Prevention of Future Deaths reports · 2014

Paul Hyde

Regulation 28 report to prevent future deaths, reference 2014-0527, written 5 Dec 2014. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report5 Dec 2014
Reference2014-0527
DeceasedPaul Hyde
CoronerVeronica Hamilton-Deeley
Coroner areaBrighton & Hove
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.

VERONICA HAMILTON-DEELEY, LL.B.
Her Majesty’s Senior Coroner
for the City of Brighton & Hove

Assistant Coroners
CATHARINE PALMER LL.B (HONS)
MICHAEL KEEN

THE CORONER’S OFFICE
WOODVALE, LEWES ROAD

BRIGHTON
BN2 3B

BE YAS
é i Telephone: Brighton (01273) 292046

Fax: Brighton (01273) 292047

KAREN HENDERSON, BSC,BM,MRCPI,FRCA

GILVA D.J.TISSHAW, BA(LAW)HONS

CORONERS SOCIETY OF ENGLAND AND WALES

ANNEX A
REGULATION 28: REPORT TO PREVENT FUTURE DEATHS (1)

NOTE: This form is to be used after an inquest.

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS
THIS REPORT IS BEING SENT TO:
. Chief Executive, Sussex Partnership Trust

1
2. BE — Chair Community Governance
3. Service Director, Brighton & Hove City Council

CORONER

1am Veronica HAMILTON-DEELEY, Senior Coroner, for the City of Brighton and Hove

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.

INVESTIGATION and INQUEST

On 4" August 2014 | commenced an investigation into the death of Paul Leslie HYDE. The
investigation concluded at the end of the inquest on 12" November 2014.The conclusion of the
inquest was MISADVENTURE

CIRCUMSTANCES OF THE DEATH
See Record of Inquest

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) On the 14" April 2014, GP Dr. Peter Deviin having anxieties expressed to him by one of the
Community Mental Health Workers concerning Paul Hyde's deteriorating condition, sought
advice from the Assessment and Treatment Team of the Community Mental Health Services.
He spoke to Graham Walton who advised him that he should refer Mr. Hyde back to ATS
(Assessment and Treatment Service). He therefore wrote a letter on the 15” July, 2014 and this

VERONICA HAMILTON-DEELEY, LL.B. THE CORONER’S OFFICE

Her Majesty’s Senior Coroner WOODVALE, LEWES ROAD
for the City of Brighton & Hove BRIGHTON
BN2 3QB

Telephone: Brighton (01273) 292046
Fax: Brighton (01273) 292047

Assistant Coroners .
CATHARINE PALMER LL.B (HONS)
MICHAEL KEEN

KAREN HENDERSON, BSC,BM,MRCPI,FRCA
GILVA D.J.TISSHAW, BA(LAW)HONS

was sent so that it arrived on the same day, expressing his anxiety.

The request was for Mr. Hyde to see a Psychiatrist to carry out a medication review.. It is clear
that this Medication Review needs to be carried out by the Psychiatrist in a face-to-face review
with the patient.

The referral was not appropriately addressed until some 14 days in to the 28-day period within
which the patient is required either to have been seen by ATS or the Psychiatrist or the GP. It
was decided, though very poorly documented that the Psychiatrist should phone the GP to see
whether, after discussion, it was possible for the GP to prescribe a new medication for Mr. Hyde.

(2

~
YL

It should have been obvious from the start that this was not a direction for this referral to take.

There seems to be no facility for the Psychiatrist to be involved in the assessment procedure and
indicate a course him or herself. There should be.

In any event, no contact was made with the GP and there is apparently no follow up system so
no one seems to have picked up that not only was Mr. Hyde not seen within the 28-days of
referral, but in fact that he was not seen at all i.e. he was lost to follow up.

(4) From the point of view of Mr. Hyde, the re-referral system was not fit for purpose.
In the event, Mr. Hyde took an overdose of the medication which had been stopped, although he

still had some tablets, and the very sedatory effect that he had complained about kicked in, resulting
in his death.

6 ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and | 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 (5"
December 2014), namely by 24" February 2015. |, Veronica Hamilton-Deeley, 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
| have sent a copy of my report to the Chief Coroner and to the following Interested Persons

1. Clinical Commissioning Group
. (Mother)
3. NEE (Father)
4. Secretary of State for Health, Department of Health
§. Sir David Nicholson/Simon Stevens — Chief Executive NHS England
6. National Patient Safety Agency

THE CORONER’S OFFICE
WOODVALE, LEWES ROAD
BRIGHTON

BN2 3QB

+ VERONICA HAMILTON-DEELEY, LL.B.
Her Majesty’s Senior Coroner
for the City of Brighton & Hove

Assistant Coroners

CATHARINE PALMER LL.B (HONS)
MICHAEL KEEN

KAREN HENDERSON, BSC,BM,MRCPI,FRCA
GILVA D.J.TISSHAW, BA(LA W)HONS

Telephone: Brighton (01273) 292046
Fax: Brighton (01273) 292047

| 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 Date: 5" December 2014 SIGNED BY:
Veronica HAMILTON-DEELEY a

Senior Coroner Brighton and Hove

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 Sussex Partnership NHS (PDF)
A teaching trust of Brighton Sussex Pa rtnership
and Sussex Medical School NHS Foundation Trust

