Episode 23 is the 1115th episode of Casualty and the 23rd episode of the 33rd series. It was preceded by Episode 22 and followed by Episode 24. The episode was directed by James Bryce and written by Debbie Owen. The events of this episode take place on 16 February 2019, a week after the airdate.
Following Jade's assault, Louise has issued body cameras to the nursing staff to help discourage violence against them. Connie disagrees with her approach, calling it a knee-jerk reaction, and makes it clear that they should only be used in threatening situations. Louise spots Ernest trying to leave the ED after his operation was cancelled and asks him to stay for an hour so she can find out what happened.
Louise soon manages to find Ernest a bed on ITU and asks Jade and Marty to help her find him. They soon find him seconds before he bites into a bread roll and tell him the good news. However, they are too late as another patient has taken his theatre slot. Frustrated, he tries to leave again, but Louise asks him to trust her and gets him to wait in the relatives room. Shortly after, news come in that the patient that took Ernest's slot has died on the table. Louise rushes to the relatives room, but Ernest is nowhere to be found. Jade and Marty soon find him in the peace garden experiencing sharp pains in his back, and they take him into resus. When his blood pressure reads as being uneven, Rash believes that his aortic aneurysm has dissected. Ernest asks Louise to call his daughter Lilley if he dies.
In reception, Connie confronts Louise and tells her that her body cameras have endangered the life of one of her patients as their mother didn't want to disclose private information. After calling Lilley, Louise greets her and takes her to her father. Lilley is angry at Ernest for not speaking to her in years, and, when he cannot promise her that he won't leave her again, she leaves. Louise stops her and tells her that Ernest cannot promise to stay as he is dying. He is delighted when Lilley returns, but Louise is informed that the theatre porters are not available. Taking matters into her own hands, she gets Jade and Marty to help her escort Ernest to theatre. Unfortunately, he arrests on the way, and he is taken back to resus. Louise desperately tries to revive Ernest, but Connie tells her to stop, and he is pronounced dead.
In the relatives room, Louise tries to tell Lilley that the hospital did the best it could to save Ernest's life, but, when she brings up the fact that his operation had been delayed, she begs to differ and leaves. In the staff room, Dylan tries to tell Louise that she did the best she could to save Ernest and tells her that her views on healthcare are unrealistically idealistic.
Outside the ED, Connie turns off her car alarm and is confronted by Lilley who is planning to write a formal complaint about her father's treatment. When a fight breaks out by the department's entrance, Connie goes up the outdoor staircase to get back in, but an unknown assailant pushes her down the stairs and repeatedly kicks her. She is then left for dead.
Meanwhile, Rash is torn between pursuing paediatrics or cardiology as his speciality and consults Connie and Gem. Later, he decides to go travelling with Gem first and applies her for a passport. Elsewhere, Duffy tries to move her appointment with neurology forward.