Prevention of Future Deaths reports · 2014

Gary Million

Regulation 28 report to prevent future deaths, reference 2014-0348, written 29 Jul 2014. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report29 Jul 2014
Reference2014-0348
DeceasedGary Million
CoronerAndrew Tweddle
Coroner areaCounty Durham & Darlington
CategoryCommunity health care and emergency services related deaths
Sourcejudiciary.uk record · original PDF
Responses publishednone published

The report

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

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS BEING SENT TO: 

1.  Chief Executive,  
North East Ambulance Trust, Ambulance Headquarters, Berncia House, The 
Waterfront, Goldcrest Way, Newburn Riverside, Newcastle upon Tyne 
NE15 8NY 

1 

CORONER 

I am Andrew Tweddle, Senior Coroner, for the coroner area of County Durham and 
Darlington 

2 

CORONER’S LEGAL POWERS 

I 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. 
(see attached sheet) 

3 

INVESTIGATION and INQUEST 

On 29th November 2013 I commenced an investigation into the death of Gary William 
Million. The investigation concluded at the end of the inquest on 24th July 2014.. The 
conclusion of the inquest was natural causes 

4 

CIRCUMSTANCES OF THE DEATH 

Mr Gary William Million (the deceased) telephoned 111 at 23:41pm on 23rd November 
2013. The recording of the phone call shows that the deceased was not able to provide 
full and clear information about his name and location and the state of his health but not 
long into the call, the deceased went silent and for a number of minutes thereafter, whilst 
the call remained “live” there was no further response from the deceased to the call 
handler. 

The 111 system in the area in which the deceased lived is administered by the North 
East Ambulance Trust which also provides blue light emergency ambulance cover in the 
same area. 

At 23:46pm the 111 call was transferred to A&E Ambulance dispatch and was prioritised 
by the 111 call handler as an “R1 Emergency” with the expectation therefore that the 
ambulance would respond within eight minutes. At the time that the Ambulance was 
dispatched neither the Ambulance Service nor the 111 call handler had a full and clear 
address for the deceased’s location to which the ambulance crew (and a rapid response 
paramedic) would attend. 

Ambulance dispatch staff/111 staff made efforts to try and obtain an address for the 
deceased with various external agencies. 

At 00:03 hrs the control room duty manager contacted British Telecommunications and 
spoke to an operator and asked the BT staff member to disclose the patient’s address. 
Correctly describing the originating call to be on the 111 system, the control room duty 
manager’s request to BT was declined on the basis that this was not an emergency and 
not being an emergency BT was not obliged or authorised to disclose that sensitive 
information.  

Ambulance dispatch staff/111 staff made further efforts to try and find someone able to 
provide an address for the deceased without success until at 00:58hrs the control duty 
manager contacted BT for a second time and coincidentally spoke to the same call 
handler who had dealt with the original request. Upon receipt of further information given 
by the call centre duty manager, the BT call handler disclosed the address at 00:59hrs. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 At 01:00hrs the dispatch team advised the ambulance to attend an address, but gave 
the wrong address.  

At  01:10 hrs the ambulance crew attended the correct address and found the 
deceased. 

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.  Once the 111 operator had failed to obtain detailed information about the callers 
location, there was a delay of some minutes before referring the matter to the 
Ambulance Trust and for the dispatch of an ambulance.  

2.  No 111/ambulance dispatch staff knew of or had been trained about the correct 

procedure to be adopted when trying to locate a potentially seriously ill patient 
when they had incomplete information as to that persons whereabouts. In short, 
they did not know how to obtain the callers address. Despite the considerable 
and well intentioned efforts of a number of people working in the call centre, 
these individuals failed to locate the deceased’s home address and as a result 
there was an inordinate delay before the ambulance crew were able to attend 
the deceased’s property. 

3.  When the ambulance service duty manager spoke to BT, that individual did not 
fully explain the nature and reason for the enquiry with the result that the BT 
operator was not seized of all relevant information with which he could make a 
fully reasoned decision as to whether to exercise his discretion or not to release 
the deceased’s home address to the caller.  

4.  A detailed investigation that was undertaken by North East Ambulance Trust is 

upon closer examination, in places lacking depth and incisiveness. 

5.  New revised North East Ambulance Service Trust protocols which are undated, 
and which were produced to the Senior Coroner only on the morning of the 
Inquest being resumed, do not deal with the problems identified in this case 
even though they were designed to address them. 

6.  The deceased died in November 2013 and within a day or two of the death 
being reported, it was clear that the circumstances of the death highlighted 
serious potential systemic failures and yet, no substantive further advice was 
given to control room staff until February 2014.  

7.  Upon receipt from BT of an email in February 2014 in which BT endeavoured to 
address the issues raised by this death, the North East Ambulance Service 
Trust, copied the email to senior managers and other staff (though it is not 
known who exactly) to advise them of the change of procedure but other than 
merely forwarding the email the North East Ambulance Service Trust did not 
take any steps to try and ensure that this potentially life saving information was 
known by all people who were involved in the call handling process. No specific 
training on this important issue has been carried out as at the date hereof and 
none was planned. 

