Prevention of Future Deaths reports · 2016

Luke Ayres

Regulation 28 report to prevent future deaths, reference 2016-0148, written 15 Apr 2016. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report15 Apr 2016
Reference2016-0148
DeceasedLuke Ayres
CoronerEmma Brown
Coroner areaBirmingham and Solihull
CategorySuicide (from 2015) · Mental Health related deaths · State Custody related deaths
Organisation namedBirmingham and Solihull Mental Health 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.

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO: Birmingham and Solihull Mental Health NHS Foundation Trust

CORONER

| am Emma Brown Area Coroner for Birmingham and Solihull

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 08/10/2015 | commenced an investigation into the death of Luke Christie AYRES. The investigation
concluded at the end of the inquest . The conclusion of the inquest was: “Luke was found unresponsive
in his room around 7pm on 27 September 2015 with a ligature around his neck. Resuscitation was
attempted but Luke could not be resuscitated.”

The medical cause of Luke’s death was:
1(a) SUSPENSION BY A LIGATURE AROUND THE NECK

CIRCUMSTANCES OF THE DEATH

Luke was 24 years old when he died on the 27" September 2015 at the time of his death he was serving a
custodial sentence as an inpatient at Raeside Clinic under section 45(a) of the Mental Health Act. Luke
was on the intensive care ward, ward Severn, on the 27" September 2015. At approaching about 18.55 a
HCA noticed that Luke had covered his observation window in his bedroom door, this sparked a series of
events that Jed to his door having to be opened with the anti-barricade system at about 19:00 when Luke
was found hanging by a ligature made of a piece of cord placed over the top of the bedroom door. CPR
was commenced and an ambulance crew arrived at Luke’s side at about 19.09 but Luke could not be
resuscitated. The case gave rise to issues surrounding the risk assessment of Luke, the operation of the
anti-barricade system and the actions of staff from the point when they realised they couldn’t get into
Luke’s room onwards.

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 999 calf to the ambulance service made by Raeside reception after the issuing of a 2222
medical emergency call was cut off when they attempted to transfer the Ambulance Service to
Ward Severn, The Ambulance Service therefore had to get the number from the operator and
called back a minute later. When they were put through to the Ward the person they were
speaking with was not at Luke’s side and did not know his current status because she was in an
office some distance away from him and the staff with him. There is no evidence that this
actually had an impact on Luke’s death but there are risks for the future arising from the fact
that: - .

a) the Ward staff do not call 999 themselves necessitating a delay and a risk of the call being
cut off when the call is transferred to the Ward; and

b) the person providing information to the Ambulance Service may not know the patient's
current status and could therefore give incorrect information.
2. The evidence was that when the Paramedics arrived in reception no-one was present to escort
them to the Ward and only once they had arrived did a member of staff go to meet them. This is
a source of obvious and dangerous delay.

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and | believe you 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
15 June 2016. 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.

COPIES and PUBLICATION

! have sent a copy of my report to the Chief Coroner and to the following Interested Persons: the parents
of Luke Ayres and their legal representatives.

|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.

15/04/2016

Signature
Emma Brown ‘Coroner Birmingham and Solihull

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 Birmingham and Solihull NHS Trust (PDF)
©) Birmingham and Solihull
~ Mental Health NHS Foundation Trust
Chair & Chief Executive’s Office
Unit 1, B1
50 Summer Hill Road
Ladywood
Birmingham B1 3RB
Tel: 0121 301 1319
Fax: 0121 301 1301

Mrs Emma Brown

HM Coroner, Coroners Court
Birmingham and Solihull Areas
50 Newton Street

Birmingham

B4 6NE

1 June 2016 [ RECEIV ED |

Dear Mrs Brown, |
REGULATION 28: REPORT TO PREVENT FUTURE DEATHS

| write in response to the Prevention of Future Deaths report that was issued following the
inquest into the death of Luke Ayres with assurance of the action that we are taking in
relation to your concerns.

