Prevention of Future Deaths reports · 2015

Alice Mead

Regulation 28 report to prevent future deaths, reference 2015-0239, written 24 Jun 2015. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report24 Jun 2015
Reference2015-0239
DeceasedAlice Mead
CoronerVeronica Hamilton-Deeley
Coroner areaBrighton and Hove
CategorySuicide (from 2015)
Organisation namedSussex Partnership NHS Foundation Trust
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.

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VERONICA HAMILTON-DEELEY, LL.B.
Her Majesty’s Senior Coroner

THE CORONER’S OFFICE
WOODVALE, LEWES ROAD

for the City of Brighton & Hove BRIGHTON
BN2 3QB
Assistant Coroners (s (a s Telephone: Brighton (01273) 292046

Fax: Brighton (01273) 292047

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:

1. Mr. Colm Donaghy, Chief Executive, Sussex Partnership NHS
Foundation Trust

2. EE | egal Support Manager, Sussex Parternship NHS
Foundation Trust

CORONER
| am Veronica HAMILTON-DEELEY, Senior Coroner, for the City of Brighton and
Hove
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 26" May 2015 | commenced an investigation into the death of Alice MEAD. The
investigation concluded at the end of the inquest on26th May 2015. The conclusion
of the inquest was SHE TOOK HER OWN LIFE
4

CIRCUMSTANCES OF THE DEATH

See Record of Inquest (attached)

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

THE CORONER’S OFFICE
WOODVALE, LEWES ROAD
BRIGHTON

BN2 3QB

Assistant Coroners

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

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.

Alice was known to the Mental Health Services, both as an inpatient and as needing
care from community services. She was looked after using the Care Programme

Approach. |

Three serious failings in her care were identified at her Inquest. It was not possible
to say that they were directly contributory to her death at the time (i.e. on the 20"
January 2015) but, they have raised sufficient concern with me.

The MATTERS OF CONCERN are as follows

(1) When her Care Co-ordinator left the Trust she was not. replaced so Alice was
left without one of the corner stones of the Care Programme Approach.
Although later a Multi-Disciplinary Team meeting decided she should have a
Care Co-ordinator, no action was taken to appoint one.

(2) In spite of Alice calling the Brighton Urgent Response Service twice in
December 2014. asking for a medication review and explaining she was not
taking her mental health medications, no action was taken to keep her informed
of discussions within the Mental Health Service. In particular her request for a
medical review was discussed with her Consultant Psychiatrist and he
apparently took the view that it was not necessary (poorly documented). Since
there was no discussion with Alice, from her point of view, there was a lacuna in
her care at a time when she was especially vulnerable, which lasted for several
weeks.

(3) Action, if it can be described as action, was only taken when Alice’s young son's
Heath Visitor wrote of her urgent concerns about Alice in good detailed e-mails
sent to Alice's GP and to the Community Mental Health Team on the evening of
the 15" January. It was clear that the Mental Health Team should react. Their |
response was to phone Alice on the 16'" and make an appointment to see her
on the 28" January.

This “hands off’ approach to a known vulnerable patient is unacceptable. The
patient should be at the heart of Care Programme Approach care (indeed any
care).

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

THE CORONER’S OFFICE
WOODVALE, LEWES ROAD
BRIGHTON

BN2 3QB

Assistant Coroners Telephone: Brighton (01273) 292046

Fax: Brighton (01273) 292047

(4) There was no evidence that Alice’s risk assessment was reviewed and updated
during December 2014 or January 2015. If it was, such reviews should have
been documented in accordance with the Care Programme Approach. They
were not

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.

YOUR RESPONSE

You are under a duty to respond to this report within 56 days of the date of this
report, namely by 11" September 2015. |, 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

hz!
. Secretary of State for Health, Department of Health

— Chief Executive NHS England
ational Patient Safety Agency

- ER Health visitor

| have also sent it to:-

1. RE oirector of Public Health, Brighton & Hove Clinical
Commissioning Group
2. ees of Clinical Quality and Primary Care, Brighton &
ove Clinical Commissioning Group

Who may find it useful or of interest.

OrhRwn-a

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

THE CORONER'S OFFICE
WOODVALE, LEWES ROAD
BRIGHTON

BN2 30B

Assistant Coroners 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.

Date: 24" June 2015 SIGNED BY:

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 Partneraship NHS Trust (PDF)
A member of: Sussex Partnership

Association of UK University Hospitals NHS Foundation Trust
Our Ref: CD/cda D |
25 August 2015 |
i Swandean
Miss Veronica Hamilton-Deeley LLB i Aun orneg

Her Majesty’s Senior Coroner for the bow 2 on West Sussex
City of Brighton & Hove BN13 3EP
The Coroner's Office

Woodvale, Lewes Road Tel: 01803 843033

Dear Miss Hamilton-Deeley

Re: The Late Alice Mead

Thank you for your report of 24 June 2015, written pursuant to the Coroners & Justice Act 2009
and regulations 28 and 29 of the Coroners (Investigations) Regulations 2013, and for highlighting
the matters giving rise to concern.

