Prevention of Future Deaths reports · 2016

Vanessa Dadswell

Regulation 28 report to prevent future deaths, reference 2016-0060, written 17 Feb 2016. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report17 Feb 2016
Reference2016-0060
DeceasedVanessa Dadswell
CoronerSimon Wickens
Coroner areaSurrey
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Organisation namedSussex Partnership 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.

IN THE SURREY CORONER’S COURT
IN THE MATTER OF:
__________________________________________________________
The Inquests Touching the Death of Vanessa Christine DADSWELL
A Regulation 28 Report – Action to Prevent Future Deaths
__________________________________________________________
THIS REPORT IS BEING SENT TO:
 Mental Health Commissioners, West Sussex County Council.
 Colm Donaghy– Chief Executive, Sussex Partnership NHS
Foundation Trust.
1 CORONER
Simon Wickens HM Area Coroner for Surrey
2 CORONER’S LEGAL POWERS
I make this report under paragraph 7(1) of Schedule 5 to The Coroners
and Justice Act 2009.
3 INVESTIGATION and INQUEST
The inquest into the death of Vanessa Christine Dadswell was opened
on the 13th April 2015 and was resumed on the 8th February 2016.
The cause of death was found to be:
1a – Multiple injuries.
A short form conclusion of ‘suicide’ was returned.
4 CIRCUMSTANCES OF THE DEATH
On the afternoon of the 2nd April 2015, Mrs Vanessa Dadswell attended
Whitley Railway Station whereupon she placed herself in the path of an
oncoming train and died of injuries sustained. She had been referred by
her GP via the urgent referral scheme to the Mental Health Services on
the 30th March 2015. Her GP requested a 24 hours referral. The options
made available were a 4 hour or within 5 day referral. The GP indicated a
4 hour referral was not necessary but she should be seen ideally with 24
hours. Mrs Dadswell had not been seen by Mental Health Services before
her death on the 2nd April 2015. However a direct causal link between the
missed opportunity of an assessment and her death could not be
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established upon the evidence.
5 CORONER’S CONCERNS
During the course of the inquest the evidence revealed that any urgent
referral by a GP would be categorised by West Sussex Community
Mental Health as either as a ‘4 hour’ referral or a ‘within 5 day’ referral.
A ‘4 hour’ referral would involve the service user having to attend A&E
urgently for an assessment within 4 hours. A ‘within 5 day referral’ was
exactly as described, an appointment within 5 days. The issue arose
where a referring GP did not consider it necessary nor appropriate for a 4
hour referral and yet believed a 24 hour visit was necessary as 5 days
would be too long. The deceased was not seen within 24 hours and
committed suicide 3 days after the referral with no direct contact having
been made. Evidence given by the Service manager for the Trust agreed
that an intermediate option for referral would not be unreasonable.
The MATTER OF CONCERN is:
Consideration should be given to an alternative, intermediate
referral time between the current ‘4 hour’ and ‘within 5 day’
periods for referrals together with effective management thereof.
6 ACTION SHOULD BE TAKEN
In my opinion action should be taken to prevent future deaths and I
believe that the people listed in paragraph one above have the power to
take such action.
7 YOUR RESPONSE
You are under a duty to respond to this report within 56 days of its date; I
may extend that period on request.
Your response must contain details of action taken or proposed to be
taken, setting out the timetable for such action. Otherwise you must
explain why no action is proposed.
8 COPIES
I have sent a copy of this report to the following:
1. Interested Persons ‐
a
b
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c
d Sussex Partnership NHS Foundation Trust
2. The Chief Coroner
Signed:
Simon Wickens
DATED this 17th February 2016
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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 Respondent Not Named (PDF)
A member of: Sussex Partnership INE

Association of UK University Hospitals NHS Foundation Trust
Our Ref: CD/cda Swandean
wa

. Arundel Road

15 April 2016 Worthing
West Sussex

Mr Simon Wickens BN13 3EP
HM Area Coroner for Surrey Tel: 03003040673
HM Coroner's Court
Woking
Surrey
GU22 7AP
Dear Sir

Re: The inquest touching the death of Vanessa Dadswell

Thank you for your letter and report of 17 February 2016, written pursuant Paragraph 7 (1) of
Schedule 5 to the Coroners & Justice Act 2009, and for highlighting your concerns.

