Alfred Hodges

Prif Weithredwr / Chief Executive
Iwan Davies, LLB (Hons) MBA
—_ v= (Hons)
Co N WY Bodlondeb , CONWY , LL32 8DU

CYNGOR BWRDEISTREF SIROL
COUNTY BOROUGH COUNCIL

Mr John Gittins,
HM Coroner's Office,
County Hall

Wynnstay Road, Ein Cyf / Our Ref: Ceo2a.coroner14
Ruthin, a Your Ref: a
Denbighshire, yddiad / Date: 12™ March 2014
LL15 1YN.

Dear Mr Gittins,

Re: Inquest of Alfred Leonard Hodges — 3 December 2013

With reference to your letter dated 24'" January 2014, | write to reply to the matters of concern
recorded in the Regulation 28 Report to Prevent Future Deaths issued by the Assistant Coroner,
Ms Nicola Jones, after the inquest of Mr Alfred Leonard Hodges on 3 December 2013, and to
explain the action taken by the Council.

Before | do so, may | first express sincere condolences to Mr Hodges' family and friends for their
loss. :

May_l also apologise that no officer from the Council attended the inquest. | am aware, of course,
We | North Wales Regional Telecare Strategic Manager submitted a written
statement in the form of a letter dated 21* October 2013 in response to the request from the
Coroner's Officer and, as | understand it, there was no specific direction requiring attendance.

However, | do think that a Council officer with relevant experience could have been of assistance
to the Assistant Coroner in this case and | am sorry that this did not happen.

In my letter to you dated 12"" December 2013, | requested that all future invitations and requests
to attend inquests were forward directly to my office and | envisage that this will ensure that
enquiries are given due consideration and appropriate action taken to prevent a recurrence of this
position.

| now turn to the issues the Assistant Coroner has recorded as matters of concern.

Telecare and Assistive Technology are community care services provided under several statutory
provisions to individuals in Conwy who have an assessed eligible need. Telecare and Assistive
Technology cover a wide range of equipment including detectors, sensors, alarms, pendants etc,
as well as services such as assessment, installation, monitoring, call centres and responses, all
designed to enable individuals and/or carers to remain safe and independent within their own
homes.

The prescription and utilisation of Telecare equipment by health and social care professionals to
meet an individual's assessed need became widespread in Wales on the inception of the
Telecare Grant from the Welsh Government in 2006/7.

Minigyf 515892

In Conwy, pre-February 2014, the basic Telecare package comprised the "Lifeline" base unit and
a pendant. The Council provided the linked “Tunstall” smoke detectors on the basis of assessed
eligible needs. Individuals who did not have an assessed need were signposted to the North
Wales Fire and Rescue Service (NWFRS) for a Home Fire Safety Check, which is free.

In January 2012 Conwy County Borough Council reached an agreement with NWFRS whereby
the Council agreed to notify the Fire Service of any new Telecare installations where there was no
assessed need for a linked smoke detector, so that the NWFRS could carry out a Home Fire
Safety Check and offer and install a linked smoke detector. Thus, in Conwy from January 2012,
the Council has been notifying NWFRS of new Telecare installations and, following a Home Fire
Safety Check, NWFRS has been installing the linked smoke detectors to the Lifeline base units in
place.

In 2012-13 Conwy Telecare Service made 41 referrals to NWFRS and 36 between April and
November 2013.

In addition, Conwy Customer Care Team also refers individuals to the NWFRS for Home Safety
Fire Checks. The Customer Care Team is the first point of contact for individuals making
enquiries of Social Services.

In 2012-13 that Team made 2,407 offers of referral to the NWFRS to individuals; 402 accepted
the offer and referrals were duly made.

In 2013-14 so far, the Team has made 2,096 offers of referral; 339 have accepted and referrals
duly made.

| consider that these statistics highlight two concerns for both agencies, the large number of
individuals refusing a referral for Home Fire Safety Check in the first place and then the resource
implications for the NWFRS to carry out those checks and to do so in a reasonable timescale.

In December 2013 there were approximately 1,880 social care clients in Conwy County Borough
Council's area with Telecare equipment installed 910 of whom did not have smoke detectors
linked to their Lifeline base units. | can report that since then Conwy Telecare Service has
installed 105 linked smoke detectors and the Team has also been proactively urging clients to
accept the units when they have met with a refusal or disinterest.

! will go on to describe in more detail what action the Council has taken later in this letter.

