Recurring concern

Unsafe emergency-department crowding leaving patients without appropriate clinical space

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First reported 24 Dec 2015•Latest report 18 Jun 2026

Definition

What this concern includes

Includes crowding or capacity failures that leave emergency-department patients without an appropriate clinical space.

Not included

Excludes generic emergency department crowding, staffing pressure or delayed patient flow unless the report directly identifies the resulting lack of designated clinical space or non-clinical-space care.
Excludes failures concerning psychiatric, inpatient or other specialist bed capacity unless they specifically concern designated clinical space for emergency department patients.
Excludes isolated clinical-care, monitoring, privacy, documentation or treatment failures that do not identify inadequate designated emergency department care space as the shared unsafe condition.

Reports: 17
Individual concerns: 19
Date range: 2015–2026
Stated actions: 117

Reports over time

Reports about this concern issued each year.

* 2026 is projected from reports observed to 7 Sep 2026.

Most frequent recipients

Reports about this concern sent to each recipient.

Department of Health and Social Care11

NHS England4

University Hospitals Sussex NHS Foundation Trust3

Care Quality Commission2

Greater Manchester Health and Social Care Partnership2

Barts Health NHS Trust1

Betsi Cadwaladr University LHB1

Cwm Taf Morgannwg University Local Health Board1

James Paget University Hospital1

NHS Norfolk and Suffolk Integrated Care Board1

Norfolk and Norwich University Hospital1

Norfolk and Suffolk NHS Foundation Trust1

Royal Cornwall Hospitals NHS Trust1

Royal United Hospital1

South West Ambulance Service Trust (SWAST)1

Concerns and responses across reports

Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.

18 Jun2026
Cornwall and Isles of Scilly
Concerns raised2
1. Failure to maintain emergency department capacity and timely patient flow
2. Failure to prevent emergency department crowding from patients left awaiting handover
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response 3
1. Action
  Invest over £450 million to expand urgent and emergency care capacity through the 2025/26 delivery plan.
  Stated by Department of Health and Social CareStated completed
2. Action
  Publish national clinical standards for emergency departments, acute pathways and discharge to improve flow and safer emergency care.
  Stated by Department of Health and Social CareStated completed
3. Action
  Work with health and care partners to improve discharge arrangements, strengthen service integration and ensure safe, timely and appropriate care.
  Stated by Department of Health and Social CareStated in progress
AI-generated summary

Geoffrey Gordon Fuller · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Geoffrey Gordon Fuller, aged 91, called an ambulance for a dislocated hip and experienced a 13-hour delay, including prolonged periods waiting for an ambulance response and hospital handover, during which he suffered pain and was unable to move. He later died at Royal Cornwall Hospital from a ruptured abdominal aortic aneurysm, which the report states was unrelated to the dislocated hip and to which the delay contributed no more than minimally. The principal concerns were persistent ambulance handover delays, emergency department overcrowding, and insufficient social care provision, with associated risks to patient care and ambulance availability.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to maintain emergency department capacity and timely patient flow
Wider context from the report
“1. On the day of Mr Fuller’s ambulance delay, RCHT ED was accommodating 105 patients. ED has a capacity of 42 patients. ED accommodated the surplus patients on trolleys in corridors, seated within the waiting room or remaining inside ambulances in the parking area outside ED. 2. The situation had not improved as at the date of this Inquest. 3. EDs have a national target for 95% of patients to be admitted, transferred or discharged within 4 hours. It was noted that there is a recent major study which shows that the standardised mortality rate starts to rise from 5 hours after the patient’s time of arrival at the ED and they concluded that after 6–8 hours, there is one extra death for every 82 patients delayed. This increased mortality is partly attributed to the fact that patients in ED are not receiving the surgery or specialist care that is available on the wards. 4. Data indicates that RCHT have been failing to meet the 4-hour target for a significant number of patients. For the opening months of 2026 approximately 50% of patients have still been in ED after 4 hours. 5. RCHT witnesses reported that over the last few weeks the ED has been regularly required to accommodate over 100 patients (in a unit with a capacity for 42 patients). This has involved significant numbers of patients still in ED after 12 hours, some still in ED after 24 hours. ”
Source location
Geoffrey Gordon Fuller · Prevention of Future Deaths report
Page 3 · concerns
Open source report
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to prevent emergency department crowding from patients left awaiting handover
Wider context from the report
“10. The court heard evidence of a new policy being implemented by SWAST to try and reduce ambulance resources being tied down in lengthy waits at hospital. After a 90-minute handover delay the ambulance paramedics will provide notice to ED that a patient is being left on a trolley in a corridor with fluids and medications if required so long as that patient is stable. This has led to significant crowding in RCHT emergency department (ED). ”
Source location
Geoffrey Gordon Fuller · Prevention of Future Deaths report
Page 3 · concerns
Open source report
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Invest over £450 million to expand urgent and emergency care capacity through the 2025/26 delivery plan.

Verbatim wording from the response
“This includes, through delivering the Urgent and Emergency Care Delivery Plan 2025/26, having invested over £450 million to expand urgent and emergency care capacity. We have also published national clinical standards through the Model Emergency Department, Model Acute Pathway and Model Discharge programmes, which are designed to improve flow through hospitals, reduce prolonged waits and support safer emergency care.”

Source location
Response from Department of Health and Social Care
Page 2 · response
Published 3 September 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Publish national clinical standards for emergency departments, acute pathways and discharge to improve flow and safer emergency care.

Verbatim wording from the response
“This includes, through delivering the Urgent and Emergency Care Delivery Plan 2025/26, having invested over £450 million to expand urgent and emergency care capacity. We have also published national clinical standards through the Model Emergency Department, Model Acute Pathway and Model Discharge programmes, which are designed to improve flow through hospitals, reduce prolonged waits and support safer emergency care.”

Source location
Response from Department of Health and Social Care
Page 2 · response
Published 3 September 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Work with health and care partners to improve discharge arrangements, strengthen service integration and ensure safe, timely and appropriate care.

Verbatim wording from the response
“We note your findings regarding the whole-system nature of these issues and will carefully consider this report alongside wider evidence on discharge delays, patient flow and urgent and emergency care pressures. The Government remains committed to working with partners across the health and care system to improve discharge arrangements, strengthen integration between services and ensure patients receive safe, timely and appropriate care.”

Source location
Response from Department of Health and Social Care
Page 2 · response
Published 3 September 2026
Open published response
22 May2026
West Sussex, Brighton and Hove
Concerns raised1
1. Failure to provide a designated clinical area for emergency department patients when capacity is reached
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response 21
1. Action
  Continue action to improve patient flow across the urgent and emergency care pathway.
  Stated by Department of Health and Social CareStated in progress
2. Action
  Continue action to expand available urgent and emergency care capacity.
  Stated by Department of Health and Social CareStated in progress
3. Action
  Provide focused support to the most challenged trusts.
  Stated by Department of Health and Social CareStated in progress
1. Action
  Strengthen direct-to-specialty pathways and expand acceptance criteria for patients accepted directly by hospital specialties.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
2. Action
  Direct inter-hospital referrals to inpatient beds rather than routing them through the Emergency Department.
  Stated by University Hospitals Sussex NHS Foundation TrustStated completed
3. Action
  Operate a 24/7 medical Same Day Emergency Care unit to stream suitable patients away from the Emergency Department.
  Stated by University Hospitals Sussex NHS Foundation TrustStated completed
4. Action
  Explore working with NEWTON to decompress the Emergency Department, strengthen Same Day Emergency Care, and improve flow for patients without a criteria to reside.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
5. Action
  Run Emergency Physician In Charge and corridor huddles continuously to review corridor patients, identify pathways, and escalate risks.
  Stated by University Hospitals Sussex NHS Foundation TrustStated completed
6. Action
  Operate and regularly review the Hospital Alternative Oversight Programme and its admission-avoidance, flow, discharge, virtual-care, frailty, therapy, and urgent-care initiatives.
  Stated by University Hospitals Sussex NHS Foundation TrustStated completed
7. Action
  Collaborate with the local Mental Health Trust to secure timely mental health admission or avoid Emergency Department attendance.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
8. Action
  Use ambulatory Emergency Department space effectively to maximise clinical capacity and reduce overcrowding.
  Stated by University Hospitals Sussex NHS Foundation TrustStated completed
9. Action
  Operate the Medicine Division’s Continuous Flow Model to move patients earlier from the Acute Floor and reduce Emergency Department admission waits.
  Stated by University Hospitals Sussex NHS Foundation TrustStated completed
10. Action
  Implement local corridor-care safety measures, including digital observations and prescribing, intentional rounding, corridor standards, high-risk reviews, and dedicated monitoring space.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
11. Action
  Complete phase one of the Acute Floor Reconfiguration programme, including opening the new Acute Medical Unit and 24/7 Medical Same Day Emergency Care unit.
  Stated by University Hospitals Sussex NHS Foundation TrustStated completed
12. Action
  Publish the Urgent and Emergency Care Plan and Medium-Term Planning Framework setting national expectations to eliminate corridor care.
  Stated by NHS EnglandStated completed
13. Action
  Support providers and Integrated Care Boards to improve hospital flow through faster senior decisions, same-day emergency care and virtual wards.
  Stated by NHS EnglandStated in progress
14. Action
  Support providers and Integrated Care Boards to reduce emergency-department demand through community and primary-care alternatives and strengthened admission-avoidance pathways.
  Stated by NHS EnglandStated in progress
15. Action
  Support providers and Integrated Care Boards to strengthen discharge processes through criteria-led discharge and discharge-to-assess models.
  Stated by NHS EnglandStated in progress
16. Action
  Develop Model Discharge guidance to reduce discharge delays and improve patient flow.
  Stated by NHS EnglandStated in progress
17. Action
  Provide targeted regional support to systems experiencing the highest levels of patient-flow pressure.
  Stated by NHS EnglandStated in progress
18. Action
  Publish corridor-care data routinely to increase transparency and enable focused intervention where patient-safety risks are greatest.
  Stated by NHS EnglandStated completed
Respondent positions 2
1. Position
  NHS England is responsible for directly addressing the concerns about corridor care and providing the full response.
  Stated by Department of Health and Social CareRedirects responsibility
1. Position
  The Trust cannot eradicate corridor care without all partner organisations working together to address the wider system problem.
  Stated by University Hospitals Sussex NHS Foundation TrustUnable to act
AI-generated summary