Swandean

Arundel Road

10 February 2015 Worthing
. : : ] West Sussex

Miss Veronica Hamilton-Deeley LLB j re BN13 3EP

Her Majesty's Senior Coroner for the City of
Brighton & Hove .
The Coroner's Office

Woodvale

Lewes Road

Brighton

BN2 3QB

Dear Miss Hamilton-Deeley
Re: The late Paul Leslie Hyde

Thank you for your letter of 2 December 2014, your report written pursuant to the Coroners
& Justice Act 2009 and regulation 28 of the Coroners (Investigations) Regulations 2013, and
for drawing your concerns to my attention. | was very sorry to read your concerns in relation
to the sad death of Mr Hyde. Firstly, | wish to offer our condolences to Mr Hyde's family.

amar ae: myself have taken the matters you have raised extremely
Seriously, and seek to reassure you that work has been undertaken, and is on-going, to
improve practice in Sussex Partnership NHS Foundation Trust. This letter is a joint
response from all recipients. The letter was directed to the City Council and although mental

health services in Brighton and Hove are integrated with the Council there was no specific
role identified for Adult Social Care & Health in Mr Hyde’s care.

Your concerns relate to the Assessment and Treatment Service (ATS) clinical triage service.
West Assessment and Treatment Service Team Manager confirmed that
ere was a four day delay in the triage administrators sending Mr Hyde's GP re referral to
the West Hove Assessment and Treatment Service.

Service Director for Brighton & Hove has confirmed that he is in discussions with
the CCG and there is in place a joint Performance Improvement Plan in relation to the 4
Week Wait for routine referrals into the Assessment & Treatment Service. Actions include, a
review of the administration triage processes to address triage waiting times. This
recognised the need for an additional administrator in Triage and | am pleased to say
recruitment to this post has been completed. A further action was a review of the triage
function/process to include increased involvement from Consultant Psychiatrists and
additional members of ATS. All clinical triage meetings have a Consultant Psychiatrist, lead
nurse, and administrator present. Following Mr Hyde’s noves Associate
Specialist has been invited to attend the triage meetings on a regular basis.

The use of the Breach Tool has been extended and the system is now more robust. Medical
Personal Assistants now complete this for all referrals, regardless of the triage decision.
Team leads have oversight of the tool and it is a ‘live’ record of all pending contacts, whether
by telephone or face to face with service users. All actions / outcomes from the clinical
triage meetings are now recorded on the Breach Tool and these are closely monitored. The
Breach Tool guidance has been reviewed and staff have received clear instruction on how to
use the tool.

Chief Executive: Colm Donaghy

Chair: John BaconCB
Head office: Sussex Partnership NHS Foundation Trust, Swandean, Arundel Road, Worthing, West Sussex, BN13 3EP

www.sussexpartnership.nhs.uk

In his evidence to you I sic that an appointment with himself would have
been appropriate for Mr Hyde. You were understandably very concerned about this, as |
was, and our shared concerns have been thoroughly addressed within the Trust. To reduce

the likelihood of a similar occurrence in the future, the following improvements to the service
have taken place in order to ensure all triage decisions are appropriate and clinically led:

A meeting with the CCG Clinical Lead, Sussex Partnership Clinical Lead for Community
Services and Sussex Partnership Managers was held to review the ATS data to ensure all
actions relating to referral management are clinically led and appropriate. In addition,

Service Manager for the Assessment & Treatment Service for Brighton & Hove has
agreed to undertake a quarterly audit of the triage outcome decisions, with an independent
senior clinician, to ensure our triage decisions are appropriate. We continue to discuss and
review our performance against key performance indicators with commissioners ona
monthly basis and maintain an updated action plan to ensure this remains a continual focus
for quality improvement.

We are always striving to improve the interface between primary care and secondary mental
health services. In order to improve relationships between GPs and Consultant
Psychiatrists, GPs have been allocated named Consultant Psychiatrists. Meetings between
the psychiatrists and GPs have been arranged. [Eis leading on this to ensure both
GPs and psychiatrists are clear on their roles and the expectations of referrals. Work is on-
going to ensure there is a joined-up approach for our service users and their families and
there is continual learning and improvement. Mr Hyde’s experience has been shared
(anonymously) with staff to drive home the lessons to be learned. In addition, to ensure
widespread learning, feedback from the case has been given t Director of
Nursing Standards and Safety. This has guaranteed the issues are hign profile and
education and understanding is widespread.

Furthermore, in order to educate all staff, lessons learned from Mr Hyde’s experience have
been included (anonymously) in the Trust’s Quarterly Quality & Patient Safety Report.

As you highlighted, we will never know if the outcome would have been different if Mr Hyde
had been seen by | prior to his sad death, however, we can reassure you that
systems have been reviewed and improved and staff have carefully reflected on what
happened.

Thank you once again for raising your concerns. | hope the actions outlined in this response
demonstrate how important these issues are to the Trust, and how seriously we have taken
the matters highlighted at Mr Hyde’s inquest. | feel sure that future service users will benefit
from the lessons we have all learned following Mr Hyde’s death and | hope Mr Hyde’s family
can take some comfort in knowing this.

Yours sincerely

olm Donaghy
Chief Executive

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