8.  The response to the incident by the Trust appears perfunctory and now, eight 
months after the death of the deceased, notwithstanding the changes made to 
practice and procedure by the North East Ambulance Service Trust it is clear 
that a clear and robust policy and practice to address this issue is not in place.  

6 

ACTION SHOULD BE TAKEN 

In my opinion action should be taken to prevent future deaths and I believe you and your 
organisation have the power to take such action.  

 
 
 
 
 
 
 
 
 
 7 

YOUR RESPONSE 

You are under a duty to respond to this report within 56 days of the date of this report, 
namely by 23nd September 2014 I, 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. 

8 

COPIES and PUBLICATION 

I have sent a copy of my report to the Chief Coroner and to the following Interested 
Persons  

Messrs Ward Hadaway 

British Telecom 

I 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. 

9 

29th July 2014 

…………………………………….. 

ANDREW TWEDDLE LLB 
H M SENIOR CORONER 
COUNTY DURHAM AND DARLINGTON
Also filed under 2014-0348: Million-2014-0348a.pdf
REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS BEING SENT TO: 
1.  The Department of Health  

Ministerial Correspondence and Public Enquiries Unit 
Department of Health 
Richmond House 
79 Whitehall 
London 
SW1A 2NS 

1 

CORONER 

I am Andrew Tweddle, Senior Coroner, for the coroner area of County Durham and 
Darlington 

2 

CORONER’S LEGAL POWERS 

I 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. 
(see attached sheet) 

3 

INVESTIGATION and INQUEST 

On 29th November 2013 I commenced an investigation into the death of Gary William 
Million. The investigation concluded at the end of the inquest on 24th July 2014.. The 
conclusion of the inquest was natural causes 

4 

CIRCUMSTANCES OF THE DEATH 

Mr Gary William Million (the deceased) telephoned 111 at 23:41pm on 23rd November 
2013. The recording of the phone call shows that the deceased was not able to provide 
full and clear information about his name and location and the state of his health but not 
long into the call, the deceased went silent and for a number of minutes thereafter, whilst 
the call remained “live” there was no further response from the deceased to the call 
handler. 

The 111 system in the area in which the deceased lived is administered by the North 
East Ambulance Trust which also provides blue light emergency ambulance cover in the 
same area. 

At 23:46pm the 111 call was transferred to A&E Ambulance dispatch and was prioritised 
by the 111 call handler as an “R1 Emergency” with the expectation therefore that the 
ambulance would respond within eight minutes. At the time that the Ambulance was 
dispatched neither the Ambulance Service nor the 111 call handler had a full and clear 
address for the deceased’s location to which the ambulance crew (and a rapid response 
paramedic) would attend. 

Ambulance dispatch staff/111 staff made efforts to try and obtain an address for the 
deceased with various external agencies. 

At 00:03 hrs the control room duty manager contacted British Telecommunications and 
spoke to an operator and asked the BT staff member to disclose the patient’s address. 
Correctly describing the originating call to be on the 111 system, the control room duty 
manager’s request to BT was declined on the basis that this was not an emergency and 
not being an emergency BT was not obliged or authorised to disclose that sensitive 
information.  

Ambulance dispatch staff/111 staff made further efforts to try and find someone able to 
provide an address for the deceased without success until at 00:58hrs the control duty 
manager contacted BT for a second time and coincidentally spoke to the same call 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 handler who had dealt with the original request. Upon receipt of further information given 
by the call centre duty manager, the BT call handler disclosed the address at 00:59hrs. 

At 01:00hrs the dispatch team advised the ambulance to attend an address, but gave 
the wrong address.  

At  01:10 hrs the ambulance crew attended the correct address and found the 
deceased. 

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.  The North East Ambulance Service Trust has carried out some system changes 

but more in this regard needs to be done.   

2.  BT’s evidence was that they have given further advice and information to blue 

light service providers (namely Fire, Police, Ambulance, Coastguard) but as they 
do not know of the identity of all 111 providers it is very possible that other 111 
providers may not understand the limitations of the BT service for disclosing 
data sensitive information and therefore, so that this issue can be considered 
and lessons learnt therefrom the Department of Health ought to consider 
sharing this information with all other 111 service providers throughout the 
country to reduce the risk of similar fatalities in the future. A copy of the full 
Regulation 28 report addressed to North East Ambulance Service Trust is 
attached. 

6 

ACTION SHOULD BE TAKEN 

In my opinion action should be taken to prevent future deaths and I believe your 
organisation have the power to take such action.  

7 

YOUR RESPONSE 

You are under a duty to respond to this report within 56 days of the date of this report, 
namely by 23rd September 2014. I, 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. 

8 

COPIES and PUBLICATION 

I have sent a copy of my report to the Chief Coroner and to the following Interested 
Persons  

British Telecom 
North East Ambulance Service Trust 
Ward Hadaway 

I 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. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 9 

29th July 2014 

…………………………………….. 

ANDREW TWEDDLE LLB 
H M SENIOR CORONER 
COUNTY DURHAM AND DARLINGTON

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