Health

Ambulance error admitted in 999 call before Pembrokeshire mother’s death

Published

3 days ago

September 15, 2024

AN ERROR in handling a 999 emergency call made on Christmas Day has been admitted by the Welsh Ambulance Service Trust (WAST) at a recent inquest hearing, following the death of 40-year-old Pembrokeshire mother, Charlotte Burston.

At the pre-inquest hearing held on Friday (Sept 13), WAST acknowledged a critical mistake in responding to urgent calls for medical assistance. Representing WAST, Trish Gaskell stated, “An advanced paramedic practitioner would normally be allocated and should have been allocated to Ms Burston before she was conveyed to hospital. The trust has accepted that error.”

Deputy Coroner Mark Layton confirmed that all reports from WAST, including transcripts of the 999 calls, had been received. He announced plans to commission an independent expert to review the evidence and determine whether a different response from the ambulance service might have altered the outcome. “The expert will examine the evidence and ascertain whether a difference could have been achieved or not had the ambulance service’s response been different,” Mr Layton said.

Charlotte’s family has been left grieving after her death on New Year’s Eve, despite repeated attempts by her 15-year-old daughter, Ella, to call for medical assistance. On Christmas morning, Charlotte began experiencing severe tingling sensations in one of her arms—a potential warning sign of a cardiac event.

“I called 111 at 8:19 am; the call lasted 53 seconds, so I hung up because it was taking too long,” Ella recounted. “I then called 999 at 8:29 am, and the call lasted 41 minutes. The woman I spoke to refused to tell me how long an ambulance would take but just said that one would be arranged.”

Despite these urgent pleas, no ambulance arrived. As Charlotte’s condition worsened, Ella contacted her grandfather, Brian Laye, who lives in Clunderwen. He immediately drove to Llanteg, arriving to find his daughter drifting in and out of consciousness.

“Charlotte was lying on the sofa, struggling to breathe,” Mr Laye recalled. “We were told an ambulance wouldn’t be available for at least an hour and a half. With no time to lose, I decided to take her to Withybush Hospital myself.”

En route to the hospital, Charlotte suffered a major heart attack near Robeston Wathen. Upon arrival at Withybush General Hospital, she was placed on life support and later transferred to Morriston Hospital. Sadly, she never regained consciousness and was pronounced dead on New Year’s Eve.

A post-mortem examination concluded that the cause of death was hypoxic brain injury—a lack of oxygen to the brain resulting from the cardiac arrest.

“If an ambulance had got to Charlotte within 15 minutes of Ella’s first call, she’d still be with us today,” said Vincent Laye, the father of Charlotte’s daughters. “The pain and the grief that this has left us with is beyond explanation. Our girls have lost a mother who they relied on and who was their best friend.”

Mr Laye expressed deep frustration over what he perceives as systemic failures within the National Health Service (NHS) and WAST. “The bottom line is that the NHS has failed in providing the care that everyone pays for and that every one of us deserves,” he stated.

He added that while schools and local charities like the Sandy Bear Children’s Bereavement Charity are offering support, there has been “absolutely no support” from other authorities. “I truly believe that this awful death could have been prevented,” he said. “Somebody needs to be held accountable for what’s happened, to prevent this from happening to somebody else.”

The depth of the family’s loss was evident as over 150 people attended Charlotte’s funeral. “Our girls have lost a mother who was with them and who cared for them 24/7,” Mr Laye said. “The community around Llanteg has lost a woman who was greatly loved.”

This heartbreaking incident is not isolated. In a similar case, a man in Pembroke Dock died after reportedly waiting nine hours for an ambulance that failed to arrive in time. Despite multiple calls for help, medical assistance did not reach him promptly, leading to his untimely death.

Family members of the deceased have expressed profound grief and frustration, citing systemic issues within emergency services. “The pain we are experiencing is immeasurable,” a relative said. “No one should have to endure such a wait in an emergency.”

