Prevention of Future Deaths reports · 2017

James Allbones

Regulation 28 report to prevent future deaths, reference 2017-0336, written 21 Jul 2017. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report21 Jul 2017
Reference2017-0336
DeceasedJames Allbones
CoronerElizabeth Didcock
Coroner areaNottinghamshire
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Organisation namedDoncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
Sourcejudiciary.uk record · original PDF
Responses publishednone published

The report

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REGULATION 28: REPORT TO PREVENT FUTURE DEATHS (1)

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS
THIS REPORT IS BEING SENT TO:

1. The Chief Executive Doncaster and Bassetlaw Hospitals NHS Trust (The
Trust)

2. The Chief Executive Bassetlaw Clinical Commissioning Group (CCG)

3. The Care Quality Commission (CQC)

1 | CORONER

| am Dr Elizabeth Didcock, Assistant Coroner, for the Coroner area of Nottinghamshire

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 the 3 March 2016, | commenced an investigation into the death of James Allbones,
aged five years. The investigation concluded at the end of the inquest on the 2™ June
2017. The conclusion of the inquest was a Narrative as follows:

James David Allbones died on the 2" March 2016 at Bassetlaw Hospital from sepsis
caused by Influenza B virus infection. He may also have had an additional bacterial
infection. The guidelines for the management of sepsis were not followed.

4 | CIRCUMSTANCES OF THE DEATH

James died from sepsis at Bassetlaw Hospital, Nottinghamshire, within 12 hours of
admission. He had been unwell in the days prior to admission, with a cough and
breathlessness. The seriousness of his condition was not recognised, and the fluid
management required as part of sepsis treatment was not given. There was very limited
Consultant management and review of James’ condition, and no early senior
consideration of whether James should have been transferred out to another hospital
that could provide Paediatric Intensive Care.

Further detail of my findings in relation to these issues is included in the written
judgment in this case, which is attached to this document.

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 therefore my statutory duty to report to you.

Essentially the serious and outstanding matters of concern are as follows:

e That a child as ill as James will again be moved from the Emergency
Department to the ward or Assessment Unit at the Hospital, rather than being
transferred out for ongoing care — there is no reassurance that a sick child will
be seen by a Consultant Paediatrician in the Emergency Department to assist
with this decision

e That the ‘red fiag’ signs of sepsis will not be recognized and acted upon by the
Paediatric team unless there is further training and awareness raising. | suggest
The Paediatric Consultant team access external training and mentoring by

senior colleagues ideally within their Critical Care network.

e that there is still no protocol for face to face medical handover

e that the Consultant team have rejected a model of care that encourages frank
discussion with nursing and other staff on the ward, aimed at helping all staff
speak up when worried about a deteriorating child (the RCPCH SAFE model)

e the level of Paediatric staffing at Bassetlaw Hospital. | understand there is often
only one junior doctor available, and that the middle grade doctor is on duty for
24 hours.

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 the 22™ September 2017. |, 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.

For the avoidance of doubt, | will require a response from both the Trust and the CCG in
relation to all concerns as above. | will require a response from the CQC setting out the
findings of their recent inspection of the Paediatric Department at Bassetlaw Hospital,
and plans to re — review in the light of this case.

The Trust and the CCG may consider it advantageous to consider some of these issues
jointly as well as individually. Should respondents favour supplementing their individual
responses to all the above issues with a joint response, such a collaborative approach
would be greatly welcomed but there is of course no obligation to do so.

COPIES and PUBLICATION
| have sént a copy of my report to the Chief Coroner and to the following Interested
Persons:

EE eres parents

PE

Chief Executive Sheffield Childrens NHS Foundation Trust (EMBRACE transport
Consultant Paediatrician, External Reviewer

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.

21 July 2017 Dr EA Didcock (G/TANGR Sp see

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