David John Smart · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

David John Smart developed a life-threatening rectal bleed after a polypectomy and required surgery after conservative management continued to be unsuccessful. He died from known complications of Andexanet Alfa, used to reverse Rivaroxaban so that surgery could be performed. The inquest raised concerns about patients being cared for in corridors when the Emergency Department reached capacity, including the continued use of corridors despite actions intended to improve patient flow.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to provide a designated clinical area for emergency department patients when capacity is reached
Wider context from the report
“During the inquest I heard evidence that at the of Mr Smart's attendance to the Emergency Department of the Royal Sussex County Hospital, Brighton that there were around 20 patients in the corridor as the Department had reached capacity and there was no clinical area available to do so. I understand from previous inquests that the area is not designated as a clinical area. I have heard in other inquests relating to deaths prior to June 2025 that is being taken by University Hospitals Sussex NHS Foundation Trust currently to (1) reduce the number of patients who present to the Emergency Department who could be seen by other services in the community and (2) to create an improved patient flow through the Royal Sussex County Hospital. The evidence in this inquest was that, despite these actions, the corridor continues to be used when the Emergency Department reaches capacity. I was also advised that the use of corridors to care for patients is not only an issue at the Royal Sussex County Hospital, Brighton but is used throughout the country. Prevention of Future Death reports in relation to the use of the corridor for patient care was made during investigations into deaths which occurred in December 2022 and February 2025 and the use of the corridor remains ongoing. ”
Source location
David John Smart · Prevention of Future Deaths report
Page 3 · concerns
Open source report
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Continue action to improve patient flow across the urgent and emergency care pathway.

Verbatim wording from the response
“The Government and NHS England will continue to take action across the full urgent and emergency care pathway to improve patient flow, expand available capacity, and reduce avoidable demand on accident and emergency departments. This includes focused support for the most challenged trusts, alongside strengthened reporting arrangements and the introduction of a consistent national definition of corridor care to support greater transparency. We will also begin publishing data on corridor care for the first time, subject to assurance of data quality.”

Source location
Response from Department of Health and Social Care
Page 1 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Continue action to expand available urgent and emergency care capacity.

Verbatim wording from the response
“The Government and NHS England will continue to take action across the full urgent and emergency care pathway to improve patient flow, expand available capacity, and reduce avoidable demand on accident and emergency departments. This includes focused support for the most challenged trusts, alongside strengthened reporting arrangements and the introduction of a consistent national definition of corridor care to support greater transparency. We will also begin publishing data on corridor care for the first time, subject to assurance of data quality.”

Source location
Response from Department of Health and Social Care
Page 1 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Provide focused support to the most challenged trusts.

Verbatim wording from the response
“The Government and NHS England will continue to take action across the full urgent and emergency care pathway to improve patient flow, expand available capacity, and reduce avoidable demand on accident and emergency departments. This includes focused support for the most challenged trusts, alongside strengthened reporting arrangements and the introduction of a consistent national definition of corridor care to support greater transparency. We will also begin publishing data on corridor care for the first time, subject to assurance of data quality.”

Source location
Response from Department of Health and Social Care
Page 1 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Strengthen direct-to-specialty pathways and expand acceptance criteria for patients accepted directly by hospital specialties.

Verbatim wording from the response
“The key workstreams include strengthening the ‘Direct to Specialty Pathways between the Emergency Department and the Trust’s specialties for patients who are accepted for care directly by the relevant specialty on presentation to the ED. We are continually looking to expand the acceptance criteria to ensure that we are maximising this process. Additionally, we are directing inter-hospital referrals away from the ED and transferring patients directly to the in-patient bed base. We have strengthened our Same Day Emergency Care (SDEC) medical model from a 7 day a week service to a 24/7 unit where patients can be streamed away from the ED and seen and treated on the Acute Medical Unit (AMU). These workstreams have all been overseen through the ED Quality Oversight Group.”

Source location
Response from University Hospitals Sussex NHS Foundation Trust
Page 2 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Direct inter-hospital referrals to inpatient beds rather than routing them through the Emergency Department.

Verbatim wording from the response
“The key workstreams include strengthening the ‘Direct to Specialty Pathways between the Emergency Department and the Trust’s specialties for patients who are accepted for care directly by the relevant specialty on presentation to the ED. We are continually looking to expand the acceptance criteria to ensure that we are maximising this process. Additionally, we are directing inter-hospital referrals away from the ED and transferring patients directly to the in-patient bed base. We have strengthened our Same Day Emergency Care (SDEC) medical model from a 7 day a week service to a 24/7 unit where patients can be streamed away from the ED and seen and treated on the Acute Medical Unit (AMU). These workstreams have all been overseen through the ED Quality Oversight Group.”

Source location
Response from University Hospitals Sussex NHS Foundation Trust
Page 2 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Operate a 24/7 medical Same Day Emergency Care unit to stream suitable patients away from the Emergency Department.

Verbatim wording from the response
“The key workstreams include strengthening the ‘Direct to Specialty Pathways between the Emergency Department and the Trust’s specialties for patients who are accepted for care directly by the relevant specialty on presentation to the ED. We are continually looking to expand the acceptance criteria to ensure that we are maximising this process. Additionally, we are directing inter-hospital referrals away from the ED and transferring patients directly to the in-patient bed base. We have strengthened our Same Day Emergency Care (SDEC) medical model from a 7 day a week service to a 24/7 unit where patients can be streamed away from the ED and seen and treated on the Acute Medical Unit (AMU). These workstreams have all been overseen through the ED Quality Oversight Group.”

Source location
Response from University Hospitals Sussex NHS Foundation Trust
Page 2 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Explore working with NEWTON to decompress the Emergency Department, strengthen Same Day Emergency Care, and improve flow for patients without a criteria to reside.

Verbatim wording from the response
“The Trust is currently exploring working with a company (NEWTON) to increase the opportunity for decompressing the EDs, further strengthening the SDECs across the Trust, and improving flow once patients do not have a criteria to reside.”

Source location
Response from University Hospitals Sussex NHS Foundation Trust
Page 2 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Run Emergency Physician In Charge and corridor huddles continuously to review corridor patients, identify pathways, and escalate risks.

Verbatim wording from the response
“All specialties in-reach to the ED and we operate a 3/2/1 bleep system to ensure this is fast and effective. We continue to run ‘Emergency Physician In Charge’ (EPIC) huddles and Corridor huddles multiple times a day 24/7 days a week. These allow line-by-line reviews of every patient in the corridor to ensure all appropriate pathways are considered; this is known as check and challenge and provides live escalation.”

Source location
Response from University Hospitals Sussex NHS Foundation Trust
Page 2 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Operate and regularly review the Hospital Alternative Oversight Programme and its admission-avoidance, flow, discharge, virtual-care, frailty, therapy, and urgent-care initiatives.

Verbatim wording from the response
“The Hospital Alternative Oversight Programme (HALO) is embedded in daily practice and continues to be reviewed regularly to ensure all opportunities are maximised. This work is aimed at the avoidance of inappropriate hospital admissions, to optimise patient flow through the hospital, and smooth discharge pathways and processes. This includes:”

Source location
Response from University Hospitals Sussex NHS Foundation Trust
Page 2 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Collaborate with the local Mental Health Trust to secure timely mental health admission or avoid Emergency Department attendance.

Verbatim wording from the response
“There continues to be ongoing collaborative work with the local Mental Health Trust, SPFT to ensure that patients requiring mental health hospital admission are admitted to an appropriate mental health unit as quickly as possible or avoid ED attendance in the first place.”

Source location
Response from University Hospitals Sussex NHS Foundation Trust
Page 3 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Use ambulatory Emergency Department space effectively to maximise clinical capacity and reduce overcrowding.

Verbatim wording from the response
“We continue to use ambulatory space as effectively as possible across the ED to maximise clinical space and reduce overcrowding.”

Source location
Response from University Hospitals Sussex NHS Foundation Trust
Page 3 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Operate the Medicine Division’s Continuous Flow Model to move patients earlier from the Acute Floor and reduce Emergency Department admission waits.

Verbatim wording from the response
“The Continuous Flow Model is embedded within the Medicine Division and continues to ensure earlier movement of patients from the Acute Floor and reducing the time patients are waiting in the ED for admission to a ward. There are ongoing discussions with clinical Divisions outside the Medicine Division to implement a similar model.”

Source location
Response from University Hospitals Sussex NHS Foundation Trust
Page 3 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Implement local corridor-care safety measures, including digital observations and prescribing, intentional rounding, corridor standards, high-risk reviews, and dedicated monitoring space.

Verbatim wording from the response
“We recognise that the contributory factors leading to corridor care are multi-faceted and complex. As these issues involve a multi-agency approach, working alongside our system partners, we acknowledge that eradicating care in non-clinical environments will take considerable time. Therefore, alongside these actions, the ED team is continuing to implement local measures to improve the quality and safety for patients receiving care in these areas. Examples of these are:”

Source location
Response from University Hospitals Sussex NHS Foundation Trust
Page 3 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Complete phase one of the Acute Floor Reconfiguration programme, including opening the new Acute Medical Unit and 24/7 Medical Same Day Emergency Care unit.

Verbatim wording from the response
“Our Acute Floor Reconfiguration, which is a £48 million capital improvement programme to improve patient and staff experience at the Royal Sussex County”

Source location
Response from University Hospitals Sussex NHS Foundation Trust
Page 3 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Publish the Urgent and Emergency Care Plan and Medium-Term Planning Framework setting national expectations to eliminate corridor care.

Verbatim wording from the response
“Since your previous Reports to us, the NHS England Urgent and Emergency Care Plan for 2025/26 has been published (in June 2025) and supported by the Medium-Term Planning Framework, which sets out a national expectation that systems take coordinated action to eliminate corridor care by improving end-to-end patient flow, reducing avoidable hospital congestion and improving timely discharge from hospital.”

Source location
Response from NHS England
Page 1 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Support providers and Integrated Care Boards to improve hospital flow through faster senior decisions, same-day emergency care and virtual wards.

Verbatim wording from the response
“Alongside this, NHS England has been and continues to support providers and Integrated Care Boards (ICBs) to improve internal hospital flow through faster senior clinical decision-making, increased use of same day emergency care and virtual wards, and more effective management of patient pathways. The plan also aims to reduce demand on emergency departments through improved access to community and primary care alternatives and strengthened admission avoidance pathways, so that patients can be assessed and treated in the most appropriate setting.”