To read the unfavourable comparison of Conwy County Borough Council's practice as regards
Telecare with that of the neighbouring Authorities is, as you would expect, a matter of concern for
me and one which | have looked into further. My understanding is that whilst the majority of the
Authorities (namely, Angelsey, Gwynedd, Flintshire and Wrexham) do install a linked smoke
detector as part of the basic Telecare package, there are some considerable uncertainties about
the sustainability of that provision — for example, in Gwynedd where the practice is being
reviewed at present, and in Flintshire where the NWFRS provide the linked detectors at present.
In Wrexham there are particular concerns about the number of refusals of the linked detectors.
The approach in Denbighshire is to install linked smoke detectors on the basis of assessed need.
As | understand it, whilst Denbighshire County Council has had discussions with NWFRS, no
other arrangements are in place except for referrals for Home Fire Safety Checks.

The conclusion, | think, is that there is certainly some inconsistency across North Wales in
respect of the basic Telecare package and serious concerns about sustainability of current
provision in some Authorities as well as concerns about the number of refusals from individuals
who are of course entitled to choose (unless lacking capacity, a decision is made in their best

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interests). These are matters which you or the Assistant Coroner may well wish to follow up not
only with the other Authorities but also with NWFRS and Betsi Cadwaladr University Health
Board.

As you will know, Mr Hodges was 97 years old and he lived alone in his own property. Mr
Hodges was wheelchair dependent and was hard of hearing and wore hearing aids. To meet Mr
Hodges’ social care needs to enable him to stay at home, the Council commissioned a
comprehensive package of care from a domiciliary care agency which included assistance with all
daily living activities including personal care and meal preparation. Mr Hodges' care plan was
reviewed regularly and manual handling risk assessments and care plans were in place.

The Galw Gofal records show that a "Lifeline” base unit (and pendant) was installed for Mr
Hodges' use on 27" October 1998. This was a self referral - ie. not as a result of a community
care assessment. The base unit was upgraded in March 2009.

lam very sorry indeed that Mr Hodges’ next of kin were mistaken in their belief that the smoke
alarm in the property was a linked detector. The question | have posed is how this mistake could
arise and how can we be sure it does not happen again.

In order to answer the first question, | think it might be useful if | refer to the Customer Care

Team's contacts in respect of Mr Hodges recorded on the Social Services computer system
which are as follows :-

31/3/2011 - Enquiry — EE (member of staft)

Son stated carbon monoxide detector not working. Advised could contact ‘Careline’.
Fire safety check offered.
Response: Son declined - stated system in place.

10/1/2012 - Enquiry — [EE (member of staff)

Fire safety check offered.
Response: Hfsc conducted as reported by son.

20/2/2013 — Significant change case note -tt~CYCY (member of staff)
Enquiry call in from the domiciliary care agency.

Fire safety check offered

Response: Smoke detectors connected to Tunstall and has Fire Angel installed.

You will see that on three occasions in three consecutive years, the Customer Care Team offered
a referral for a Home Fire Safety Check. In 2012 it appears that Mr Hodges’ son informed the
Customer Care Team that a Home Fire Safety Check had been carried out by NWFRS. | cannot
comment on why that did not result in a linked smoke detector being installed. {n 2013, most
unfortunately, it appears that the smoke alarm in situ was mistaken for a linked smoke detector.

| now tum to address the Assistant Coroner’s request for an explanation of action taken by Conwy
County Borough Council.

The Council and NWFRS reviewed the current practice in October 2013. The NWFRS concluded
that it would be beneficial for people in Conwy if a linked smoke detector was installed as part of
the basic Telecare package on initial installation, or during regular support visits to those already
with a Telecare package. The NWFRS donated 900 linked smoke detectors to the Council for the
Conwy Telecare Service to install for clients identified as not having a linked detector.

Whilst the donated smoke alarms were very welcome, the issue then became the timescale for
installation and how and who to prioritise. It was estimated that this installation programme would

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take the existing installation staff team approximately 12 - 18 months to complete alongside their
normal duties.

Officers from NWFRS and Conwy County Borough Council met again on 11" December 2013
and reached an agreement for the funding of a full time post in the Council for 6 months in order
to install the linked smoke alarms in a considerably shorter timescale. The NWFRS also agreed
to provide 500 smoke alarms during 2014/15 and have provided refresher training for Conwy
Telecare Services installers on the correct positioning of smoke detectors in domestic dwellings
and, will be providing fire safety awareness training for social services staff. Between December
and February 105 detectors have been installed and the new full time officer has now started
work.

In order to raise staff awareness and to request that staff visiting clients at home take note of and
test smoke alarms, a briefing note has been prepared for all Social Services staff and has been
posted to them via the Council’s intranet; the briefing paper includes a photograph of the
“Tunstall” linked smoke detector used in the County to help staff identify the equipment in situ.

The Council is working hard to meet the social care needs of clients who wish to remain in their
homes and, mindful of our respective statutory responsibilities, we are committed to work in
partnership with the NWFRS, the Health Board and other agencies in the best interests of all our
residents.

| do hope | have provided a comprehensive response. Please do not hesitate to contact me if
there is anything further | can assist with.

Yours sincerely,

Iwan Davies
Chief Executive