The transformation of patient flow at Morriston Hospital in Swansea Bay University Health Board is a story of leadership, resilience, and practical change. At its centre is Callum Allen-Ridge, Head of Patient Flow, whose journey through the Climb Leadership Programme and the Spread and Scale Academy has equipped him with the skills and confidence to tackle one of the most challenging problems facing the Welsh NHS: how to restore safety, dignity, and efficiency to acute care under intense pressure.
When Callum stepped into his role, the Emergency Department at Morriston was overwhelmed. Ambulances often queued for more than twenty hours, patients were held for days in the department, and unsafe practices such as placing beds in corridors and even in front of fire doors had become routine. Staff were demoralised, processes were inconsistent, and the environment was unsafe for patients.
Recognising that the system was broken, Callum chose to confront the reality with honesty. His first act was to create a shared sense of urgency, and a space for colleagues to share frankly the challenges that they faced. This candour laid the groundwork for collaboration and change.
Over the months that followed, Callum and his colleagues introduced a series of changes that transformed patient flow. Drawing on lessons from Spread & Scale, he emphasised persistence through the uncomfortable early stages of implementation and made sure clinicians were engaged at the outset. From Climb, he brought the confidence to lead with compassion and authenticity, acknowledging the pressures but also enabling staff to believe change was possible.
Processes were standardised so that flow teams across the hospital worked with a single language and framework. Peer-to-peer leadership and safe-to-fail tests were encouraged, with clinicians talking to clinicians, nurses to nurses, and managers to managers, building ownership across professional groups. Callum also reframed the purpose of the changes, stressing not only that they were operationally necessary but that they would make work safer, calmer, and more joyful for staff.
One flagship initiative was the launch of Your Next Patient, a model that schedules two moves every hour from the Emergency Department to specialty wards. Previously, wards released beds only when discharges were complete. Under the new approach, wards are instructed which patients to pull through next, shifting responsibility onto them to support ED flow. This practical change, coupled with stronger front door decision-making and improved collaboration with local authority partners, created momentum that began to be felt almost immediately.
Lessons from Climb and Spread & Scale
The Climb Leadership Programme instilled in Callum the importance of authenticity and emotional intelligence in leadership. His willingness to acknowledge the chaos of the department, to speak honestly with colleagues, and to persist in the face of difficulty reflects Climb’s emphasis on compassionate and courageous leadership.
The Spread & Scale Academy provided him with the tools to design change at scale. By applying the Model for Unleashing, Callum dug into the lived experience of staff, envisioned a safe and dignified Emergency Department, designed a system that could benefit the whole hospital rather than a small unit, and distributed leadership responsibility across teams.
The transformation has been validated by robust data collected between April and August 2025. Ambulance handover performance has improved dramatically, with the number of handovers completed within 45 minutes rising from 18 per day to 46 per day: a 155% improvement. The average handover time has reduced from 2 hours and 43 minutes to just 33 minutes, representing a 79.7% improvement. Lost ambulance hours caused by queuing have dropped from 163 hours per day to 37 hours per day, a 77% reduction, even as the number of ambulance conveyances increased from 51 to 56 per day.
Flow within the Emergency Department has also improved markedly. The total time patients spend in the department each day has reduced by 22%, from 2,496 hours to 1,946 hours. The number of patients awaiting admission at 9 a.m. has fallen from 49 to 29, a 41% improvement. Meanwhile, the consistency of weekday medical discharges has improved, with variation reduced by 46% (from ±13 to ±7 discharges per day), offering greater predictability and control.
The introduction of Your Next Patient has been central to this success. The model has driven a sustained increase in Same Day Emergency Care (SDEC) transfers, rising from an average of 86 per month (February–May 2025) to 289 transfers in July 2025. These improvements have been achieved despite continued high demand, demonstrating that the gains reflect systemic change rather than temporary reductions in activity.
The operational impact translates into significant benefits for both patients and the system. National analysis suggests ambulance handover delays in England and Wales in 2022 cost the system in excess of £225 million annually (LBC, 2022). Given that Morriston’s improvement reduced lost ambulance hours by more than 120 per day, a conservative estimate that this work is releasing capacity worth hundreds of thousands, if not millions of pounds each year. More importantly, faster handovers mean patients reach appropriate care more quickly, reducing clinical risk and potential harm. Shorter ED stays and steadier discharge patterns also lessen the likelihood of deterioration, falls, and healthcare-acquired infections associated with prolonged waits and overcrowding.
Culturally, the shift has been just as striking. Staff who once described the Emergency Department as unworkable now talk of calm, control, and pride. Senior charge nurse Tristan Taylor reflected that he no longer goes home worrying about whether patients were safe. Callum described it as “a completely different world,” where staff can smile again and patients receive calmer, more attentive care.
Callum’s leadership is characterised by authenticity, persistence, and empowerment. He does not shy away from naming uncomfortable realities, but he also provides the confidence that improvement is possible if the team holds its nerve. He embodies the principle of no heroes, ensuring responsibility is shared across the system rather than concentrated in one individual. This style, nurtured through Climb and Spread and Scale, has created a culture where staff feel listened to, valued, and proud of their work.
Next steps
Although the improvements have been dramatic, Callum and his colleagues are clear that the journey is not over. The next challenge is to support inpatient wards, which continue to face heavy demand and staff shortages, and to build further resilience into discharge processes. Plans are also in place to extend consultant presence at the front door seven days a week and to work towards a fifteen-minute ambulance handover target.
The transformation at Morriston demonstrates how investment in leadership development translates into tangible improvements for patients and staff. Callum reflects that “Wales has invested in me, so I need to give back to Wales.” His work shows that with the right combination of tools, persistence, and compassion, it is possible to turn one of the most pressured environments in the NHS into a safer, calmer, and more dignified place for both staff and patients.
