Angela Darlow

I am Kate Robertson, Assistant Coroner for North Wales (East and Central)

On 13 June 2025 an investigation was commenced into the death of Angela  Frances Darlow (DOB 19 April 1952) who died on 7 June 2025. The investigation  concluded at the end of the inquest on 5th February 2026. The conclusion of the  inquest was a narrative conclusion that death was due to natural causes  contributed to by opportunities for medical investigations and potential treatment lost due to the time it took for the ambulance to arrive and convey her to hospital  where such investigations may have afforded her treatment for the condition from which she died

The circumstances of the death are as follows : Angela Darlow had a  stroke at home on 6 January  2025. An Ambulance was immediately called. This arrived after 23 hours and 20 minutes. She was conveyed to the Countess of Chester Hospital arriving 1 hour and 7 minutes later. She was diagnosed with an extensive left middle cerebral artery infarct. Given the passage of time she was not suitable for investigations and  thrombectomy. She instead received antiplatelets and was admitted to the stroke ward. She remained stable and was transferred to Mold Communty Hospital on 7 March 2025 with a poor prognsis. She died from the effects of the stroke at hospital on 7 June 2025.

(resources) During the course of the inquest, the evidence revealed matters giving rise to concern. In my opinion there is a risk that future deaths will occur unless action is taken. In the circumstances it is my statutory duty to report to you. The MATTERS OF CONCERN are as follows. Angela Darlow was suffering from symptoms of a stroke at home during the  afternoon of 6 January 2025. Her husband immediately contacted the Welsh  Ambulance Service via 999. Given the significant demand at this time, it took 23  hours and 20 minutes for an emergency ambulance to attend. The calls made to  the Trust were correctly categorised. By the time Angela arrived at the nearest  hospital, The Countess of Chester, she was outside the time for investigations for thrombectomy. At the time in question demand was unprecedented. This is reflected by the 23 hour and 20 minute delay in ambulance arriving. There were significant hospital handover delays at the time which added to the demand on the Trust. The facts in Angela’s death speak for themselves. I continue to remain concerned  about the time is it taking for ambulances to arrive in the context of the  multifactorial reasons for this which include patient flow in hospitals and limited  social care provision. People are dying due to these issues and yet we are no closer to improvement.

In my opinion action should be taken to prevent future deaths and I believe you have the power to take such action.