The deaths of two women after delays in being transferred between two hospitals just a mile apart have prompted concerns from Norfolk's senior coroner.
The tragedies saw the patients fall ill after undergoing routine operations at Spire Hospital in Colney, requiring them to be taken to the nearby Norfolk and Norwich University Hospital.
But in each case, ambulances were not available to collect them and their conditions deteriorated - dying after eventually arriving at the neighbouring public hospital.
It has prompted senior coroner Jacqueline Lake to highlight concerns that more people could die if more is not done to speed up the region's ambulance service.
Both cases involved women aged in their 70s, happening 10 months apart during 2021.
Under an agreement reached during the pandemic, the private hospital has been helping to clear NHS waiting lists.
However, it is unclear whether the women were private or NHS patients at the time of their operations.
The first woman was 71-year-old Barbara Hollis, who died on February 23, 2021 after undergoing a knee replacement.
Ten months later and the issue produced the same result, when 79-year-old Christina Ruse died on December 15, 2021, following a hip replacement.
During the respective inquests, heard earlier this year, Mrs Lake heard evidence that the region's ambulance trust had taken steps to address delays - but that it was too soon to see if they had proven effective.
In both reports, Mrs Lake wrote: "It is accepted that EEAST [the East of England Ambulance Service Trust] have taken steps following the increase in call demand and subsequent delays in responding to patients.
"However, evidence was heard that it will take up to a year to see if these steps are effective.
"In the meantime, there is a concern that future deaths will occur."
In the case of Mrs Hollis, there was one hour and 36 minutes between an ambulance being called and arriving.
For Mrs Ruse, the delay was one hour and 27 minutes, by which time she was taken back into the operating theatre.
She was not taken to the N&N until 10.42pm - three hours and 12 minutes after the ambulance was called for.
EEAST chief executive Tom Abell said: "We would like to reiterate our sincere condolences to the families of Mrs Hollis and Mrs Ruse and apologise to them for the delays they experienced.
"We are giving careful consideration to the prevention of future death reports and are responding to the coroner.
"We have been facing incredibly high demand for some time and are seeing increasing numbers of very poorly patients, while significant delays at hospitals are continuing to have an impact on our ability to reach patients as quickly as we would like.
"We are working with NHS colleagues to identify ways to reduce hospital handover delays, are also carrying out a number of initiatives to increase our capacity.
"This includes increasing the number of private ambulances we have on shift, recruiting additional clinical staff and using non-clinical drivers to support our clinicians to maximise the number of ambulances we have on the road.
"We are also developing projects across our region to reduce the number of patients requiring hospital admission, including directing patients to urgent community response services."
A spokesperson for Spire Healthcare, which runs the private hospital in Old Watton Road, in Colney, said: "Spire Healthcare again offers our most sincere condolences to the families of Christina Ruse and Barbara Hollis for the loss of their loved ones.
“Spire Healthcare provided evidence for the inquests of both Christina Ruse and Barbara Hollis, at the conclusion of which the Coroner expressed no concerns in relation to the care provided by Spire to either patient.”
“We continue to work closely with the NHS on ways we can help ease delays for patients receiving care.”
'Staff are working hard'
Local health and social care champion Healthwatch Norfolk hope the ambulance service will take on board the coroner's concerns fully following the deaths of Mrs Hollis and Mrs Ruse.
Judith Sharpe, deputy chief executive of Healthwatch Norfolk, said: "While we cannot comment on the individual cases, we would like to offer our condolences to the loved ones of both Barbara Hollis and Christina Ruse.
"We would also be interested to see the response from the East of England Ambulance Service to the questions of coroner Jacqueline Lake.
"There is no doubt ambulance service staff are working hard and several initiatives have been put in place to try and ease delays, particularly around the transfer of patients into hospital, both by the trust itself and by hospitals.
"Equally we are aware of delays and blockages in the overall health and care system which can delay the deployment of ambulances.
"The concern of Healthwatch nationally is that people will be put off calling for help because of the concerns about waiting times.
"We hope that the new health and social care system in Norfolk which sees people working more closely together will be able to help deal with this problem, and Healthwatch Norfolk is happy to share data or information that can help with this."
Analysis
Each of these cases had tragic outcomes and it is clear that the coroner's concerns are very valid and very real.
The challenges facing the region's ambulance trust are abundantly clear and need addressing with the utmost urgency.
But equally, there are underlying concerns exposed by each of these cases that patients need reassurances over.
Healthcare is clearly something that hinges on many working parts and as a result, it only takes one of these to stop moving to create devastation across the system.
While it cannot be said whether these were NHS patients, there are concerns either which way.
Had they opted for private care, it would have likely been because the public one could not meet their means - but it still tragically caught up with them.
If they were NHS patients, it just demonstrates how efforts to tackle one of its issues had been hampered by another.
It is abundantly clear that the system we all rely on when we are at our most sick, is sick itself.
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