Prevention of Future Deaths reports · 2014

Leslie Pates

Regulation 28 report to prevent future deaths, reference 2014-0043, written 30 Jan 2014. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report30 Jan 2014
Reference2014-0043
DeceasedLeslie Pates
CoronerJohn Pollard
Coroner areaManchester South
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Sourcejudiciary.uk record · original PDF
Responses published1

The report

Text recovered by OCR from a scanned PDF. OCR is imperfect: check anything you rely on against the source PDF. Reproduced verbatim, including the scan's own layout.

REGULATION 28: REPORT TO PREVENT FUTURE DEATHS

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO:
Chief Executive Tameside NHS Foundation Trust
Chief Executive, Tameside MBC

1 | CORONER

lam John Pollard, senior coroner, for the coroner area of South Manchester

2 | CORONER’S LEGAL POWERS

| make this report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009
and regulations 28 and 29 of the Coroners (Investigations) Regulations 2013

3 | INVESTIGATION and INQUEST

On 5" April 2013 | commenced an investigation into the death of Leslie Alfred Pates
dob 21° February 1932. The investigation concluded on the 29" January 2014 and the
conclusion was that he died from Natural Causes. The medical cause of death was 1a
Sepsis 1b Pressure sore 1c Immobility/stroke 2 Vascular dementia, Chronic Obstructive
Pulmonary Disease, Hypertension, Stroke.

4 | CIRCUMSTANCES OF THE DEATH

On the 11" December 2012 he was admitted to Tameside General Hospital Medical
Assessment Unit, later being placed on wards 42 and 43. He was eventually discharged
home on the 22"° January 2013 against the wishes of his family. The Consultant
heading up his care accepted that he did not see the patient prior to his discharge, that
he had no grounds for saying that “the family were happy for him to go home” and that
there was no reasonable analysis made by the hospital and others as to his fitness to
return home.

The social worker conceded that there had been no meeting with the family to discuss
discharge (as should be the case), that matters “were not in place from a Social
Services position” and that there had been no liaison between social services and the
District Nurse teams.

On the 27" January 2013 he had to be transferred from his home toa Nursing Home
and by the 17" February 2013 his condition was so bad that he was re-admitted to
Tameside General Hospital by 999 ambulance.

A doctor at the hospital supplied an MCCD to the coroner which gave the cause of death
on the 2" April 2013 as sepsis when | heard evidence from the consultant chest
physician that he found the patient on the morning of the 2" April 2013 to be apyrexial
with clean pressure sore.

5 | CORONER’S CONCERNS

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. —
1.There has been a complete breakdown in effective communication between the

hospital and the family of the deceased.

2. Neither the hospital staff nor the social services staff took any, or any proper, account
of the wishes and views of the family prior to the discharge home of the patient.

3. The patient who was aged 80 years was sent home with severe pressure sores and
without the facility of a pressure relieving mattress.

4. Tameside Social Services failed completely or adequately to consider the views of the
family of the deceased before determining and bringing into effect a plan for his
discharge.

5. The required “meeting” between Social Services and the family prior to discharge
from hospital, simply never took place.

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and | believe you have the
power to take such action. It is essential that full information is passed promptly to the
GP practice of a patient being discharged.

YOUR RESPONSE

You are under a duty to respond to this report within 56 days of the date of this report,
namely by 30" March 2014. |, the coroner, may extend the period.

Your response must contain details of action taken or proposed to be taken, setting out
the timetable for action. Otherwise you must explain why no action is proposed.

COPIES and PUBLICATION

| have sent a copy of my report to the Chief Coroner and to the following Interested
Persons namely SM 2uchtcr of the Deceased.

| am also under a duty to send the Chief Coroner a copy of your response.

The Chief Coroner may publish either or both in a complete or redacted or summary
form. He may send a copy of this report to any person who he believes may find it useful

or of interest. You may make representations to me, the coroner, at the time of your
response, about the release or the publication of your response by the Chief Coroner.

30 January 2014 John Pollard, HM Senior Coroner

Responses

1 response published against this report on judiciary.uk. A response is a body's written reply to the coroner's concerns; publication is at the discretion of the Chief Coroner's office, so an absent response does not mean nobody replied.

Response from Tamside Hospital NHS (PDF)
Tameside Hospital NHS)

NHS Foundation Trust

Tameside General Hospital

Chief Executives Office

Silver Springs Fountain Street
Tameside General Hospital Ashton-Under-Lyne
Ashton-Under-Lyne Tameside
OLG ORW OL6 SRW

Telephone: 0161 331 6000

Our Ref: KA/PW/AD/JB/Coroner
Your Ref: JSP/KA/00911-2013

Date: 26 March 2014

Strictly Private & Confidential

Mr JS Pollard

Senior Coroner
Coroner’s Court

1 Mount Tabor Street
Stockport

SK1 3AG

RESPONSE TO REGULATION 28 LETTER

Dear Mr Pollard

Thank you for your letter of the 30" January 2014 setting out your concerns under Regulations
28 of the Coroners (Investigations) Regulations 2013.