Firstly, may | offer my sincere condolences to Mr Dadswell. | hope this letter will assure you, and
Mr Dadswell, that the matters you have raised have been taken seriously and improvements in
Sussex Partnership have been made to enhance the service we provide to service users and their
families.

As you heard at the inquest, historically, urgent General Practitioner referrals into West Sussex
triage were taken by the triage worker and passed to the Assessment & Treatment team to action.
The options available were to be seen within 4 hours or within 5 working days. The system has
since been reviewed and improved to allow greater flexibility. The system improvements are as
follows:

e Triage Team Leaders now have direct bookable Priority Appointment slots and do not need to
pass priority referrals to the Assessment & Treatment Duty Worker for booking.

e There is senior staff oversight of the new system whereby the Triage Team Leader takes
ownership and makes contact with the General Practitioner and service user throughout the
process. The Team Leader prioritises the incoming work on a daily basis and supports the triage
workers.

e Every morning the Triage Team Leader assesses all incoming referrals received out of hours
and, if the referrer has requested the service user to be seen within 24 hours but did not consider a
4 hour response was clinically required, appointments within 24 hours are arranged.

e Referrals can be fast track allocated by the Triage Team Leader so they do not wait up to 5 days
for a slot; they are given the first available appointment, dependent on assessment of risk, often
within 2-3 days.

e lf the member of staff taking the referral out of hours has any concerns about the referral or
appointment needs, they now immediately escalate the referral to the on call manager.

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 Schoo!

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e More home visits are now offered where clinically indicated (as in Mrs Dadswell’s case).

_ e All referrals and referral decisions, including the rationale behind the decision, are documented
on our new electronic records system, CareNotes, which all clinical staff Trust wide have access

to.

In addition, we are recruiting a full time band 7 member of staff to provide cover to the Team
Leaders in times of absence to ensure the system is robust and not reliant on any one individual.

Penny Fenton, General Manager Coastal West Sussex Care Delivery Service (CDS), Nadia
Anderson, Service Manager Western, Working Age Mental Health Services, Coastal West Sussex
Care Delivery Service (CDS) and Liam Rudden, Service Manager for Adur, Arun & Worthing
Assessment and Treatment Service are currently drafting a protocol encompassing the improved
system throughout Coastal West Sussex CDS. The checklist and flowchart developed and
exhibited at the inquest will be appended so there is a clear user friendly guide for staff. Dr Brian
Solts, Divisional Clinical Director — Coastal West Sussex Care Delivery Service (CDS) has
confirmed he will present the protocol, together with the learning from Mrs Dadswell’s inquest, to
the Adult Management Board to maximize learning and embed the improvements introduced.

The Service Specification for the Urgent Care Pathway detailing the 4 hour and 5 day referral
options was developed in partnership with our West Sussex Commissioners and is due for
renewal. Dr Solts has requested a meeting to be arranged with the West Sussex Mental Health
commissioners to review the pathway jointly with us, in light of the improvements we have made,
and the greater flexibility we have introduced, so it reflects current practice.

Furthermore, Dr Soits is hosting a % day Report and Learn Forum for Coastal West Sussex CDS
which will identify learning from incidents and inquests and he will share the learning
(anonymously) from Mrs Dadswell’s inquest so CDS staff can reflect and take forward the lessons

learned.

As a Trust we are committed to learning and improving safety. Lessons from Mrs Dadswell’s
inquest were shared (anonymously) through the Trust’s monthly Report and Learn Bulletin and via
the Trust's Quarterly Quality and Safety Report, both are distributed throughout the Trust and

externally with our Clinical Commissioning Groups.

The Trust has no objections to this letter being shared or published by the Chief Coroner.

Yours faithfully

olm Donaghy
Chief Executive

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