Our thoughts are with Ms Mead’s family and friends and we would like to reiterate our condolences
on their tragic loss. Following Ms Mead’s death, a serious incident investigation was conducted
and following the inquest, John Child, Service Director - Brighton & Hove, convened a meeting with
both managerial and clinical colleagues in his service who were directly involved in Ms Mead’s
care, to discuss the learning and actions arising. This letter summarises the learning and | hope it
provides assurance that the matters you have raised have been taken seriously and improvements
in Sussex Partnership have been made to continually improve the care we provide to our service
users and their families.

As you say, a care coordinator was not allocated to Ms Mead when her previous care coordinator
left the Trust. At that time, Ms Mead’s case was reviewed, and the decision was made not to
allocate a new care coordinator. [J General Manager, Community Services Brighton &
Hove, has confirmed the introduction of an improved system; where, all care coordinators’
caseloads are reviewed with a Consultant Psychiatrist and Team Leader. Particular focus is
applied to caseload reviews when a care coordinator is leaving and the decisions and outcomes
are documented by the reviewing team on the electronic health record clinical information system.
Service users will-be allocated a lead practitioner or care coordinator, based on their clinical need
and are not reliant on calling the duty team. There is a rolling programme of case load reviews for
all clinical community staff and the review team consists of a Consultant Psychiatrist, the team
leader and clinical supervisor as a minimum.

The Care Programme Approach (CPA) is in the process of being reviewed across the Trust. This
work is being led Director of Occupational Therapy and Recovery Practice. We
have a newly constituted CPA steering group, with cross care group representation and we are
agreeing the new processes in preparation for the roll out of Carenotes (the new electronic records
system). A new CPA policy has been drafted and we hope to launch it in September 2015. When
the new CPA policy is launched there will be full staff training in place. Information leaflets and
short films will be available and all information will be available on the Trust's intranet. The training
will be co-produced with service users and peer trainers to ensure a holistic approach. We are also
developing .practice guidance to help staff to think about how to plan care more sensitively in
consultation with the service user. This work is quality focussed and will provide greater clarity for
staff and their roles within CPA.

Chair: Caroline Armitage Chief Executive: Colm Donaghy
Trust Headquarters: Sussex Partnership NHS Foundation Trust, Swandean, Arundel Road, Worthing, West Sussex, BN13 3EP
www.sussexpartnership.nhs.uk

A Teaching Trust of Brighton and Sussex Medical School

In relation to the calls Ms Mead made and communication with staff, Brighton Urgent Response
Service, now Mental Health Rapid Response Service (MHRRS), and the Assessment and
Treatment Service (ATS) Duty Team are now co-located in the same working space. They have
agreed a protocol for information sharing. This allows for improved communication between the
teams and for vital information on service users to be shared with staff and fed back to service
users. There is a communication book in place and a whiteboard to keep key pieces of information
and service user contacts prominent within the team. In addition, to aid improved communication,
there is now a Duty Lead working every day. The Duty Lead working that day prioritises the
incoming work and supports the decisions made by the call takers. They review and update the
communication book and whiteboard. The Team Leaders go in to provide extra support and they
have reiterated to their staff the importance of good communication and documeniation. Within the
local leadership team it has been agreed to form three clusters that will cover a set group of GP
surgeries. Once fully established this will allow the team to work more closely together and provide
each with greater support.

Staff in the East ATS and MHRRS, responsible for assessing service users’ risk, have undergone
bespoke Applied Suicide Intervention Skills Training (ASIST). This internationally renowned
training was delivered in June 2015 by Grassroots, Suicide Prevention charity. To ensure risk
assessments are up to date we have developed a new East ATS caseload spread sheet to capture
tisk assessment dates; supervisors will monitor this frequently, audit compliance, and escalate to
the Team Leaders if action is required.

Following Ms Mead’s inquest, a new approach to calls is underway in East ATS. If a service user
calls 3 times in a 2 week period in need of mental health input, they will be seen face to face. The
only exceptions will be in circumstances when the case is reviewed by a senior member of the
team and a face to face appointment is not deemed in the best interests of the service user or
appropriate; in these cases a detailed record will be kept documeniing the decision rationale.

There are local monthly leadership meetings, chaired by Fiona Blair, ATS Service Manager,
Brighton & Hove Locality. Fiona has shared the learning from Ms Mead’s inquest (anonymously) at
the Leadership Meeting.

As a Trust we are committed to learning and improving patient safety. Lessons from Ms Mead’s
experience were shared through the Trust's Report and Learn Bulletin and via the Trust’s Quality
and Safety Report, distributed throughout the Trust and with the CCGs.

Thank you again for your report. The Trust has no objections to this letter being shared or
published by the Chief Coroner.

Yours sincerely

Colm Donaghy
Chief Executive

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