These successive tragedies have intensified public outcry over ambulance response times and resource allocation within WAST. Community leaders and residents are demanding urgent action to address these shortcomings to prevent further loss of life.

Liam Williams, Executive Director of Quality and Nursing at WAST, extended condolences to the Burston family. “We were deeply sorry to hear about Ms Burston’s passing and would like to extend our thoughts and condolences to her family on their sad loss,” he said. “A thorough investigation has begun, and we will be contacting Ms Burston’s family to invite them to participate in this process.”

Sonia Thompson, WAST’s Assistant Director of Operations, acknowledged the extreme pressures on the ambulance service due to wider NHS system issues. “Our ambulance service is under extreme and well-documented pressure as a result of wider system pressures across the NHS,” she noted. “We’re thinking very differently about the way we deliver services in future and are already testing some new ways of working across Wales to understand how we can relieve some of the pressure.”

The Welsh Government has stated that despite budget pressures, it is investing in same-day emergency care, extra community beds, and social care services to improve patient flow through hospitals. “We recognise the challenges faced by emergency services and are committed to supporting initiatives that enhance response times and patient care,” a spokesperson said.

Mr Laye emphasised that the issue extends beyond his family’s tragedy. “This is about every other person out there who deserves to be looked after when they are most in need,” he said. “The NHS and the local authority have failed us in a way that’s going to change our lives forever, and I’m refusing to allow this to be brushed aside.”

Local officials and healthcare advocates are calling for a thorough investigation into both cases, urging the Welsh Government to implement necessary reforms. The recurring nature of these tragedies underscores the urgent need for improved resource allocation, staffing, and operational protocols within WAST.

As the inquest proceeds, the Burston family and the wider community await answers. The repeated failures in emergency response have prompted calls for systemic reforms within WAST and the NHS in Wales. Without significant changes, the safety and well-being of the public remain at risk.

Ms Burston is survived by her two daughters, whose prompt actions highlight the critical importance of effective emergency services. The family’s plight serves as a stark reminder of the real-life consequences of systemic shortcomings in healthcare provision. Their hope is that by sharing their story, they can prevent similar tragedies from occurring in the future.

The next pre-inquest hearing is scheduled for January 17, where it is hoped that the details for the full inquest will be finalised.

Health

Better pregnancy or baby loss bereavement care for people in Wales

Published

10 hours ago

September 18, 2024

Tom Sinclair

SANDS the UK’s leading pregnancy and baby loss charity, is supporting the National Strategic Clinical Network for Maternity and Neonatal Services to create tailored bereavement care pathways for those who have experienced pregnancy or baby loss in Wales.

The pathways aim to reduce inequalities and improve the quality of bereavement care provided to parents and families, and has been made possible by funding from the Welsh Government. The pathway materials will include guidance for healthcare professionals based on evidenced best-practice, and a set of standards relating to important aspects of bereavement care.

Good quality bereavement care is vital for parents who have experienced the loss of a pregnancy, or whose baby has died. It includes sensitive communication with parents, providing a bereavement room away from maternity or labour wards, and parents being given informed choices about decisions relating to their care and the care of their babies.
Clea Harmer, Sands’ Chief Executive, said: “Everyone affected by pregnancy loss or the death of a baby deserves high quality bereavement care and support.

“We know that no level of care can remove the grief that many parents will feel after pregnancy loss or the death of a baby, but good care can make this devastating experience feel more manageable. We also know that poor quality or insensitively delivered care can compound and exacerbate pain.

“This launch follows a huge amount of hard work and determination from our partner organisations, the generous support of many bereaved parents and families, and medical professionals who have shared their experiences.

“We hope that through supporting the National Strategic Clinical Network for Maternity and Neonatal Services, we can work together to make sure everyone affected by pregnancy or baby loss gets the care that they need.”

In developing the pathways for Wales, Sands carried out a series of listening events for parents and health professionals during 2024, to understand how bereavement care in Wales can be improved.