Source location
Response from NHS England
Page 1 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Support providers and Integrated Care Boards to reduce emergency-department demand through community and primary-care alternatives and strengthened admission-avoidance pathways.

Verbatim wording from the response
“Alongside this, NHS England has been and continues to support providers and Integrated Care Boards (ICBs) to improve internal hospital flow through faster senior clinical decision-making, increased use of same day emergency care and virtual wards, and more effective management of patient pathways. The plan also aims to reduce demand on emergency departments through improved access to community and primary care alternatives and strengthened admission avoidance pathways, so that patients can be assessed and treated in the most appropriate setting.”

Source location
Response from NHS England
Page 1 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Support providers and Integrated Care Boards to strengthen discharge processes through criteria-led discharge and discharge-to-assess models.

Verbatim wording from the response
“A key element of improving patient flow is reducing delays in discharging patients who no longer require acute hospital treatment. Delayed discharges contribute to high bed occupancy, reducing capacity for emergency admissions and increasing pressure on emergency departments. NHS England is supporting providers and ICBs to strengthen”

Source location
Response from NHS England
Page 1 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Develop Model Discharge guidance to reduce discharge delays and improve patient flow.

Verbatim wording from the response
“discharge processes, including through the consistent use of criteria-led discharge and discharge to assess models. NHS England is also developing “Model Discharge” guidance to support trusts in reducing delays and improving patient flow.”

Source location
Response from NHS England
Page 2 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Provide targeted regional support to systems experiencing the highest levels of patient-flow pressure.

Verbatim wording from the response
“To strengthen oversight and drive improvement, NHS England is working through regional teams to provide targeted support to systems experiencing the highest levels of flow pressure. From May 2026, the routine publication of corridor care data has begun, increasing transparency and enabling more focused intervention where risks to patient safety are greatest.”

Source location
Response from NHS England
Page 2 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Publish corridor-care data routinely to increase transparency and enable focused intervention where patient-safety risks are greatest.

Verbatim wording from the response
“To strengthen oversight and drive improvement, NHS England is working through regional teams to provide targeted support to systems experiencing the highest levels of flow pressure. From May 2026, the routine publication of corridor care data has begun, increasing transparency and enabling more focused intervention where risks to patient safety are greatest.”

Source location
Response from NHS England
Page 2 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
NHS England is responsible for directly addressing the concerns about corridor care and providing the full response.

Verbatim wording from the response
“In considering your report, officials within the Department of Health and Social Care have made enquiries with NHS England and concluded that these concerns are more appropriately addressed by NHS England directly. I am advised that NHS England will therefore provide you with a full and comprehensive response on the concerns you have raised.”

Source location
Response from Department of Health and Social Care
Page 1 · response
Published 17 July 2026
Open published response
Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
The Trust cannot eradicate corridor care without all partner organisations working together to address the wider system problem.

Verbatim wording from the response
“The use of Emergency Department (ED) corridors to care for patients is a significant national problem. The Executive team is working closely with very senior members of the local ICB (Integrated Care Board), CQC (Care Quality Commission), local mental health Trust, and social care providers to tackle the problem. As a Trust we cannot solve the problem without all partner organisations working together. I am so sorry you have had the need to write to us again with your concerns and I too share these concerns.”

Source location
Response from University Hospitals Sussex NHS Foundation Trust
Page 2 · response
Published 17 July 2026
Open published response
5 Aug2025
West Sussex, Brighton and Hove
Concerns raised1
1. Failure to provide sufficient designated clinical space for Emergency Department patients
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response 27
1. Action
  Publish data on the prevalence of corridor care to improve transparency and drive improvement.
  Stated by Department of Health and Social CareStated planned
2. Action
  Progress the Acute Floor Reconfiguration capital programme to improve patient flow, capacity, and the clinical environment.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
3. Action
  Implement a hospital-wide no-corridor culture through nominated leaders, staff empowerment, rapid response, feedback, learning, recognition, and scenario-based training.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
1. Action
  Operate the Direct to Specialty Pathway Agreement with specialty acceptance, rapid in-reach, escalation via the bleep system, daily referral monitoring, and cross-specialty flow meetings.
  Stated by University Hospitals Sussex NHS Foundation TrustStated completed
2. Action
  Lead the Hospital Alternative Oversight Programme to reduce inappropriate admissions and improve hospital flow and discharge through alternative-care, urgent-treatment, same-day, virtual, frailty, therapy, planning, and acuity initiatives.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
3. Action
  Provide consultant advice to ambulance services at the point of contact to support appropriate emergency-department referrals and avoid unnecessary attendances.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
4. Action
  Coordinate with the local mental health trust to support rapid admission of patients requiring mental health care to appropriate units.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
5. Action
  Educate high-presenting nursing homes about avoiding unnecessary emergency-department attendances and navigating alternative care.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
6. Action
  Realign bed spaces and workforce through capacity-and-demand modelling to match service demand.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
7. Action
  Convert a trolley cubicle into a reclining-chair area in the emergency department to increase clinical space.
  Stated by University Hospitals Sussex NHS Foundation TrustStated completed
8. Action
  Operate the Continuous Flow Model to move patients earlier from the Acute Floor and reduce emergency-department waits for ward admission.
  Stated by University Hospitals Sussex NHS Foundation TrustStated completed
9. Action
  Publish principles for providing safer care in Temporary Escalation Spaces when demand exceeds capacity.
  Stated by NHS EnglandStated completed
10. Action
  Develop the operating model supporting providers to eliminate emergency-department crowding and corridor care.
  Stated by NHS EnglandStated in progress
11. Action
  Progress patient-flow improvements through Operational Planning guidance, including productivity, reduced length of stay and improved clinical outcomes.
  Stated by NHS EnglandStated in progress
12. Action
  Develop services that shift unplanned urgent activity from acute hospitals to alternative settings and support proactive care and discharge.
  Stated by NHS EnglandStated in progress
13. Action
  Mandate daily reporting of Temporary Escalation Space use by acute hospitals in emergency departments and wards.
  Stated by NHS EnglandStated completed
14. Action
  Work with regional teams to improve the quality, timeliness and completeness of Temporary Escalation Space data.
  Stated by NHS EnglandStated in progress
15. Action
  Publish Temporary Escalation Space usage data during 2025/26 to drive reductions in corridor care.
  Stated by NHS EnglandStated planned
16. Action
  Deliver the Acute Floor Reconfiguration capital programme to improve capacity, patient flow and the clinical environment.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
17. Action
  Lead a hospital-wide no-corridor culture programme using nominated leaders, staff empowerment, response targets, feedback, recognition and scenario-based training.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
18. Action
  Operate the Direct to Specialty Pathway Agreement, supported by specialty in-reach, rapid bleep escalation, daily referral monitoring and cross-specialty flow meetings.
  Stated by University Hospitals Sussex NHS Foundation TrustStated completed
19. Action
  Lead the Hospital Alternative Oversight Programme to avoid inappropriate admissions, improve hospital flow and smooth discharge through alternative-care and same-day emergency initiatives.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
20. Action
  Provide Trust consultant advice at ambulance point of contact with SECAmb to direct only patients requiring emergency care to the ED.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
21. Action
  Educate teams at ten local nursing homes about avoidable ED attendances and alternatives to ED care.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
22. Action
  Realign bed spaces and matching workforce through capacity-and-demand modelling.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
23. Action
  Convert a trolley cubicle into a reclining-chair area in ED Majors to increase clinical space.
  Stated by University Hospitals Sussex NHS Foundation TrustStated completed
24. Action
  Operate the Continuous Flow Model to move patients earlier from the Acute Floor and reduce ED waits for ward admission.
  Stated by University Hospitals Sussex NHS Foundation TrustStated completed
Respondent positions 1
1. Position
  NHS England is responsible for addressing the concerns and has already provided a response.
  Stated by Department of Health and Social CareRedirects responsibility
AI-generated summary

Maureen Brenda Batchelor · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Maureen Brenda Batchelor was admitted to hospital with diarrhoea and vomiting, was diagnosed with gastroenteritis and aspiration pneumonia, and died on 26 February 2025 from septicaemia caused by aspiration pneumonia. The report raised concerns that patients were being treated in the Emergency Department corridor, a non-clinical area, because of insufficient capacity, with this practice continuing and no evidence as to when it would end.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to provide sufficient designated clinical space for Emergency Department patients
Wider context from the report
“During the inquest I heard evidence from clinicians at University Hospitals Sussex NHS Foundation Trust that when the Emergency Department of the Royal Sussex County Hospital, Brighton reached capacity patients would be moved to and treated in the corridor as there was no clinical area available to do so. The area is not designated as a clinical area. I understand that at the time of Mrs Batchelor's attendance on 25 February there were 25 patients in the Emergency Department corridor, and this increased to 32 patients. Clinicians from University Hospitals Sussex NHS Foundation Trust gave evidence as to the action that is being taken by the Trust currently to (1) reduce the number of patients who present to the Emergency Department who could be seen by other services in the community and (2) to create an improved patient flow through the Royal Sussex County Hospital. The evidence was however that, despite these actions, the corridor remains in use for patients currently as there is insufficient space within the department to care for patients. When asked there was no evidence as to when this practice would no longer be necessary. I was also advised that the use of corridors to care for patients is not only an issue at the Royal Sussex County Hospital, Brighton but is used throughout the country when the capacities of Emergency Departments has been reached and there is nowhere to treat patients and the only other alternative would be to hold patients in ambulances outside of the hospital. A Prevention of Future Deaths report in relation to the use of the corridor for patient care was made during an investigation into a death which occurred in December 2022 and the use of the corridor remains ongoing. ”
Source location
Maureen Brenda Batchelor · Prevention of Future Deaths report
Page 2 · concerns
Open source report
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Publish data on the prevalence of corridor care to improve transparency and drive improvement.

Verbatim wording from the response
“Regarding your concerns on corridor care, the provision of clinical care in corridors is unacceptable. We will publish data on the prevalence of corridor care for the first time to support transparency and drive improvement. NHS England has been working with trusts since 2024 to put in place new reporting arrangements. The data quality is currently being reviewed, and we expect to publish the information shortly.”

Source location
Response from Department for Health and Social Care
Page 2 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Progress the Acute Floor Reconfiguration capital programme to improve patient flow, capacity, and the clinical environment.

