Emily Voukelatou

Camden and Islington INHS|

NHS Foundation Trust

Executive office

4" Floor, East Wing
St Pancras Hospital
4 St Pancras Way
London NW1 OPE
Tel: 020 3317 7016

www.candi.nhs.uk

6 March 2017

Coroner ME Hassell
Senior Coroner

Inner North London

St Pancras Coroner’s Court
Camley Street

London N1C 4PP

Confidential

Dear Senior Coroner Hassell
Re: Emily Voukelatou

| write further to your report of 11 January 2017 in which you highlighted concerns
about the care provided to Ms Voukelatou.

You have recorded two matters of concern. | will deal with each in turn.
1. Our communication with Ms Voukelatou’s family

You heard evidence from the consultant psychiatrist responsible for Ms Voukelatou’s
care that it is not routine practice for the crisis team to involve family members in a
patient’s care. You have asked whether this policy would benefit from
reconsideration to ensure that potentially helpful input from family members is not
lost. You have also questioned whether arrangements might have been made for a
telephone meeting with Ms Voukelatou’s family in Greece.

The first point | would like to make is that we are in complete agreement with you
that family input can be extremely important and beneficial for both the patient, and
for the clinicians involved. We fully accept that this was not the message which was
conveyed during the inquest. Therefore we would like to assure you that family
involvement is routinely assessed in partnership with our patients throughout the

Chair: Leisha Fullick Your partner in CRI
Chief Executive: Angela McNab care & improvement

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care pathway, including during an admission to a Crisis House. Our assessment
reflects both the family’s role and involvement in the patient’s care, and the patient’s
wishes and consent for us to contact their family. Indeed, full involvement of family
members and carers has been an integral part of several quality improvement
projects that have been led by the Consultant Psychiatrist responsible for Ms
Voukelatou’s care.

We have also reinforced the importance of working with families in our updated, risk
assessment training which has been rolled out over the last 12 months. | have
enclosed our updated risk assessment training for your information. Our risk
assessment training is mandatory for all clinical staff. Our updated training has been
implemented throughout the last year. It is run on a monthly basis, in partnership
with Middlesex University. To date nearly 500 members of staff have been trained.

Turning to Ms Voukelatou’s case, we would like to clarify that staff did give
consideration to contacting her family. We appreciate that this was not articulated at
the inquest and we would like to take this opportunity to set out our rationale for not
making contact with family members.

First, staff took into account the fact that Ms Voukelatou was herself in regular
contact with her family, and that she discussed with staff her good relationship with
her mother and sister in particular. It is documented in Ms Voukelatou’s records that
she informed staff on 18 June 2016 that she was in skype contact with her mother
and her sister, and that on 23 and 26 June she discussed with staff separate
conversations she had had with her mother and her sister. She also informed staff on
25 June that she had had skype contact with her father, and on 27 June she discussed
her phone contact with her father. Staff were therefore satisfied that Ms Voukelatou
was in regular contact with her family, they knew where she was, and they were
having regular conversations during her time at the Crisis House.

The other factors which staff took into account were that she had informed staff that
there was no need to contact her family and that her sister and mother did not speak
english. Although it has become apparent that Ms Voukelatou’s sister does speak
good english, Ms Voukelatou’s assertion indicated to staff that she did not want them
to contact her family. Of course, there may be instances when staff would contact
family without a patient’s consent, for example, if the patient is assessed as being at
imminent risk of self-harm. However, as was explored at the inquest, while Ms
Voukelatou had reported an attempt to strangle herself and this was of significant
concern to staff, she was not assessed to be at risk of imminent risk of self-harm.
Rather her behaviour was assessed to be part of a long standing and known pattern
of behaviour.

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NHS)

In summary, contact with Ms Voukelatou’s family was considered. However staff
decided that it was not appropriate for the reasons set out above. It is clear that we
did not convey this clearly during the inquest hearing. Please accept our unreserved
apologies for this. | hope that the information above clarifies our rationale with
regards our lack of contact with Ms Voukelatou’s family and provides you with
reassurance that it was not the case that communication with family members was
not considered. | also hope | have been able to provide you with reassurance that as
an organisation we believe very strongly in involving a patient’s family wherever
appropriate, and that this is reflected and reinforced in our training to staff.

2. Ms Voukelatou’s attempts to make contact with the Crisis House

You have raised your concern that Ms Voukelatou’s sister,

telephoned the Crisis House before and after Ms Voukelatou’s death and that her
calls were not passed onto the right people.

We agree that leaving relatives’ calls unanswered is unacceptable. As you have said,
not only can potentially valuable information be lost, it is discourteous and it can
create significant additional anxiety.

As you refer in your report, staff at the crisis house were unaware that Ms
Voukelatou’s sister had been trying to make contact with them. It would of course be
a core expectation of crisis house staff to telephone back any individual trying to
make contact with one of their patients, and they were very disappointed to learn
that the family had been unable to make contact. As soon as EEE community
matron, became aware of the problems which had experienced,
he telephoned and emailed her to discuss this, and they agreed that we should
investigate her concerns formally through our complaints procedure.

As part of our investigation into HE concerns, we established that
she had been telephoning our switchboard. EE discussed what had happened
with our switchboard supervisor who made enquiries with the relevant staff. They
could not recollect calls. However, it was confirmed that the
staff were aware of North Camden Crisis House and they had the correct contact
number for the Crisis House. We conveyed this information to

in our formal complaints response together with our unreserved apology and
acknowledgment that she had raised a valid concern. also met with
ae. her mother in November, and this issue was discussed
again.

ME ead of Facilities, has confirmed that switchboard staff have the

number for all crisis houses, including North Camden Crisis House, and that staff
would transfer an individual’s call to the crisis house, and also give them the direct

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NHS

number so that they can contact the crisis house directly. She has explained that we
have long standing staff at our switchboard with many years of experience and that
North Camden Crisis House is well known and has not changed name or relocated.

In light of the information set out above we have unfortunately been unable to get to
the bottom of what happened when JEM tried to contact the Crisis
House, and why her calls were not connected. From our enquiries with the
switchboard supervisor, and i however, we are satisfied that switchboard
staff have the correct number for the crisis house. Nevertheless, given the
significance of this issue, we have issued staff at North Camden Crisis House with
clear guidance to ensure that numbers and contact details are clearly provided to
families participating in a services user’s care so they are able to speak directly to a
senior staff member,

Please accept my apologies once again for our lack of clarity during the inquest
hearing about our decision making with regards communicating with Ms
Voukelatou’s family. | hope that my letter has provided you with a comprehensive
explanation in his regard. | also hope that it has provided you with reassurance about
the weight we place on contacting a patient’s family where appropriate, and the
efforts we have made to assure ourselves that individuals are able to contact our
services through the switchboard.

Yours sincerely
Nu

Angela McNab

Chief Executive