria for de-escalation to the next level. The Welsh Government will work with 
the  health  board  to  agree  the  support  required  depending  on  the  areas  of  concern  and 
ensure that this is implemented and progress against the escalation frameworks is reviewed 
monthly in formal meetings.  Achievement of this criteria  will  result  in  de-escalation,  while 
failure to achieve will increase the level and nature of interventions.