Luke Ayres sadly died when he was an inpatient on Severn Ward, Reaside Clinic on 27
September 2015. Luke was found kneeling on the floor with a ligature around his neck at
approximately 7pm that evening and despite attempts by staff and paramedics, he was
unable to be resuscitated.

There are a range of improvement measures that we have put in place as a result of the
death of Luke as part of our serious incident investigation. These include:-
e Implementation of a single anti barricade system on Severn Ward
e Funding allocation to enable the whole of Reaside Clinic to operate a single anti
barricade system ‘the Kingsway system’. Works have already commenced in this
regard and will complete at the end of September 2016. The Kingsway system will
also be operating on Severn Ward at this stage
e Replacement of 70 observation panels at Reaside Clinic
e Piloting of a new clinical handover tool — the WHAT tool on Severn Ward. Initial
evaluation has proved positive and we are now seeking to roll out this approach to
documented longitudinal and cross sectional risk within clinical handover across the
Trust
e A review of our observation policy - amendments to the policy and associated
training requirements are scheduled to be approved in July 2016
e Implementation of a more robust approach to Environmental and ligature risk
assessments with input from subject matter experts from the Health and Safety
Team, Estates and Facilities Team working alongside Ward Managers

Chair: Sue Davis, CBE Chief Executive: John Short

Customer Relations Mon - Fri, 8am —- 8pm Tel: 0800 953 0045 Text: 07985 883 509
Email: customerrelations@bsmhft.nhs.uk Website: www.bsmhft.nhs.uk

Mey. Stonewall
3 O04 .
VV DIVERSITY Impreving mental health wellbeing

spar

During the inquest, evidence gave rise to concern about the procedures associated with the
handling of medical emergency calls at Reaside Clinic, together with a lack of assurance that
Paramedics would always be greeted in reception by a member of ward staff who could
immediately escort them to the scene of the incident.

As a result of these concerns we have reviewed all of the technical telephony reports
associated with the medical emergency call and can see that the call to the ambulance
service was cut off during or immediately following transfer from reception to Severn Ward.
We believe that this was user error on this occasion, however we are aware that the
telephony system at Reaside Clinic is very aged and cannot therefore rule out a technical
fault. We have therefore approved funding to replace the telephony system at the clinic so
that it is in line with systems in place across our other Trust sites. We anticipate that this
work will commence in Quarter 3 of this year (circa October 2016). We would like to thank
you for bringing this matter to our attention.

During the inquest you raised concern that the individual handling the medical emergency
call was not at the side of the patient and questioned whether it would be appropriate to
therefore have a cordless telephone on the ward for use in medical emergency situations.
We have explored this matter with our information technology colleagues. Sadly due to the
age and construct of the building at Reaside Clinic, there are a range of points where wi-fi
connection cannot be assured. We therefore believe that a cordless telephone may result in
greater risk of delay in gaining medical emergency response. We have therefore decided to
extend the simulation of medical emergencies on our wards at Reaside to include the
connection of the call to the ambulance service and to also ensure that the individual
nominated to make the call has all of the relevant medical information and observations of
the patient to hand. We currently deliver quarterly medical emergency simulation exercises
at Reaside Clinic (the most recent being just 2 weeks ago) and will explore the possibility of
increasing the frequency.

On the matter of receiving the Paramedics at the Clinic, we have amended our local protocol
to ensure that the nurse in charge nominates an individual to await arrival of the Paramedics.
This individual will also wear a high visibility vest so that they are immediately identifiable
upon arrival of the paramedic team.

We believe that the improvements identified above will enhance our current arrangements
for medical emergencies at Reaside Clinic and would like to thank you once again for
bringing these matters to our attention.

You may find it helpful if | write to you again in six months to update you on our progress and
| will diarise this accordingly.

Yours sincerely

Pprrsnort

John Short
Chief Executive

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