Prevention of Future Deaths reports · 2014

Stephen Amer

Regulation 28 report to prevent future deaths, reference 2014-0344, written 25 Jul 2014. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report25 Jul 2014
Reference2014-0344
DeceasedStephen Amer
CoronerEdward Thomas
Coroner areaHertfordshire
CategoryCommunity health care and emergency services related deaths
Sourcejudiciary.uk record · original PDF
Responses published1

The report

Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.

CORONER'S OFFICE
DISTRICT OF HERTFORDSHIRE

The  Old Courthouse,  StAlbans  Road East,  Hatfield,  Hertfordshire' AL10 oES
DX:  100702  Hatfield
Tel: 01707 292780 Fax:  0'1707  897399

MRGRAHAMorNeunv,BlrE#[t?DsBiT-?Htr"il--3lilr,ro*o*oroloMoNs
Assistant  Coroners

25'n  July 2014

INTERNAL POST

John Wood
Chief  Executive
Hertfordshire  County  Council
Peg  Lane
Hertford
Hertforshire
SG13  3DY

Your  Ref:  t.b.a.
Our Ref: 00229-2014

Dear Mr Wood,

Re: Stephen Mark AMER, deceased

I am writing to you under  the  provisions  of schedule  5 (paragraph 7) of the coroners & Justice
Act 2009 which came into force in July 2013. This  re-enacted  the provisions  of the old  Rule  43
of the Coroners  Rules 1984. Attached to this letter  is information  concerning  the new rules and
regulations from which you will see  requires  a written response.  Copies  oi this letter and the
response received  from you will be forwarded to the other interested  persons identified at the
inquest in accordance  with the list attached.  I am also sending a copy of this letter  to my
contact.  at the. Care  Quality Commission  and the University  HertforOstrire  partnership NHS
Trust who carried out a seven day review in connection  to their  previous  contact with  Siepnen
and with whom there  had  been  discussions  over this tragic  incident.

on the 23'd July 2014,  I concluded an inquest  into the tragic death of stephen Mark  Amer wno
was born  on lhe 4'n January  1954 and had therefore reacied  60yrs just before  he died. please
find attached  a copy of the Record  of Inquest.  stephen  had i; fact been born at his home
address; 
  and was the sole  carer  of his mother,  retiring
from  him employment  as a lorry driver some time previously. In January 2014  his mothe, *as
admitted to hospital and stephen was taken by his family to the Accident  & Emergency
Department  at the  Lister  Hospital  where he was  found  to be malnourished  and  reported  hearing
a noise in his head. He was assessed both physically  and mentally and was felt to be
objectively and subjectively  depressed.  He was prescribed mirtazapine  and to be seen by his
doctor and for his family members  to oversee  his mother's  care. stephen  was  seen by his
General Practitioner Dr Turner and saw him subsequently  on the 16th  January 2014 where ne
self  reported  as being  very much  better  and well  supported  by his family and that the

Cont'd...  ...

 
 
 Page Two

Stephen  Amer

responsibility  of caring  for his 88yr old mother had  been too much  for him.  There had been  no
previous reports of self-harm  and he denied any  ideation or intention  of self-harm.  Stephen's
blood  pressure  was  normal and it was the general  opinion  of all that he was making  good
progress.

A multi-disciplinary  case conference  had taken place at the Lister  Hospital  at which it was
  best interest to be cared for by residential  assessment
concluded that it was  in 
was
initially for respite.  However  the Social  Worker reported  subsequently  that when 
seen  on her  own  that  she  very much  expressed  the  wish  and desire to return home  and to the
Social Worker  on her own expressed  the view that she  was not happy  about  going  into
residential care  not  withstanding that it appeared  that  she  had  accepted going  into residential
care when seen  with  the  family. The assessment  of the Social  Worker was  that 
  had
capacity  and therefore  the provisions  of the Mental  Capacity  Act and Deprivation  of Liberty was
and  her  son  had  never  requested  a full  package  of care but  the Team
not applicable. 
should  be returned  home  with  a full package  of care  to support  l
Manager  felt that 

  in her  perceived  wish to be at home  and to support  her carer, Stephen.