Verbatim wording from the response
“As you know from the evidence heard at the inquest, the Medicine Divisional Leadership team, the Hospital Directors, and Executive team are continuously working on several separate but linked workstreams, which were previously in their infancy, to eradicate the use of the ED corridor for patient care and ensure they are treated in the most appropriate clinical environment with dignity and without delays.”

Source location
2025-0406 - Response from Hospital Trust
Page 1 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Implement a hospital-wide no-corridor culture through nominated leaders, staff empowerment, rapid response, feedback, learning, recognition, and scenario-based training.

Verbatim wording from the response
“Our Interim Assistant Director for Leadership and Management is leading on a cultural mindset change throughout the hospital, so we have a ‘no corridor culture’. This includes nominated leaders, staff empowerment, a 4 hour response timeline, celebration of teams preventing corridor use, regular feedback and learning loops, and scenario based training to reinforce the cultural mindset change.”

Source location
2025-0406 - Response from Hospital Trust
Page 2 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Operate the Direct to Specialty Pathway Agreement with specialty acceptance, rapid in-reach, escalation via the bleep system, daily referral monitoring, and cross-specialty flow meetings.

Verbatim wording from the response
“We now have a Direct to Specialty Pathway Agreement between ED and the Trust’s specialties so certain categories of patient are accepted by the relevant specialty on presentation to the ED. Our Interim General Manager for Medicine and Urgent Care (Brighton and Haywards Heath) is the Responsive workstream lead for this, and data is collected daily for all specialty referrals from ED, to monitor the response times from the specialties. Specialties in-reach to ED/AMU/SDEC and we operate a 3/2/1 bleep system to ensure this is fast and effective. There are regular cross specialty flow meetings over the course of the day.”

Source location
2025-0406 - Response from Hospital Trust
Page 2 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Lead the Hospital Alternative Oversight Programme to reduce inappropriate admissions and improve hospital flow and discharge through alternative-care, urgent-treatment, same-day, virtual, frailty, therapy, planning, and acuity initiatives.

Verbatim wording from the response
“We have an Operational Flow Improvement Manager in post who is leading the Hospital Alternative Oversight Programme (HALO). This work is aimed at the avoidance of inappropriate hospital admissions, to optimise patient flow through the hospital, and smooth discharge pathways and processes. This includes:”

Source location
2025-0406 - Response from Hospital Trust
Page 2 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Provide consultant advice to ambulance services at the point of contact to support appropriate emergency-department referrals and avoid unnecessary attendances.

Verbatim wording from the response
“I am pleased to say that we are working closely with SECAmb by having a Consultant of ours giving advice at the point of contact to ensure only the correct patients (those in need of emergency care) are coming to the ED. This work has demonstrated that 8 -10 ambulance attendances are avoided each day.”

Source location
2025-0406 - Response from Hospital Trust
Page 2 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Coordinate with the local mental health trust to support rapid admission of patients requiring mental health care to appropriate units.

Verbatim wording from the response
“Furthermore, we work closely with the local Mental Health Trust, SPFT, as part of HALO to try to ensure that patients requiring mental health hospital admission are admitted to an appropriate mental health unit as quickly as possible.”

Source location
2025-0406 - Response from Hospital Trust
Page 2 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Educate high-presenting nursing homes about avoiding unnecessary emergency-department attendances and navigating alternative care.

Verbatim wording from the response
“One of our Frailty Consultants is working with the 10 local Nursing Homes which have the highest number of presentations of their residents to ED, to educate their teams on non necessary attendances to ED and providing them with confidence in navigating alternatives to the ED.”

Source location
2025-0406 - Response from Hospital Trust
Page 2 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Realign bed spaces and workforce through capacity-and-demand modelling to match service demand.

Verbatim wording from the response
“There is a Capacity and Demand modelling piece of work underway which is realigning areas with increased bed spaces to areas with less bed spaces with workforce changes to match the demand.”

Source location
2025-0406 - Response from Hospital Trust
Page 3 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Convert a trolley cubicle into a reclining-chair area in the emergency department to increase clinical space.

Verbatim wording from the response
“We have converted what was previously a trolley cubicle into a reclining chair area within Majors in ED to increase clinical space.”

Source location
2025-0406 - Response from Hospital Trust
Page 3 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Operate the Continuous Flow Model to move patients earlier from the Acute Floor and reduce emergency-department waits for ward admission.

Verbatim wording from the response
“The Continuous Flow Model has improved the earlier movement of patients from the Acute Floor and reduced the time patients are waiting in the ED for admission to a ward.”

Source location
2025-0406 - Response from Hospital Trust
Page 3 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Publish principles for providing safer care in Temporary Escalation Spaces when demand exceeds capacity.

Verbatim wording from the response
“The delivery of care in Temporary Escalation Spaces (TES) in EDs experiencing patient crowding (including providing care at beds and chairs) is not acceptable and should not be considered as standard. TES refers to care given in any unplanned settings (such as corridors) and, in September 2024, NHS England published a set of principles for supporting improved quality of care should patient demand outstrip capacity. These principles have been developed to support point-of-care staff to provide the safest, most effective and highest quality care possible when TES care has been deemed necessary, and the principles should be applied alongside any local standard operating procedures and arrangements governing flow pathways and safe staffing.”

Source location
Response from NHS England
Page 1 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Develop the operating model supporting providers to eliminate emergency-department crowding and corridor care.

Verbatim wording from the response
“In June 2025, NHS England published the Urgent and Emergency Care (UEC) Plan for 2025/26, which included an ambition to ‘improve flow through hospitals with a particular focus on patients waiting over 12 hours and making progress on eliminating corridor care’. NHS England is working through the operating model to support providers to eliminate crowding in EDs in the longer term. Improvements are being progressed through NHS England’s Operational Planning guidance, where healthcare systems were asked to focus on areas to deliver improved patient flow. This has included increasing the productivity of acute and non-acute hospital services, improving flow and length of stay, as well as clinical outcomes. In addition to this, we”

Source location
Response from NHS England
Page 1 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Progress patient-flow improvements through Operational Planning guidance, including productivity, reduced length of stay and improved clinical outcomes.

Verbatim wording from the response
“In June 2025, NHS England published the Urgent and Emergency Care (UEC) Plan for 2025/26, which included an ambition to ‘improve flow through hospitals with a particular focus on patients waiting over 12 hours and making progress on eliminating corridor care’. NHS England is working through the operating model to support providers to eliminate crowding in EDs in the longer term. Improvements are being progressed through NHS England’s Operational Planning guidance, where healthcare systems were asked to focus on areas to deliver improved patient flow. This has included increasing the productivity of acute and non-acute hospital services, improving flow and length of stay, as well as clinical outcomes. In addition to this, we”

Source location
Response from NHS England
Page 1 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Develop services that shift unplanned urgent activity from acute hospitals to alternative settings and support proactive care and discharge.

Verbatim wording from the response
“are continuing to develop services that shift activity from acute hospital settings to settings outside of an acute hospital for patients with unplanned urgent needs, supporting proactive care, alternatives to admission and improving hospital discharge.”

Source location
Response from NHS England
Page 2 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Mandate daily reporting of Temporary Escalation Space use by acute hospitals in emergency departments and wards.

Verbatim wording from the response
“Furthermore, since January 2025, NHS England has mandated all acute hospitals to report daily TES usage in EDs and wards. Most are now submitting data, and NHS England is working with regional teams to improve its quality, timeliness and completeness. The goal is to begin publishing data during 2025/26, to drive reductions in the use of corridor care across the country and achieve the ambition set out in the UEC plan.”

Source location
Response from NHS England
Page 2 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Work with regional teams to improve the quality, timeliness and completeness of Temporary Escalation Space data.

Verbatim wording from the response
“Furthermore, since January 2025, NHS England has mandated all acute hospitals to report daily TES usage in EDs and wards. Most are now submitting data, and NHS England is working with regional teams to improve its quality, timeliness and completeness. The goal is to begin publishing data during 2025/26, to drive reductions in the use of corridor care across the country and achieve the ambition set out in the UEC plan.”

Source location
Response from NHS England
Page 2 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Publish Temporary Escalation Space usage data during 2025/26 to drive reductions in corridor care.

Verbatim wording from the response
“Furthermore, since January 2025, NHS England has mandated all acute hospitals to report daily TES usage in EDs and wards. Most are now submitting data, and NHS England is working with regional teams to improve its quality, timeliness and completeness. The goal is to begin publishing data during 2025/26, to drive reductions in the use of corridor care across the country and achieve the ambition set out in the UEC plan.”

Source location
Response from NHS England
Page 2 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Deliver the Acute Floor Reconfiguration capital programme to improve capacity, patient flow and the clinical environment.

Verbatim wording from the response
“Our Acute Floor Reconfiguration, which is a £48 million capital improvement programme to improve patient and staff experience at the Royal Sussex County Hospital, is well underway.”

Source location
Response from Hospital Trust
Page 1 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Lead a hospital-wide no-corridor culture programme using nominated leaders, staff empowerment, response targets, feedback, recognition and scenario-based training.

Verbatim wording from the response
“Our Interim Assistant Director for Leadership and Management is leading on a cultural mindset change throughout the hospital, so we have a ‘no corridor culture’. This includes nominated leaders, staff empowerment, a 4 hour response timeline, celebration of teams preventing corridor use, regular feedback and learning loops, and scenario based training to reinforce the cultural mindset change.”

Source location
Response from Hospital Trust
Page 2 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Operate the Direct to Specialty Pathway Agreement, supported by specialty in-reach, rapid bleep escalation, daily referral monitoring and cross-specialty flow meetings.

Verbatim wording from the response
“We now have a Direct to Specialty Pathway Agreement between ED and the Trust’s specialties so certain categories of patient are accepted by the relevant specialty on presentation to the ED. Our Interim General Manager for Medicine and Urgent Care (Brighton and Haywards Heath) is the Responsive workstream lead for this, and data is collected daily for all specialty referrals from ED, to monitor the response times from the specialties. Specialties in-reach to ED/AMU/SDEC and we operate a 3/2/1 bleep system to ensure this is fast and effective. There are regular cross specialty flow meetings over the course of the day.”

Source location
Response from Hospital Trust
Page 2 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Lead the Hospital Alternative Oversight Programme to avoid inappropriate admissions, improve hospital flow and smooth discharge through alternative-care and same-day emergency initiatives.