These insights will be incorporated into work with the National Strategic Clinical Network for Maternity and Neonatal Services to introduce pathways to address specific needs after miscarriage, Termination of Pregnancy for Foetal Anomaly (TOPFA), stillbirth, neonatal death or Sudden Unexpected Death in Infancy (SUDI).

Chief Midwifery Officer for Wales, Karen Jewell said: “We are delighted that we have been able to support this important initiative to develop and implement a National Bereavement Care Pathway for Pregnancy and Baby Loss.

“Pregnancy loss or the death of a baby is devastating, and this initiative will help to ensure that every family who suffer from this are appropriately and compassionately supported.

“Our significant investment into bereavement services will improve care and ensure consistency across Wales, the Bereavement Support Grant will continue to support organisations like Sands to extend and deepen bereavement support and fill the gaps that currently exist.”

Healthcare professionals are an important part of the Sands community, and the charity wants to support them to deliver good bereavement care. The pathways will introduce dedicated support for medical staff who care for bereaved families in Wales.

Cara Moore, Lead Midwife from the National Strategic Clinical Network for Maternity and Neonatal Services said: “We are thrilled to be leading the development and implementation of the development and implementation of bereavement care pathways in Wales in collaboration with Sands. The development of pathways will ensure consistent high quality and sensitive bereavement care is offered to all bereaved parents in Wales. This will be supported through training, interdisciplinary collaboration and continuous monitoring and promises a sustained improvement in the experiences of bereaved parents.

“We are also pleased that the implementation of the pathways align with and supports long term plans for the delivery of high quality maternity and neonatal care in Wales.”

Marc Harder, Head of Bereavement Care & Hospital Liaison at Sands, said: “Earlier this year, bereaved parents and families in Wales generously shared their stories of pregnancy and baby loss with us during a series of listening events. Key themes that arose included gaps in compassionate care, inappropriate and insensitive medical terminology, care outside of the hospital and inconsistency in bereavement care provision.

“We are delighted to be working in partnership with the National Strategic Clinical Network for Maternity and Neonatal Services to develop bereavement care pathways that will begin to address these concerns and lead to higher quality care at such a difficult time for parents and families. We will continue to work with parents, professionals and other stakeholders to ensure an evidence-based and community-led approach to the development of Wales-specific pathways.”

More information about the bereavement care pathways in Wales
The project in Wales is led by Sands in collaboration with a number of other charities and professional organisations, and funded by the Welsh Government. The project provides dedicated, evidence-based care pathways designed for all healthcare professionals and staff involved in the care of women, birthing people, partners and families at all stages of pregnancy and baby loss.

Five experiences of pregnancy or baby loss are included in the pathway project including miscarriage, TOPFA, stillbirth, neonatal death and SUDI.

Sands is here to support all bereaved families in Wales and across the UK. The charity provides support through its Freephone helpline, online community and resources, and through a network of regional support groups run by trained befrienders, all offering in-person peer support.
Find out more about all the ways the charity offers bereavement support.

Health

‘Junior’ doctors change name to ‘resident’ doctors

Published

10 hours ago

September 18, 2024

Tom Sinclair

THIS WEEK (Sept 18) the doctors who formerly were known as “junior” doctors mark their official transition to the title “resident” doctors. The BMA, the representative body for doctors in the UK, from today will refer to this cohort of doctors as resident doctors and leave the former misleading title behind.

Resident doctors are fully qualified doctors who are either currently in postgraduate training or gaining experience as locally employed doctors, to become the consultants, GPs or specialists of tomorrow. They form the largest single group in the UK’s medical workforce, with many having more than a decade of experience as highly qualified professionals. After many years of calls for the term “junior” to be retired as both misleading and demeaning to the skills of doctors, the BMA voted in 2023 to move to a new term.

In February 2024 a BMA survey showed the change to “resident” was supported by 91% of junior/resident doctors. From Wednesday, the word “junior” will be replaced by “resident” in all BMA and Government communications, with the NHS, media and healthcare institutions all encouraged to follow suit. “Resident doctor” also brings the UK closer to international terminology, the title being used in the US, Canada, Spain, Australia and many others.