On the 29" January 2014, you held an Inquest into the death of Leslie Alfred Pates who died
on the 2™ April 2013. The medical cause of death was recorded as:

1(a) Sepsis
1(b) Pressure sore

1(c) Immobility/stroke
II Vascular dementia, Chronic Obstructive Pulmonary Disease, Hypertension, Stroke

At the conclusion of the Inquest you set out a number of concerns. These concerns were
reported to the Trust and we are now in a position to advise you of what action has been taken

to address the issues identified.

1. There has been a complete breakdown in effective communication between the
hospital and the family of the deceased.

To improve effective communication between the Integrated Transfer Team and the patients
and their immediate carers/family regarding the discharge plan, the following actions are being
taken.

Develop a checklist to ensure all members of the Multidisciplinary Team (MDT) have engaged
with patients and their family prior to discharge.

The Team leader to ensure through the computer systems between social services and the
Trust (IAS/EIS systems) that there is documented evidence that all Integrated Transfer Team
(ITT) cases have been discussed with patients and their designated carers.

2. Neither the hospital staff nor the social services staff took any, or any proper,
account of the wishes and views of the family prior to the discharge home of the

patient.

To ensure the patients and families wishes are fully raised and given full consideration in the
discharge process the following actions have been undertaken:

To ensure all patients and families have every opportunity to discuss plans and have a
dedicated name and contact number for the social worker managing their discharge.

A Leaflet has been produced and is in publication process for patients and carers about
“Leaving our Care”.

To ensure all newly appointed staff/agency workers are adequately orientated to the hospital
and all procedures and policies are outlined from both Tameside MBC and Tameside
Foundation Trust (TFT) to the expected standards of practice.

All temporary workers located within the Transfer Team will have an induction process and
complete the induction checklist within one week of commencing role.

Each temporary worker will receive an induction and adequate support and documented
regular supervision.

3. The patient who was aged 80 years was sent home with severe pressure sores
and without the facility of a pressure relieving mattress.

All patients returning home with care package will have their equipment needs assessed and
documented in hospital.

Social workers to communicate effectively with the Nurse Coordinators , SO that timely referrals
for assessment of equipment needs can be made. The daily length of stay meetings will
ensure that the checklist process for discharge is followed.

A complex care plan has been formulated for all parties to agree the patient is supported and
fully ready for home.

4. Tameside Social Services failed completely or adequately to consider the views
of the family of the deceased before determining and bringing into effect a plan for

his discharge.

All plans of care for patients must be shared with the patient and, with patient's consent, their
next of kin and agreed before discharge.

Each member of the ITT should ensure all care plans are prepared accurately and presented
before being discussed and shared. This will be monitored through regular supervision of
Tameside MBC staff and through daily length of stay. The ITT supervisors will monitor
documentation via Social worker IAS system.

The Head of Patient Flow and Team Leader for ITT now have transparency and ability to view
and monitor all social worker involvement with cases through Tameside MBC IAS system. This

is monitored daily for all cases known to the ITT.

5. The required “meeting” between Social Services and the family prior to
discharge from hospital, simply never took place.

To improve communication from the ward staff to the ITT through the induction of robust daily
SHOP board round.

A Pilot of “Sick Patients Home Other Plan” (SHOP) is in progress on two medical wards. This is
to be escalated across the trust over the next 3 months and become embedded Practice. This

will improve ward based communication to the discharge team and is documented. The SHOP
process is a full MDT process daily where all patients are discussed and discharge plans agreed

daily. This is documented and evidenced by the ITT team.

In addition, the profile of the ITT team is being raised through public awareness and increased
visibility and open access
e Creating information boards and posters to display across the wards and departments

to raise awareness of the team to allow patients, families and carers to have easy
access to the team for support and guidance in the discharge process.

The team has a social worker available 6 days a week to patients and relatives and a
Clinical Discharge Facilitator (CDF) available seven days a week, from 0800-2000hrs to

speak with patients, staff and relatives for advice.

CDF team are providing training to new staff on their Corporate Induction about
planning discharges.

ITT team are training all staff on the Nursing documentation relating to discharge and
compiling a data base of all staff trained.

I hope that these reassurances address the issues that have been raised,

Yours sincerely

Interim Chief Executive

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