Verbatim wording from the response
“We have an Operational Flow Improvement Manager in post who is leading the Hospital Alternative Oversight Programme (HALO). This work is aimed at the avoidance of inappropriate hospital admissions, to optimise patient flow through the hospital, and smooth discharge pathways and processes. This includes:”

Source location
Response from Hospital Trust
Page 2 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Provide Trust consultant advice at ambulance point of contact with SECAmb to direct only patients requiring emergency care to the ED.

Verbatim wording from the response
“I am pleased to say that we are working closely with SECAmb by having a Consultant of ours giving advice at the point of contact to ensure only the correct patients (those in need of emergency care) are coming to the ED. This work has demonstrated that 8-10 ambulance attendances are avoided each day.”

Source location
Response from Hospital Trust
Page 2 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Educate teams at ten local nursing homes about avoidable ED attendances and alternatives to ED care.

Verbatim wording from the response
“One of our Frailty Consultants is working with the 10 local Nursing Homes which have the highest number of presentations of their residents to ED, to educate their teams on non necessary attendances to ED and providing them with confidence in navigating alternatives to the ED.”

Source location
Response from Hospital Trust
Page 2 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Realign bed spaces and matching workforce through capacity-and-demand modelling.

Verbatim wording from the response
“There is a Capacity and Demand modelling piece of work underway which is realigning areas with increased bed spaces to areas with less bed spaces with workforce changes to match the demand.”

Source location
Response from Hospital Trust
Page 3 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Convert a trolley cubicle into a reclining-chair area in ED Majors to increase clinical space.

Verbatim wording from the response
“We have converted what was previously a trolley cubicle into a reclining chair area within Majors in ED to increase clinical space.”

Source location
Response from Hospital Trust
Page 3 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Operate the Continuous Flow Model to move patients earlier from the Acute Floor and reduce ED waits for ward admission.

Verbatim wording from the response
“The Continuous Flow Model has improved the earlier movement of patients from the Acute Floor and reduced the time patients are waiting in the ED for admission to a ward.”

Source location
Response from Hospital Trust
Page 3 · response
Published 5 August 2025
Open published response
Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
NHS England is responsible for addressing the concerns and has already provided a response.

Verbatim wording from the response
“In preparing this response, my officials have made enquiries with NHS England and I understand they have already responded to address your concerns.”

Source location
Response from Department for Health and Social Care
Page 1 · response
Published 5 August 2025
Open published response
16 Jun2025
East London
Concerns raised1
1. Failure to provide appropriate care for patients requiring monitoring in A&E corridors
This report raised 8 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response 2
1. Action
  Open and operate a 17-bed temporary escalation space with dedicated nursing and medical staff to relieve Emergency Department capacity pressures.
  Stated by Barts Health NHS TrustStated completed
2. Action
  Reconfigure the Emergency Department into a dedicated 14-trolley assessment area and remove existing corridor space.
  Stated by Barts Health NHS TrustStated in progress
AI-generated summary

Mrs Norma Faye Campbell · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Mrs Norma Faye Campbell attended Whipps Cross Hospital emergency department on 13 January 2024 with clear signs of sepsis and died there in the early hours of 14 January 2024 after suffering a cardiac arrest. The report identifies delays and omissions in sepsis treatment, monitoring, fluid resuscitation and escalation of care. It also raises concerns about overcrowding, inadequate staffing and facilities, insufficient resuscitation beds, lack of electronic observations and the absence of Critical Care Outreach Team support in the emergency department.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to provide appropriate care for patients requiring monitoring in A&E corridors
Wider context from the report
“2. The inquest heard that it is not uncommon to find patients in corridors when they need to be monitored. On the 13 January 2024 there were more than 25 patients in the corridors. They were not receiving an appropriate level of care. ”
Source location
Mrs Norma Faye Campbell · Prevention of Future Deaths report
Page 2 · concerns
Open source report
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Open and operate a 17-bed temporary escalation space with dedicated nursing and medical staff to relieve Emergency Department capacity pressures.

Verbatim wording from the response
“Where we do have days that there is overcrowding within the Emergency Department, additional nurses are redeployed to provide “fundamentals of care” and care for the patients waiting to be admitted to the hospital. In winter 2024/2025 an additional 17 bedded “temporary escalation space” was opened with dedicated nursing and medical staff next to the Emergency Department to care for patients who required admission to hospital and had already commenced treatment to free up space within the Emergency Department for patients who were requiring assessment.”

Source location
Response from Barts Health NHS Foundation Trust
Page 3 · response
Published 26 June 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Reconfigure the Emergency Department into a dedicated 14-trolley assessment area and remove existing corridor space.

Verbatim wording from the response
“The Trust has committed to reconfiguring the Emergency Department at Whipps Cross Hospital. Work to do this has commenced and is due to be fully completed in March 2026. This will reconfigure the current Emergency Assessment area from 4 cubicles and some corridor space to a dedicated 14 trolley assessment area (this work is due to be completed by January 2026) and remove the current corridor space.”

Source location
Response from Barts Health NHS Foundation Trust
Page 3 · response
Published 26 June 2025
Open published response
12 May2025
Cornwall and Isles of Scilly
Concerns raised1
1. ED crowding delaying care and holding patients in ambulances and corridors
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response 3
1. Action
  Publish the Urgent and Emergency Care Plan for 2025/26 to improve ambulance response and handover, emergency department performance, and delayed discharge.
  Stated by Department of Health and Social CareStated completed
2. Action
  Provide around £450 million in capital funding to expand same-day emergency care and mental health crisis assessment capacity.
  Stated by Department of Health and Social CareStated planned
3. Action
  Invest £9 billion through the Better Care Fund in integrated health and social care services during 2025/26.
  Stated by Department of Health and Social CareStated in progress
AI-generated summary

JAMES FREDERICK SMITH · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

James Frederick Smith, known as Jim, died on 25 June 2024 at Royal Cornwall Hospital Truro after complications during surgery following a fall and fractured hip. The report identified concerns about insufficient social care provision, significant ambulance handover delays, and emergency department crowding, which increased risks to patients and impeded hospital and ambulance capacity.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
ED crowding delaying care and holding patients in ambulances and corridors
Wider context from the report
“(3) ED crowding leading to increased risk in mortality for patients being held in ambulances and corridors and being delayed from receiving surgery or specialist treatment on wards. ”
Source location
JAMES FREDERICK SMITH · Prevention of Future Deaths report
Page 4 · concerns
Open source report
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Publish the Urgent and Emergency Care Plan for 2025/26 to improve ambulance response and handover, emergency department performance, and delayed discharge.

Verbatim wording from the response
“But we know that we need to start making progress immediately. On 6 June 2025, we published our Urgent and Emergency Care Plan for 2025/26. The plan requires the NHS to focus on those activities that will have the biggest impact on improving urgent and emergency care performance, including ambulance response and handover times:”

Source location
Response from DHSC
Page 2 · response
Published 21 May 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Provide around £450 million in capital funding to expand same-day emergency care and mental health crisis assessment capacity.

Verbatim wording from the response
“• capital funding of around £450 million to increase provision of Same Day Emergency Care, Mental Health Crisis Assessment Centres, avoiding unnecessary admissions to hospital and supporting the diagnosis, treatment and discharge on the same day for patients;”

Source location
Response from DHSC
Page 2 · response
Published 21 May 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Invest £9 billion through the Better Care Fund in integrated health and social care services during 2025/26.

Verbatim wording from the response
“On 31 January 2025, the Government published a revised policy framework for the Better Care Fund (BCF), which took effect on 1 April 2025. Through the BCF, £9 billion are invested in integrated health and social care services in 2025-26, including those to tackle delayed discharges and ensure a timely transition for patients into social care. The objectives of the BCF have been reassessed to put a focus on prioritising preventative care such as early intervention services and community-based support to help people stay healthy and independent and increase patient flow through hospital. The BCF also seeks to bring care closer to home by delivering integrated care in local settings, including people’s homes, to support older adults and those with more complex needs.”

Source location
Response from DHSC
Page 3 · response
Published 21 May 2025
Open published response
19 Feb2025
Manchester South
Concerns raised1
1. Emergency Department design unsuitable for prolonged observation of high-risk patients
This report raised 7 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.

No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
AI-generated summary

Kenneth James CLAYTON · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Kenneth James Clayton was admitted to Tameside General Hospital after falls at home and later had an unobserved fall in the Emergency Department while waiting about eight hours for an inpatient bed. He fractured his neck of femur, underwent surgery, deteriorated with complications, and died at the hospital. The concerns included prolonged Emergency Department waits, an environment and equipment that were not suited to prolonged observation of high-risk patients, limited bed availability linked to delayed discharges, and uncertainty about consistent national falls-risk management.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Emergency Department design unsuitable for prolonged observation of high-risk patients
Wider context from the report
“1. The inquest heard evidence that a key factor in the fall was the prolonged time Mr Clayton was in the Emergency Department waiting for a bed to become available on a ward. The evidence was that he had been in the emergency department for about 8 hours when he fell. The inquest was told that the design of an Emergency Department is not suited to a need for prolonged observation of high risk patients. In addition generally patients are cared for on hospital trolleys which cannot be lowered in the way a hospital bed can be which further increases the risk of falls. ”
Source location
Kenneth James CLAYTON · Prevention of Future Deaths report
Page 1 · concerns
Open source report
4 Feb2025
North East Kent
Concerns raised1
1. Unavailability of beds for emergency department patients
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response 10
1. Action
  Increase same-day emergency care so more patients are seen, treated and discharged within one day.
  Stated by Department of Health and Social CareStated planned
2. Action
  Increase the proportion of patients discharged by or on day seven of admission.
  Stated by Department of Health and Social CareStated planned
3. Action
  Develop local NHS and social-care partnerships to reduce delayed discharges and patients waiting to leave hospital.
  Stated by Department of Health and Social CareStated planned
1. Action
  Reform the Better Care Fund so pooled NHS and local-authority funding supports reducing emergency admissions, delayed discharges and care-home admissions.
  Stated by Department of Health and Social CareStated in progress
2. Action
  Continue operating-model work with regions to support providers in reducing Emergency Department crowding.
  Stated by NHS EnglandStated in progress
3. Action
  Issue operational planning guidance requiring systems to improve patient flow through alternative urgent and emergency care services.
  Stated by NHS EnglandStated completed
4. Action
  Strengthen use of Discharge Ready Date and Reason for Discharge Delay data to identify and reduce discharge delays.
  Stated by NHS EnglandStated in progress
5. Action
  Work with local areas and health, social care and local-government partners to maximise discharge-funding impact and improve timely patient discharge.
  Stated by NHS EnglandStated in progress
6. Action
  Collect daily data on patients experiencing long Emergency Department waits and track actions to support appropriate accommodation and patient-safety review.
  Stated by NHS EnglandStated in progress
7. Action
  Collect weekly data on patients waiting over 100 days for discharge and use system leadership, coordination calls and regional engagement to enable appropriate discharge.
  Stated by NHS EnglandStated in progress
AI-generated summary