The Welsh Resident Doctors Committee (WRDC) co-chairs Dr Oba Babs-Osibodu and Dr Peter Fahey said: “This change is a positive step forward for both doctors in Wales, who will now feel acknowledged for their extensive skills and years of experience, and for patients, who can rest assured that there is nothing ‘junior’ about the doctor looking after them”

Health

Paul Davies MS demands urgent action on ambulance services in Pembrokeshire

Published

24 hours ago

September 17, 2024

Tom Sinclair

CONCERNS over ambulance services in Pembrokeshire have escalated, with local politician Paul Davies MS raising critical questions in the Senedd today, demanding urgent reassurances from the Welsh Government. The issue comes in the wake of several distressing incidents, including the recent death of a man after a nine-hour wait for an ambulance in Pembroke Dock.

In a statement posted on his Facebook page, Mr Davies expressed his alarm following numerous complaints from local residents. He said: “I’ve called for a statement from the Welsh Government on the delivery of ambulance services, following local concerns that I’ve received. Reassurances must be given that beds will not be removed from Withybush Hospital, as the removal of beds will only add further strain to the system. Support is also needed as a matter of urgency, as staff feel that they’re facing more and more paperwork and targets.”

The Conservative Senedd Member also highlighted that ambulance staff are increasingly struggling under heavy pressure, with added paperwork and challenging targets contributing to low morale. He raised the matter in the Senedd chamber, calling on the new Cabinet Secretary for Health and Social Care to make an urgent statement.

Addressing the Trefnydd, Mr Davies said: “Ambulance staff have raised concerns with me about services in Pembrokeshire, and I was alarmed to hear that 30 beds are to be removed from Withybush Hospital and Glangwili Hospital in due course. I was also alarmed to hear that ambulances despatched to Pembrokeshire are no longer ring-fenced to return, and the priority is to clear the backlog at Glangwili Hospital before any backlogs at Withybush Hospital.”

He further noted that staff are now facing a target of 15 minutes to complete a patient handover at A&E and another 15 minutes to restock and clean the ambulance, which is putting significant strain on already overstretched emergency workers. According to Mr Davies, morale among ambulance staff is at an all-time low, with many refusing to work overtime, particularly at night, due to concerns over spending extended hours waiting to discharge patients at hospitals.

“These are serious issues affecting both patient care and staff wellbeing,” he said. “Staff are telling me they are under more pressure than ever, with unnecessary paperwork and a target-driven approach that’s draining morale. It’s clear that we need a statement from the new Cabinet Secretary for Health and Social Care to address these concerns urgently.”

***David Bye, pictured here with his wife Pauline, died after a nine-hour wait for an ambulance in Pembroke Dock***

The demand for action follows a number of recent tragedies in the area linked to delayed ambulance response times. The case of David Bye, who died after a nine-hour wait for an ambulance in Pembroke Dock, has shocked local residents, who are now vocal in their demands for improved healthcare services across Pembrokeshire. Mr Bye’s death, along with other similar incidents, has intensified the public outcry for improvements to the region’s emergency response system.

The Welsh Ambulance Service has cited broader system-wide pressures, including long delays in transferring patients into hospitals, as a key cause of slow ambulance response times. However, residents and staff alike have expressed fears that removing beds from hospitals like Withybush will only exacerbate the problem.

Mr Davies has warned that without immediate intervention, the already stretched healthcare system in Pembrokeshire could deteriorate further, with severe consequences for patients and medical staff alike.

In his closing remarks in the Senedd, Mr Davies reiterated the urgency of the situation: “In light of the seriousness of the concerns raised, I believe that we need a statement now from the new Cabinet Secretary for Health and Social Care to address some of these concerns as soon as possible.”

The Pembrokeshire community will be watching closely to see if the Welsh Government responds with decisive action to ensure that local ambulance services and hospitals are properly supported, and that no more lives are lost due to delays in care.