Prevention of Future Deaths reports · 2015

Tamara Holboll

Regulation 28 report to prevent future deaths, reference 2015-0171, written 27 Apr 2015. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report27 Apr 2015
Reference2015-0171
DeceasedTamara Holboll
CoronerMary Hassell
Coroner areaInner North London
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Organisation namedCamden and Islington NHS Foundation Trust
Sourcejudiciary.uk record · original PDF
Responses published1

The report

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

Regulation 28:  Prevention of Future Deaths report 

Tamara HOLBOLL (died 09.05.14) 

THIS REPORT IS BEING SENT TO: 

1.  Ms Wendy Wallace 
Chief Executive 
Camden & Islington NHS Foundation Trust 
4th Floor, East Wing 
St Pancras Hospital  
4 St Pancras Way 
London  NW1 0PE 

1 

CORONER 

I am:   Coroner ME Hassell 
           Senior Coroner  
           Inner North London 
           St Pancras Coroner’s Court 
           Camley Street 
           London  N1C 4PP 

2 

CORONER’S LEGAL POWERS 

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

3 

INVESTIGATION and INQUEST 

On  10  May  2014,  one  of  my  assistant  coroners,  William  Dolman, 
commenced  an  investigation  into  the  death  of  Tamara  Holboll,  aged  47 
years.  The  investigation  concluded  at  the  end  of  the  inquest  on  20  April 
2015.  I made a narrative determination, which I attach to this letter. 

4 

CIRCUMSTANCES OF THE DEATH 

Tamara Holboll died from stab wounds to the neck and chest.  Her son, 
,  pleaded  guilty  to  her  manslaughter  on  the  ground  of 
diminished responsibility.  He has been detained in a secure hospital for 
an unlimited period. 

1 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Two  days  before  her  death,  the  Holbolls  uncharacteristically  sought 
hospital  admission  from  Camden  &  Islington  NHS  Trust,  because  they 
feared that 
would harm his mother.  As you can see from the 
narrative attached, that admission was never effected. 

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.  

I heard evidence at inquest of a great many changes being implemented 
by  Camden  &  Islington  since  Ms  Holboll’s  death,  and  I  have  a  copy  of 
your 17 point action plan. 

I shall not rehearse those matters now, but I want simply to re-iterate the 
overarching  point  that  I  discussed  with  your  clinical  director  of  acute 
services.   

It  seemed  to  me  from  the  evidence  I  heard  that,  when  a  need  for  good 
communication  (for  example  between  clinician  and  bed  manager)  has 
been  identified,  there  has  been  a  lack  of  precision  in  your  trust  about 
exactly what that means and how it needs to be actioned.   

Rather than simply talking about the need for better communication, it  is 
necessary  to  identify  that  information  A  must  be  delivered  on  every 
occasion, by person B, at time C, and using method D.  Without this level 
of  detail,  staff  are  left  with  a  vague  concept  and  the  communication  is 
unlikely to achieve the desired result. 

I  appreciate  that  this  does  not  give  you  much  in  the  way  of  specifics  to 
work on, but your organisation has already identified these.  What I hope 
to do is to share with you what I perceive to be a recurring theme in your 
organisation, that has been particularly highlighted by Ms Holboll’s death. 

6 

ACTION SHOULD BE TAKEN 

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

2 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 7 

YOUR RESPONSE 

You are under a duty to respond to this report within 56 days of the date 
of  this  report,  namely  by  26  June  2015.    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 following. 

  HHJ Peter Thornton QC, the Chief Coroner of England & Wales 

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

it  useful  or  of 

find 

9 

DATE                                                   SIGNED BY SENIOR CORONER 

27.04.15 

3

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 Camden and Islington NHS Trust (PDF)
Camden and Islington

NHS Foundation Trust

Executive office

4" Floor, East Wing
St Pancras Hospital
4 St Pancras Way
London NW1 OPE
Tel: 020 3317 7016
Fax: 020 7561 4461
www.candi.nhs.uk

26" June 2015
Coroner ME Hassell
Senior Coroner
Inner North London
St Pancras Coroner’s Court
Camley Street
London N1iC 4PP

Dear Ms Hassell

Re: Regulation 28 Prevention of Future Deaths report — Tamara Holboll (date of inquest 20
April 2015)

| write in response to the Regulation 28 Prevention of Future Deaths report sent by you on
27 April 2015. You raised in your letter a concern about the lack of precision in our trust with
respect to recommendations arising from Serious Incidents investigations on the need for
good communication. Thank you for your very helpful comment and example of the clear
format for the wording of actions to address the need for better communication. We have
considered your recommendation carefully and we agree with you that we should improve
the way we formulate our actions to ensure they achieve the desired result. We have an
ongoing plan in place to review and improve our Serious Incidents processes; we are
committed in particular to improving our ability to learn from incidents.

Before | explain what actions we have taken to improve on this, it may be helpful to set out
briefly the process of preparing and reviewing action plans arising from serious incident
investigations. Serious incident investigations are usually allocated to an appropriately
trained senior manager (Lead Investigator) from a Division other than the one where the
incident occurred (the purpose of this is to achieve a level of objectivity); they are supported
by a Clinical Expert from the Division where the incident occurred; this person is a specialist

cont...
Chair: Leisha Fullick Your partner in
Chief Executive: Wendy Wallace care & improvement
P29 C&l is an NHS Foundation Trust providing treatment and social care for mental ill-health
FCamden ISLINGTON ™ nd substance misuse in adults in partnership with Camden and llington councils,

NHS

in the clinical area relevant for the investigation, but have not had direct involvement with
the service user involved in the incident. The Lead Investigator and Clinical Expert prepare a
report with recommendations following from their findings. Each serious incident
investigation has an allocated Action Plan Manager, who is a senior manager in the Division
where the incident occurred. The Action Plan Manager assists the investigators with
preparing the action plan to ensure that the actions are in line with the workings of the
service or appropriate to the Division. The Action Plan Manager also is also responsible for
ensuring that the action plan is implemented. The action plan template is designed to
prompt the author to allocate a responsible person for each action, a deadline for
completion of each action and what evidence is required to confirm that the action has been
completed (for example, if a policy needs revising the evidence will be a revised policy).
Draft reports with action plan are reviewed by the Clinical Governance team, who may work
further with the authors to ensure that the report and action plan comply with the Trust
guidance included in the Serious Incident Investigation template. Finally, the report with
action plan is approved and signed off by Executive Directors.

The trust has taken the following actions to address the issue you have raised in your letter;
some of these actions were started shortly before the inquest as part of our ongoing
improvement plan for learning from serious incidents:

1. We have amended the action plan template and revised our guidance to authors writing
recommendations and action plans.

a) We have added an action row in the action plan table to prompt the authors to write
an action arising from each respective recommendation. We find that
recommendations are usually drafted in rather general and less concrete language,
the prompt to produce and action based on the recommendations helps to remind
the authors that specific, concrete action is required.

Previous action plan template from former guidance:

RECOMMENDATION AND) TIMESCALE EVIDENCE REQUIRED

cont...

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