Dorothy Lilian REID · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Dorothy Reid, a 91-year-old woman, suffered spinal fractures after a fall and later died from a pulmonary embolism on 3 April 2024. Concerns included delays and poor conditions in the emergency department, the impact of hospital bed shortages on emergency care, and patients’ reluctance to attend hospital because of long waiting times.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Unavailability of beds for emergency department patients
Wider context from the report
“(1) During the course of the evidence it became clear that on both attendances to the emergency department at QEQM she had to wait on a chair as there were no beds. The first attendance led to such a poor experience that she chose not to go back to hospital when an ambulance was called on 31 March 2024. Had she gone to hospital on 31 March 2024 when advised to do so it is likely that her pulmonary embolus would have been diagnosed in the emergency department and treated and she would not have died when she did. Delays in being seen by a doctor at the second attendance were of concern but were found not to be causative of her death. ”
Source location
Dorothy Lilian REID · Prevention of Future Deaths report
Page 2 · concerns
Open source report
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Increase same-day emergency care so more patients are seen, treated and discharged within one day.

Verbatim wording from the response
“The NHS will focus on delivering the following range of practical actions to improve performance in 2025/26:”

Source location
Response from DHSC
Page 2 · response
Published 7 February 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Increase the proportion of patients discharged by or on day seven of admission.

Verbatim wording from the response
“The NHS will focus on delivering the following range of practical actions to improve performance in 2025/26:”

Source location
Response from DHSC
Page 2 · response
Published 7 February 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Develop local NHS and social-care partnerships to reduce delayed discharges and patients waiting to leave hospital.

Verbatim wording from the response
“Regarding the concern raised about bed capacity and 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.”

Source location
Response from DHSC
Page 2 · response
Published 7 February 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Reform the Better Care Fund so pooled NHS and local-authority funding supports reducing emergency admissions, delayed discharges and care-home admissions.

Verbatim wording from the response
“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.”

Source location
Response from DHSC
Page 2 · response
Published 7 February 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Continue operating-model work with regions to support providers in reducing Emergency Department crowding.

Verbatim wording from the response
“NHS England will continue to work through the operating model and assist its Regions with supporting providers to reduce crowding in EDs. In the longer term, NHS England hopes to eliminate this by focusing on reducing the number of patients that wait longer than 12 hours in EDs. Improvements are being demonstrated through NHS England’s operational planning guidance, where systems were asked to focus on areas to deliver improved patient flow such as increasing the proportion of patients streamed to alternative services such as urgent treatment centres (UTCs), same day emergency care (SDEC) and acute frailty services (AFS). This includes increasing the productivity of acute and non-acute hospital services, improving flow as well as clinical outcomes.”

Source location
Response from NHS England
Page 1 · response
Published 7 February 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Issue operational planning guidance requiring systems to improve patient flow through alternative urgent and emergency care services.

Verbatim wording from the response
“NHS England will continue to work through the operating model and assist its Regions with supporting providers to reduce crowding in EDs. In the longer term, NHS England hopes to eliminate this by focusing on reducing the number of patients that wait longer than 12 hours in EDs. Improvements are being demonstrated through NHS England’s operational planning guidance, where systems were asked to focus on areas to deliver improved patient flow such as increasing the proportion of patients streamed to alternative services such as urgent treatment centres (UTCs), same day emergency care (SDEC) and acute frailty services (AFS). This includes increasing the productivity of acute and non-acute hospital services, improving flow as well as clinical outcomes.”

Source location
Response from NHS England
Page 1 · response
Published 7 February 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Strengthen use of Discharge Ready Date and Reason for Discharge Delay data to identify and reduce discharge delays.

Verbatim wording from the response
“NHS England recognises the significant impact that delayed discharges have on hospital flow, ambulance handovers and the patients affected by these delays. To address this, we are strengthening the use of Discharge Ready Date (DRD) and Reason for Discharge Delay (RfDD) data to gain a clearer understanding of discharge delays and their key contributing factors, both locally and nationally, so that measures can be taken to reduce the number of patients occupying beds who are ready for discharge.”

Source location
Response from NHS England
Page 2 · response
Published 7 February 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Work with local areas and health, social care and local-government partners to maximise discharge-funding impact and improve timely patient discharge.

Verbatim wording from the response
“Over the coming year we will be working with local areas to support them to maximise the impact of this investment, for example by providing additional or enhanced support to those areas which face particular challenges, and working with partners in local government and social care including the Local Government Association (LGA), Directors of Social Services (DASSs) and Care and Health Improvement Advisers (CHIAs) to support local systems to improve timely discharge of patients.”

Source location
Response from NHS England
Page 2 · response
Published 7 February 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Collect daily data on patients experiencing long Emergency Department waits and track actions to support appropriate accommodation and patient-safety review.

Verbatim wording from the response
“NHS England has commenced a data collection of patients experiencing long waits in Emergency Departments on a daily basis and will ensure actions are in place to appropriately accommodate these patients as soon as possible. The data is discussed at the National Coordination Centre call, with actions tracked to ensure executive oversight and assurance as well as patient safety and harm reviews of/for patients waiting.”

Source location
Response from NHS England
Page 2 · response
Published 7 February 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Collect weekly data on patients waiting over 100 days for discharge and use system leadership, coordination calls and regional engagement to enable appropriate discharge.

Verbatim wording from the response
“In addition, to reduce the number of very long discharge waits, we have been collecting weekly data to identify the number of patients waiting over 100 days and will ensure actions are being taken through system leadership to enable patients to be discharged to the most appropriate setting as soon as possible. The patients identified as waiting over 100 days will be discussed at a weekly National Coordination Centre call, and themes will be tracked through weekly regional engagement meetings.”

Source location
Response from NHS England
Page 2 · response
Published 7 February 2025
Open published response
17 Jan2025
South Wales Central
Concerns raised1
1. Failure to provide emergency department care in appropriate clinical spaces
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response 5
1. Action
  Develop a capital programme for a dedicated ambulatory bay, including feasibility, costing and timeframe work.
  Stated by Cwm Taf Morgannwg University Local Health BoardStated in progress
2. Action
  Roll out the Optimise patient-flow programme to the Princess of Wales site using real-time tracking, eWhiteboards, Red2Green and SAFER board rounds.
  Stated by Cwm Taf Morgannwg University Local Health BoardStated in progress
3. Action
  Strengthen float-nurse monitoring, senior review, safety huddles and escalation processes for patients receiving care in non-clinical spaces.
  Stated by Cwm Taf Morgannwg University Local Health BoardStated completed
1. Action
  Maintain a ring-fenced emergency-department escalation space and activate site-wide responses when its capacity is exceeded.
  Stated by Cwm Taf Morgannwg University Local Health BoardStated completed
2. Action
  Operate a dedicated BRATZ assessment area to support rapid triage and safe, efficient ambulance handovers.
  Stated by Cwm Taf Morgannwg University Local Health BoardStated completed
AI-generated summary

Jackson Yeow · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Jackson Yeow, aged 16, became seriously unwell with abdominal pain and vomiting and later developed diabetic ketoacidosis and other complications. He waited approximately 9½ hours for an ambulance after his family called 999, and died on 9 April 2022. Concerns included delays in ambulance handovers associated with emergency department overcrowding, corridor care, and delayed discharge of medically fit patients.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to provide emergency department care in appropriate clinical spaces
Wider context from the report
“Although the Cwm Taf Morgannwg University Health Board did not provide direct care to Jackson Yeow during the period within scope, it provided the evidence of a consultant in emergency medicine to the inquest on the issue of delays in ambulance handovers at the Princess of Wales Hospital, Bridgend. That evidence directly identified the following matters of concern: (1) Care for patients in the emergency department is frequently provided in the corridor and other non clinical spaces, which: (a) Impedes efficient clinical assessment, causing clinicians to take longer performing tasks and rendering clinical care more difficult; (b) Impedes the ability of staff to recognize a patient’s deteriorating condition; (c) Increases patient morbidity through environmental factors compromising a patient’s ability to sleep, hygiene and nutrition. (d) May slow the process of ambulance handovers. (2) Care in corridors and other non clinical spaces has been normalized, which in the opinion of the consultant who gave evidence is unsafe. (3) When conducted routinely, care in corridors and other non clinical spaces reduces the capacity of the Emergency Department so that should acuity escalate, it is likely to cause delays to the release of ambulances. (4) The underlying obstacle to improving flow through the hospital and relieving pressure on the Emergency Department is the significant number of patients who are medically fit to be discharged but whose discharge is delayed due to non medical reasons. ”
Source location
Jackson Yeow · Prevention of Future Deaths report
Page 3 · concerns
Open source report
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Develop a capital programme for a dedicated ambulatory bay, including feasibility, costing and timeframe work.

Verbatim wording from the response
“We are committed to ongoing improvement across our Emergency Departments and working towards the eradication of corridor care unless in extremis. As part of this work the leadership team are working in collaboration with the POW site based team to develop a capital programme to create a dedicated ambulatory bay. The scoping for this work has already happened and capital colleagues are working through feasibility, costing and timeframes for this work. This is a priority to reduce the reliance on non-clinical spaces and to improve patient experience within the ED.”

Source location
Response from Cwm Taf Morgannwg University Health Board
Page 3 · response
Published 20 January 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Roll out the Optimise patient-flow programme to the Princess of Wales site using real-time tracking, eWhiteboards, Red2Green and SAFER board rounds.

Verbatim wording from the response
“Additionally, the STAMP (Strategic Transformation of Acute Medicine Programme) and OPTIMISE programmes have been introduced to improve patient flow across CTM. The Optimise programme utilises real-time digital tools, such as Red2Green and eWhiteboards, to ensure patients are placed in the right clinical area as quickly as possible. Early implementation of these initiatives across Royal Glamorgan and Prince Charles Hospital have significantly reduced patient delays and improved overall care efficiency and the next phase of roll out includes POW site.”