This decision  was communicated  to Stephen  by telephone  and shortly thereafterwards he took
his  own  life. His body  was discovered some two days  after contact  had  been  made.

  who  gave  evidence at the  Inquest.
A helpful  investigation  was  carried  out  by 
I also  was  in receipt of a seven day  report from the Hertfordshire University Partnership NHS
Trust who had  recommended  that there should  be liaison with  Social  Care  concerning  a
protocol  to share  intormation  concerning  seNice  users  presenting  with  significant  carer fatigue.

informed  that  this protocol  was underway and  we discussed  the issues of
consent and  how these  matters should be communicated.  At the Inquest it was debated  as to
whether it might  be helpful:-

.  To try and ensure that  appropriate  consents  are always  given from service  users to
enable  those  responsible for providing  care to have  full  information to ensure the most
appropriate  care is provided. i.e.  it would  have  been  helpful  for the Adult  Care  Team  to
have  had  Mr Amer's  consent  for them  to have  received  the  information  from  his General
Practitioner  and also the Hertfordshire  University  Partne.ship NHS Trust as to their
assessment  carried  out  at the Lister  Hospital.

.  lf as in this  case there is a change  of plan that  the  full details of the plan  should  at least
be in embryo  form before the change of plan is given  to the  relevant  person, in
particular  the  carer.

.  The manner  of communication  should  be considered  carefully.  I would  suspect that a
face to face  communication  if possible  would be more appropriate as it gives the  ability
for questions  to be answered  and full explanations given. lt also enables  those
informing  the decision  to be able to gauge the reaction  of the recipient of that
informataon.

It would  have been  useful  if the Adult  Care  Team  had known the content  of the Hertfordshire
Univerity  Partnership  NHS Trust assessment and  the contact  with the GP made  on the 16h
January  2014.

Cont'd....

 Page Three

Stephen  Amer

I  discussed  the above with 
communicating  some  of these issues  outside  Hertfordshire  and that is why  I lelt it appropriate

and he indicated  that he would  be

to write  more formally  as this letter is then made  public  through  the helpful register kept  by the
Chief  Coroner.

I hope  therefore  that my drawing  your attention  to this case  and to some of the comments
made  during the Inquest  \,vill be helpful  for  you.

The schedule  requires  a response from  you within  56 days of receipt which I calculate is the
Friday 19'"  September 2014.  Please let me know if there  are difficulties  in complying  with  this
timescale  or whether there is anything  you wish to discuss.  I am willing  to extend  the deadline  if
there is good  reason  to do so-

I look forward  to receiving  your  views  in due  course.

Yours  sincerely

Edward  G fhomas
Senior  Co

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 Hertfordshire County Council (PDF)
Chief Executive's  Office
Chief Executive  & Director  - Environment: John

iF.,lg/eltrqVF

Coroner's Office
District  of Hertfordshire
The Old  Courthouse
St Albans  Road  East
Hatfield
Hertfordshire
ALlO OES

Hertfordshire  County  Council
CH 0238, County Hall
Hertford  SG13  BDE
Fax: 
Tel
Minicom: 
Contact: 
My ref:  JW/MGB/1651HCS
Your ref:
Date:  7 August  2014

Dear  Mr Thomas

Re: Stephen Mark Amer  (Deceased)

Thank you for your letter oJ the 2s July 20'14,  issued  under Regulation  2g (paragrapn
7(1 ) of schedule 5 of the coroner and Justice  Act 2009,  followr:ng  the inqulst into the
death  of Mr Stephen  Amer.

I have  had the opportunity  to discuss  the tragic death  of this  genfleman and the
important  observations and recommendations  you  have  raised  in your  letter with  the
Director  of the Health  & Community Services  dLpartment.

