Coroner rules ambulance delay for Fred Pring unacceptable
The Inquest into the death of Fred Pring, who died after waiting nearly 50 minutes for an ambulance following a heart attack, has found the delay was unacceptable. The coroner has warned that further lives are at risk unless changes are made.
Standing outside the inquest, Joyce Pring said she was glad her husband's death had received such media attention because the feels it is "such an important issue".
She said she had been "shocked" at some of the revelations during this inquest, and says to this day she has "no idea" what she could have said to the ambulance call handlers to elevate it from a category 2 emergency to category 1, the highest emergency.
She said she hoped changes made following this inquest would stop others going through her ordeal.
In a joint statement the Welsh Ambulance Trust and Betsi Cadwaladr UHB said:"We extend our condolences to the Pring family at what is a very sad and difficult time. It is with deep regret that on this occasion there was no ambulance available to send to Mr Pring in a more timely manner.
"It is our responsibility to ensure we have a safe, effective and high-quality urgent care system and together we are working hard to reduce any delays in transferring patients to hospital. We have already made a number of improvements since March 2013."
They said they were strengthening the training for on-call managers and ensuring handover procedures were clear for staff across the organisations.
They are also currently revising working practices to make sure they have "appropriate staffing" during periods of high demand.
"The urgent healthcare system across Wales is facing unparalleled pressure with high demands on both the ambulance services and on hospital emergency departments."
"We are taking a range of actions to ensure that our busy ambulances and emergency departments are available to those who need them most urgently", they added.
The categorisation of [ambulance] calls and the prioritising of resources does not currently appear to take into account the issue of delay and the potentially catastrophic impact of delay on both the patient and those seeking care for him.
– John Gittins, Coroner
He also criticised the current system of giving ambulance crews rest breaks that mean them returning back to their base because it "may result in an unacceptable diminution in available resources".
He also said the current practices in place for the handover of patients at A&E departments "far too often results in wholly unacceptable delayed with patients being kept waiting for long periods in ambulances and ambulance resources consequently being unavailable for allocation to other calls".
The loss of even a single life to a potentially avoidable delay is unacceptable and so I intend to make reports to both the Ambulance Trust and the Health Board advising them of my concerns that unless action is taken, circumstances creating a risk of other deaths will continue to exist.
Ending the inquest with a narrative conclusion, the coroner said if an ambulance had been sent sooner - after Mrs Pring's first call - it was "probable" that Fred Pring would have survived long enough to receive medical attention at hospital.
He said it was "unacceptable" for ambulance delays to cause the potential loss of one life, and warned that other lives would also be at risk if action was not taken to improve matters.
The coroner asked the medical director to provide an explanation of the handover process between ambulance crew and hospital staff, in order to free up the ambulance to be deployed to another emergency.
Professor Makin said the hospitals and the ambulance service had a joint target time of 15 minutes when it comes to handing over a patient.
He said on March 20th last year, the health board only achieved this handover target time with 57% of its 197 admissions.
He said, however, that on that day, North Wales had done better than the average for Wales, which was 53%.
The all-Wales target is to achieve a 15 minute handover time with 95% of admissions.
Professor Makin said: "All too often in the health service we trot this thing out about lessons being learned. I want to see changes that significantly improve performance."
He said a number of measures were already in place to improve the health board's process of managing patients and minimising delays in admissions.
Coroner John Gittins told the medical director: "The reality is, the crux of how this problem arose was due to this triaging process, where a patient is cared for in an ambulance whilst waiting for admission... in this instance it's hugely important that improvements happen rapidly."
Betsi Cadwaladr University Health Board conducted a serious incident review following Fred Pring's death and found the hospitals had been under considerable strain that week.
The coroner asked: "Does it fundamentally come down to an issue of staffing and bed numbers?"
Professor Makin, medical director, said it "doesn't characterise it appropriately to say it was just about not enough beds being available."
He then provided the inquest with a snapshot of what the health board was dealing with that day. He said all three major hospitals in North Wales were reporting a problem with over-capacity and anticipating having more admissions than beds available.
"Twenty-two ambulances were waiting outside hospitals to transfer patients; there were major patients being held in minor [units]; there were long waits for medical beds," Professor Makin said.
He added it was important to say that the problem was a Wales-wide problem at the time - not just specific to North Wales.
The Fred Pring inquest has resumed, with evidence from Professor Matthew Makin - medical director of Betsi Cadwaladr University Health Board.
He said it was clear that there was "considerable stress" on the system within A&E last March, when Mr Pring needed an ambulance. There was an increased demand for in-patient beds, which was a fairly typical pattern for March and April.
"In the last 20 years, the populations of patients who attend A&E department has changed considerably," he said.
"Now they are very elderly and frail, and when they are admitted they are in for a longer stay.
"The question is, how do we keep up with that demand?"
A Welsh Ambulance Service manager has told an inquest she held an investigation after Fred Pring's death, which concluded that there were no ambulances available to go to his aid.
Jill Plemming said: "Between 0109 hours and 0142 hours there were no resources available to this patient. The reason for this was the significant delays in transferring patients both to Wrexham Maelor and Glan Clwyd hospitals."
She added the delays were further impacted by the urgent requirement to give crews 'non-disturbable' breaks after five hours of duty.
An accumulation of these breaks also had a knock-on effect on resources available at that time, Ms Plemming said.
The inquest has heard that one ambulance, which would have been allocated Fred Pring's emergency that night, was stuck at Wrexham Maelor Hospital waiting to transfer a patient for almost five hours - 287 minutes to be exact.
Coroner John Gittins told manager Ms Plemming that is "a very long time" to wait to transfer a patient.
She replied: "Yes, it is."
When he asked if there was a target patient transfer time, she told him it was 15 minutes.
Mr Gittins: "So, in a nutshell, six ambulances waiting to transfer patients at Wrexham Maelor, three ambulances waiting to transfer patients at Glan Clwyd. All experiencing delays significantly longer than the 15 minute target time?"