Source location
Response from Cwm Taf Morgannwg University Health Board
Page 3 · response
Published 20 January 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Strengthen float-nurse monitoring, senior review, safety huddles and escalation processes for patients receiving care in non-clinical spaces.

Verbatim wording from the response
“CTMUHB recognises that corridor care presents significant challenges to efficient clinical assessment and patient safety. We are actively working to reduce reliance on non-clinical spaces through investment in additional nursing staff, transformation programmes and improvements in patient flow, and the implementation of enhanced escalation processes.”

Source location
Response from Cwm Taf Morgannwg University Health Board
Page 1 · response
Published 20 January 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Maintain a ring-fenced emergency-department escalation space and activate site-wide responses when its capacity is exceeded.

Verbatim wording from the response
“The float nurse role has been strengthened to provide continuous monitoring of patients in non-clinical spaces. Additionally, DATIX incident reporting is used to capture any patient safety concerns, ensuring rapid escalation to the appropriate senior staff for immediate action. Any patient safety concerns are escalated immediately with prompt transfer of patients to a more clinically appropriate area. This is supported by a ring-fenced escalation space within the ED at POW. Once this space is breached initiates a site based response to on-board patients into pre-identified areas across the site in order to balance risk.”

Source location
Response from Cwm Taf Morgannwg University Health Board
Page 5 · response
Published 20 January 2025
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Operate a dedicated BRATZ assessment area to support rapid triage and safe, efficient ambulance handovers.

Verbatim wording from the response
“Corridor care can contribute to delays in ambulance handovers. To mitigate this, we have implemented: - A fully recruited nursing workforce, reducing the reliance on agency staff and ensuring a consistent, well-trained team is available to manage ambulance arrivals efficiently and make dynamic risk-based decisions on ensuring timely handover of patients and release of ambulance resources. - We have made significant improvements at POW on ambulance handover times over the past 18 months and we are committed to ongoing improvement in this area. - A dedicated BRATZ assessment area, where patients are triaged quickly to allow for safe and efficient handovers.”

Source location
Response from Cwm Taf Morgannwg University Health Board
Page 5 · response
Published 20 January 2025
Open published response
15 Oct2024
West Sussex, Brighton and Hove
Concerns raised2
1. Failure to include corridor patient care areas in the Emergency Department nursing staffing template
2. Failure to provide sufficient designated clinical space for Emergency Department patients
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response 9
1. Action
  Publish principles for providing safe, good-quality care in temporary escalation spaces when demand exceeds capacity.
  Stated by NHS EnglandStated completed
2. Action
  Develop the NHS England operating model to help regional teams support providers to eliminate Emergency Department crowding.
  Stated by NHS EnglandStated in progress
3. Action
  Continue developing services that shift unplanned urgent activity outside acute hospitals, including proactive care, admission alternatives and improved discharge.
  Stated by NHS EnglandStated in progress
1. Action
  Conduct joint regional visits and focused reviews of non-designated Emergency Department care, engaging staff, patients and relatives and providing improvement feedback.
  Stated by NHS EnglandStated completed
2. Action
  Use operational planning guidance to direct systems toward improved patient flow, productivity, length of stay and clinical outcomes.
  Stated by NHS EnglandStated completed
3. Action
  Advance the Unscheduled Care Navigation Hub to reduce avoidable emergency-department attendance and support alternative admission pathways.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
4. Action
  Implement continuous flow with scheduled transfers from the Acute Assessment Unit to specialty medicine and frailty wards.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
5. Action
  Open the Surgical Assessment Unit to receive surgical presentations and ambulances.
  Stated by University Hospitals Sussex NHS Foundation TrustStated completed
6. Action
  Expand the Surgical Assessment Unit by adding trolley beds and patient chairs as nursing recruitment allows.
  Stated by University Hospitals Sussex NHS Foundation TrustStated in progress
Respondent positions 1
1. Position
  NHS England is best placed to address local urgent and emergency care performance and RSCH’s mitigation of temporary escalation space use.
  Stated by Department of Health and Social CareRedirects responsibility
AI-generated summary

Tamara DAVIS · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Tamara Davis attended hospital after being unwell for five days and was treated for suspected chest infection before deteriorating and dying on 13 December 2022 from multi-organ failure associated with bronchopneumonia caused by Influenza A infection. A substantive concern was the use of an overcrowded Emergency Department corridor for patient care, where patients lacked privacy, toilet facilities and confidentiality, and where the area was not designated as a clinical area or included in the nursing staffing template.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to include corridor patient care areas in the Emergency Department nursing staffing template
Wider context from the report
“During the inquest I heard evidence from clinicians at University Hospitals Sussex NHS Foundation Trust that when the Emergency Department of the Royal Sussex County Hospital, Brighton reached capacity patients would be moved and treated in the corridor as there was no clinical area available to do so. The area is not designated as a clinical area and is not included within the Nursing staffing template for the ED. When Ms Davis was treated in the Royal Sussex County Hospital, Brighton on 11 December 2022 there were, at times, more than 20 patients in that area. Clinicians from University Hospitals Sussex NHS Foundation Trust gave evidence as to the action that is being taken by the Trust currently to (1) reduce the number of patients who are sent to the Emergency Department who could be seen by other services in the community and (2) to create an improved patient flow through the Royal Sussex County Hospital. The evidence was however that, despite these actions, the corridor remains in use for patients currently as there is insufficient space within the department to care for patients. There was no evidence as to when, and if, this practice would no longer be necessary. I heard that the provision of care in the ED corridor meant that patients lacked privacy, toilet facilities and confidentiality. I understood from the evidence of the clinicians that they were concerned that patients were being moved into the Corridor but there appeared to be no other option when the Emergency Department exceeds capacity. I heard that in the event of a major incident University Hospitals Sussex NHS Foundation Trust would have to clear the Emergency Department, as they had done on occasion, as this would be the only way to create the necessary clinical space when the department was already over capacity and using the corridor. I was also advised that the use of corridors to care for patients is not only an issue at the Royal Sussex County Hospital, Brighton but is used throughout the country when the capacities of Emergency Departments has been reached and there is nowhere to move patients to. ”
Source location
Tamara DAVIS · Prevention of Future Deaths report
Page 2 · concerns
Open source report
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Failure to provide sufficient designated clinical space for Emergency Department patients
Wider context from the report
“During the inquest I heard evidence from clinicians at University Hospitals Sussex NHS Foundation Trust that when the Emergency Department of the Royal Sussex County Hospital, Brighton reached capacity patients would be moved and treated in the corridor as there was no clinical area available to do so. The area is not designated as a clinical area and is not included within the Nursing staffing template for the ED. When Ms Davis was treated in the Royal Sussex County Hospital, Brighton on 11 December 2022 there were, at times, more than 20 patients in that area. Clinicians from University Hospitals Sussex NHS Foundation Trust gave evidence as to the action that is being taken by the Trust currently to (1) reduce the number of patients who are sent to the Emergency Department who could be seen by other services in the community and (2) to create an improved patient flow through the Royal Sussex County Hospital. The evidence was however that, despite these actions, the corridor remains in use for patients currently as there is insufficient space within the department to care for patients. There was no evidence as to when, and if, this practice would no longer be necessary. I heard that the provision of care in the ED corridor meant that patients lacked privacy, toilet facilities and confidentiality. I understood from the evidence of the clinicians that they were concerned that patients were being moved into the Corridor but there appeared to be no other option when the Emergency Department exceeds capacity. I heard that in the event of a major incident University Hospitals Sussex NHS Foundation Trust would have to clear the Emergency Department, as they had done on occasion, as this would be the only way to create the necessary clinical space when the department was already over capacity and using the corridor. I was also advised that the use of corridors to care for patients is not only an issue at the Royal Sussex County Hospital, Brighton but is used throughout the country when the capacities of Emergency Departments has been reached and there is nowhere to move patients to. ”
Source location
Tamara DAVIS · Prevention of Future Deaths report
Page 2 · concerns
Open source report
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Publish principles for providing safe, good-quality care in temporary escalation spaces when demand exceeds capacity.

Verbatim wording from the response
“The delivery of care in temporary escalation spaces (TES) in departments experiencing patient crowding (including beds and chairs) is not acceptable and should not be considered as standard across the NHS. TES refers to care given in any unplanned settings (such as corridors) and recently NHS England have published a set of principles for supporting improved quality of care should patient demand outstrip capacity - NHS England – Principles for providing safe and good quality care in temporary escalation spaces (16 September 2024). These principles have been developed to support point-of-care staff to provide the safest, most effective and”

Source location
Response from NHS England
Page 1 · response
Published 15 October 2024
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Develop the NHS England operating model to help regional teams support providers to eliminate Emergency Department crowding.

Verbatim wording from the response
“In the meantime, NHS England is working through the operating model so that NHS England’s Regions can support providers to eliminate crowding in Emergency Departments in the longer term. Improvements are being demonstrated through NHS England’s operational planning guidance, where systems were asked to focus on areas to deliver improved patient flow, and this has included increasing the productivity of acute and non-acute hospital services, improving flow and length of stay, as well as clinical outcomes. In addition to this, we are continuing to develop services that shift activity from acute hospital settings to settings outside an acute hospital for patients with unplanned urgent needs, supporting proactive care, alternatives to admission and improving hospital discharge.”

Source location
Response from NHS England
Page 2 · response
Published 15 October 2024
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Continue developing services that shift unplanned urgent activity outside acute hospitals, including proactive care, admission alternatives and improved discharge.

Verbatim wording from the response
“In the meantime, NHS England is working through the operating model so that NHS England’s Regions can support providers to eliminate crowding in Emergency Departments in the longer term. Improvements are being demonstrated through NHS England’s operational planning guidance, where systems were asked to focus on areas to deliver improved patient flow, and this has included increasing the productivity of acute and non-acute hospital services, improving flow and length of stay, as well as clinical outcomes. In addition to this, we are continuing to develop services that shift activity from acute hospital settings to settings outside an acute hospital for patients with unplanned urgent needs, supporting proactive care, alternatives to admission and improving hospital discharge.”

Source location
Response from NHS England
Page 2 · response
Published 15 October 2024
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Conduct joint regional visits and focused reviews of non-designated Emergency Department care, engaging staff, patients and relatives and providing improvement feedback.