During  the inquest, 
referred  to a new  protocol  which  was being
developed  with our hearth partners. we entirery agree  with your  recommendation  that
consent  arrangements should be included  to aliow  patient information  to be shareo  with
social  care  services  (your  first bullet  point on page 2 of your  letter).
Hertfordshire County  Council recognises  the value  of this recommendation  which  will
also  support  and promote.the  appropriate exchange  of information 
*" .ou" towards
further integration  of health  and.social  care  servicEs and the n"* ,""ponribiliiies  set out
,I 
October  2014.

th9 C{9 Act (2014).  We  wiil devetop  and introduce  a consent  form by the 20

"a 

we also understand  that  where  there is a change  of pran, in this case, refrecting  tne
clearly  expressed view of Mrs  Amer that sne wiineo  to return to her home,  that the
change of pran  is given to the relevant  person,  in jarticular  the 
""r"r.  | ,"ibi io yo*
:::gid bullet point on.page  2 of your  tetter and In the light ot tnis  tragic  c;se, ine
department has issued  a practice instruction  to sociar  cire starto ciEale  oiirpoate  a
separate carer's assessment. This must consider  the impact  of the decision on the
carer  and set out in oeta]]  tr9 support  they wirr require  to continue  canng-ri-init i. tn"i,
wish'  The assessment must  arso. addresi  continjency  plans if for any  reason  they
oecome unable to care for the vulnerable  p"r.onl  rh6 bounty counir riilrs*nare  tnis
new  requirement  with hearth.coileagues  and request  that they  foilow  tne same practce
when  they arrange hospital  discharles  ot vutneiaote  patients  or carers  outside of social
care  referral  arrangements.

www. hertsdirect.org

 
 
 
 The method  of communication  must  indeed  be considered  carefully  (your third
recommendation).  Whilst carers  and relatives  may choose  not to take up the
opportunity of a face  to face meeting  to discuss  discharge arrangements,  this remains
the preferred  and most effective method  of communicating  care arrangements.  This
arrangement provides  a better  opportunity  to discuss and clarify every  aspect  of care
and any associated  concerns.  lt is recognised  that mounting  pressure  on NHS hospital
beds can result  in very limited notice of discharge. We will share  your  conclusions  with
local hospital  trusts in an effort to ensure  that they allow  sufficient  time  to discuss
discharges with relatives  / carers face  to face.

I would like to thank you for your recommendations  which  we formally accept.  We will
introduce  the revised  arrangements  outlined  above  and will share  these  with our health
partners  within Hertfordshire.  We will also take  the opportunity  to share  your
observations and recommendations  more widely  with other local authorities  through  the
network  of practice  development meetings  organised by the Association of Directors  of
Adult Social Services.

Yours sincerely

John Wood
Chief Executive  & Director - Environment

 CORONER'S OFFICE
AREA OF HERTFORDSHIRE

The Old Courthouse,  St Albans  Road  East,  Hatfield,  Hertfordshire' AL10 oES
DX: 100702  Hatfield
Tel:  Ol 707  292780  F a><:  01 707  897399  E-mail:coroner.service@hertfordshire.gov.uk
MR  EDWARD  THOMAS Senior  Coroner  MR GRAHAM  DANBURY  Deputy  Coroner
Dr FRANCES  CRANFIELD, ALISON GRIEF, EDWARD  SOLOMONS ASSiStANt  COTONETS

19 August  2014

Mr John  Wood
Chief Executive  & Director  - Environment
CH 0238  County Hall
Hertford
SG13 8DE

Your  Ref: JWMGB/1651  HCS
OurRef: 00229-2014

Dear Mr Wood,

Re: Stephen  Mark AMER, deceased

Dear  Mr Wood

Thank you very  much  indeed for your  letter  of the 2/h July and for your  prompt  response  to my
Regulaiion  28 iefter. I have circuiated  copies to the Interested  Persons  according  to my list.

Kind regards

Yours  sincerely

Edward  G
Senior  C

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