Verbatim wording from the response
“My Regional colleagues in the South East Clinical Quality Improvement team have recently visited the Emergency Departments at both University Hospitals Sussex in Worthing and Royal Sussex County Hospital as part of a programme of joint Nursing and Integrated Care Board (ICB) visits to NHS Trusts, led by their Deputy Director. The programme of visits aims to understand how and why patients are selected to reside in non-designated areas, how they are observed for deterioration, and how dignified care can be provided. These focused reviews of non-designated care practices in the Emergency Department have included engaging with staff, patients and relatives to test safety measures in place and provide detailed feedback for the organisations on areas for improvement.”

Source location
Response from NHS England
Page 2 · response
Published 15 October 2024
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Use operational planning guidance to direct systems toward improved patient flow, productivity, length of stay and clinical outcomes.

Verbatim wording from the response
“In the meantime, NHS England is working through the operating model so that NHS England’s Regions can support providers to eliminate crowding in Emergency Departments in the longer term. Improvements are being demonstrated through NHS England’s operational planning guidance, where systems were asked to focus on areas to deliver improved patient flow, and this has included increasing the productivity of acute and non-acute hospital services, improving flow and length of stay, as well as clinical outcomes. In addition to this, we are continuing to develop services that shift activity from acute hospital settings to settings outside an acute hospital for patients with unplanned urgent needs, supporting proactive care, alternatives to admission and improving hospital discharge.”

Source location
Response from NHS England
Page 2 · response
Published 15 October 2024
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Advance the Unscheduled Care Navigation Hub to reduce avoidable emergency-department attendance and support alternative admission pathways.

Verbatim wording from the response
“The Medicine Division have employed an Operational Flow Improvement Manager who is leading the Hospital Alternative Oversight Programme. The aim of this work is to reduce admissions, optimise flow through the hospital, and smooth discharge pathways and processes. A number of the initiatives already in progress are as follows:”

Source location
Response from University Hospitals Sussex
Page 1 · response
Published 15 October 2024
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Implement continuous flow with scheduled transfers from the Acute Assessment Unit to specialty medicine and frailty wards.

Verbatim wording from the response
“Continuous Flow Model - Reducing overcrowding in the Emergency Department”

Source location
Response from University Hospitals Sussex
Page 2 · response
Published 15 October 2024
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Open the Surgical Assessment Unit to receive surgical presentations and ambulances.

Verbatim wording from the response
“Surgical Assessment Unit (SAU)”

Source location
Response from University Hospitals Sussex
Page 2 · response
Published 15 October 2024
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Expand the Surgical Assessment Unit by adding trolley beds and patient chairs as nursing recruitment allows.

Verbatim wording from the response
“The SAU opened in October 2024 and is being expanded in line with nursing recruitment. This will increase the hospital’s bed stock by 12 patient trolley beds and 12 patient chairs. It is expected to manage most surgical patient presentations to the ED and receive ambulances directly.”

Source location
Response from University Hospitals Sussex
Page 2 · response
Published 15 October 2024
Open published response
Source evidence

How this respondent position was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
NHS England is best placed to address local urgent and emergency care performance and RSCH’s mitigation of temporary escalation space use.

Verbatim wording from the response
“The report raises concerns over emergency department capacity, poor patient flow and the use of corridor care at Royal Sussex County Hospital (RSCH) and nationally. I understand that your report and matters of concerns have also been sent to NHS England, and they are best placed to respond with the specific actions being taken locally to improve urgent and emergency care performance at RSCH.”

Source location
Response from DHSC
Page 1 · response
Published 15 October 2024
Open published response
25 Mar2024
Cornwall and Isles of Scilly
Concerns raised1
1. Crowding and extremely long waiting times in the emergency department
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response 5
1. Action
  Publish and implement the delivery plan for recovering urgent and emergency care services.
  Stated by Department of Health and Social CareStated completed
2. Action
  Maintain the uplift of 5,000 staffed, permanent hospital beds delivered through the urgent and emergency care plan.
  Stated by Department of Health and Social CareStated completed
3. Action
  Invest an additional £1 billion through the Discharge Fund to support timely and effective hospital discharge.
  Stated by Department of Health and Social CareStated in progress
1. Action
  Ensure every acute hospital has access to a care transfer hub supporting complex discharges and early planning.
  Stated by Department of Health and Social CareStated completed
2. Action
  Continue working with NHS England to reduce patient waiting times.
  Stated by Department of Health and Social CareStated in progress
AI-generated summary

ROBERT ANDREW PROWSE · Prevention of Future Deaths report

This summary was generated using AI from the published report. Please read the original report for the complete account.

Report summary

Robert Andrew Prowse, who was 86, became unconscious and was suspected of having had a seizure before an ambulance was called. The ambulance arrived after a delay of three hours and 47 minutes, and further delays occurred in transferring him into the emergency department, where sepsis was identified; he died before prescribed antibiotics could be administered. The report identified systemic ambulance and hospital delays, including emergency department crowding and delayed patient handovers, as concerns that likely contributed to preventing lifesaving treatment.

Read the report on judiciary.uk
Source evidence
How this individual concern was interpreted
PFD Monitor created a concise, searchable interpretation from the report wording shown below.
PFD Monitor interpretation
Crowding and extremely long waiting times in the emergency department
Wider context from the report
“9. The court heard evidence that Treliske have established a triage centre in the car park, known as the Rapid Assessment and Treatment Centre. The primary purpose of triage is to identify those patients in immediately life-threatening condition. The triage centre is an attempt to mitigate the risks due to ambulance delay and overcrowding in ED. ████████ stated that the vast majority of patients are now seen in the car park, inside ambulances or in the triage centre, rather than in ED. 10. The court heard evidence of crowding at Treliske ED with patients being accommodated in the corridors. Evidence was heard from ████████ regarding a scientific study by Royal College of Emergency Medicine (published in the Emergency Medicine Journal). This study discussed the adverse impact of crowding in ED. The study calculated the estimated number of excess deaths occurring across the United Kingdom associated with crowding and extremely long waiting times. The study showed that for every 72 patients waiting between eight- and 12-hours from their time of arrival in the Emergency Department there is one patient death. 11. The court heard evidence that in September 2023 patients had spent a total of 14,327 hours in Treliske ED when it was clinically appropriate for these patients to be discharged or moved to a ward. This period of time is equivalent to closing 19 cubicles in Treliske ED for a whole month. Treliske ED has 26 cubicles. ”
Source location
ROBERT ANDREW PROWSE · Prevention of Future Deaths report
Page 3 · concerns
Open source report
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Publish and implement the delivery plan for recovering urgent and emergency care services.

Verbatim wording from the response
“I recognise the significant pressure the urgent and emergency care system is facing. That is why we published our ‘Delivery plan for recovering urgent and emergency care services’ which aims to deliver sustained improvements in waiting times. Our ambition for this year is to reduce Category 2 ambulance response times to 30 minutes on average. The plan is available at https://www.england.nhs.uk/wp-content/uploads/2023/01/B2034-delivery-plan-for-recovering-urgent-and-emergency-care-services.pdf”

Source location
Response from Department of Health and Social Care
Page 1 · response
Published 3 April 2024
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Maintain the uplift of 5,000 staffed, permanent hospital beds delivered through the urgent and emergency care plan.

Verbatim wording from the response
“Your report also highlights that Royal Cornwall Hospital was experiencing high demand with long handover delays. I recognise that ambulance trusts work within a health and care system and issues such as delayed patient handovers to hospitals, as you rightly identify in your report, can impact on capacity and response times. That is why a key part of the delivery plan is about improving patient flow and bed capacity within hospitals. We achieved our 2023/24 ambition of delivering 5,000 more staffed, permanent hospital beds this year compared to 2022/23 plans, backed by £1 billion of dedicated funding, and we will maintain this capacity uplift in 2024/25. We have also achieved our target of scaling up virtual ward bed capacity to over 10,000 ahead of winter 2023/24, and there are now over 12,000 beds available nationally.”

Source location
Response from Department of Health and Social Care
Page 2 · response
Published 3 April 2024
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Invest an additional £1 billion through the Discharge Fund to support timely and effective hospital discharge.

Verbatim wording from the response
“We are also investing an additional £1 billion this year through the Discharge Fund, to support the NHS and local authorities to ensure timely and effective discharge from hospital. This funding follows £600 million last year and £500 million in 2022/23. The NHS and local authorities are using this funding to help provide people with the right care in the right place when they are discharged from hospital. We have also ensured every acute hospital has access to a care transfer hub, bringing together professionals from the NHS and social care to manage discharges for people with more complex needs who need extra support with a view to promoting early planning and timely discharge. These measures are helping improve patient flow through hospitals, reducing delays in patient handovers so ambulances can swiftly get back on the roads.”

Source location
Response from Department of Health and Social Care
Page 2 · response
Published 3 April 2024
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Ensure every acute hospital has access to a care transfer hub supporting complex discharges and early planning.

Verbatim wording from the response
“We are also investing an additional £1 billion this year through the Discharge Fund, to support the NHS and local authorities to ensure timely and effective discharge from hospital. This funding follows £600 million last year and £500 million in 2022/23. The NHS and local authorities are using this funding to help provide people with the right care in the right place when they are discharged from hospital. We have also ensured every acute hospital has access to a care transfer hub, bringing together professionals from the NHS and social care to manage discharges for people with more complex needs who need extra support with a view to promoting early planning and timely discharge. These measures are helping improve patient flow through hospitals, reducing delays in patient handovers so ambulances can swiftly get back on the roads.”

Source location
Response from Department of Health and Social Care
Page 2 · response
Published 3 April 2024
Open published response
Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation
Continue working with NHS England to reduce patient waiting times.

Verbatim wording from the response
“However, I recognise there is still more to do to reduce patient waiting times further, and the Government will continue to work with NHS England to achieve this.”

Source location
Response from Department of Health and Social Care
Page 2 · response
Published 3 April 2024
Open published response

Data last updated 7 September 2026

What this concern includes

Not included

Reports over time

Concerns raised2

Failure to maintain emergency department capacity and timely patient flow

Failure to prevent emergency department crowding from patients left awaiting handover

Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3

Concerns raised1

Failure to provide a designated clinical area for emergency department patients when capacity is reached

Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.21

Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.2

Concerns raised1

Failure to provide sufficient designated clinical space for Emergency Department patients

Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.27

Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1

Actions described in response 3

Actions described in response 21

Respondent positions 2

Actions described in response 27

Respondent positions 1