Prevention of Future Deaths reports · 2018

Natasha Ford

Regulation 28 report to prevent future deaths, reference 2018-0052, written 13 Feb 2018. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report13 Feb 2018
Reference2018-0052
DeceasedNatasha Ford
CoronerZafar Siddique
Coroner areaBlack Country
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Sourcejudiciary.uk record · original PDF
Responses published1

The report

Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.

REGULATION 28:  REPORT TO PREVENT FUTURE DEATHS  

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT IS BEING SENT TO: 

1.  Hospital Director, Raglan House. 
2.  Chief Executive, Cambian Group. 

1 

CORONER 

I am Zafar Siddique, Senior Coroner, for the coroner area of the Black Country. 

2 

CORONER’S LEGAL POWERS 

I 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 27 September 2017, I commenced an investigation into the death of Ms Natasha 
Ford.    The  investigation concluded  at  the  end  of  the  jury  inquest  on  24  January  2018. 
The conclusion of the inquest was a short narrative conclusion of: 

Taking  all  of  the  evidence  into  account,  the  jury  believe  the  cause  of  Natasha  Ford’s 
death;  by  placing  a  plastic  bag  over  her  head,  secured  by  a  shoelace,  to  be 
misadventure causing her to pass away on the 20th September 2017 

The cause of death was:   

1a     Hypoxic Brain Encephalopathy 
Asphyxial Cardiac Arrest 
  b 
Suffocation 
  c   

4 

CIRCUMSTANCES OF THE DEATH 

i)  Miss Ford was a previous patient at Raglan House in Smethwick which is a 
25  bed  mental  health  hospital  designed  to  provide  an  environment  which 
promotes mental health recovery for women. 

ii)  She was readmitted to Raglan House on 4th May 2017 under Section 3 of 
the  Mental  Health  Act  1983  (amended  2007).    She  struggled  to  live 
independently and her condition declined.   

iii)   Ms Ford had a complex medical history and a diagnosis of: 

• Borderline type of Emotionally Unstable Personality Disorder 

• Asperger’s Syndrome (Autism Spectrum Disorder, high functioning) 

• Dependent and Anxious/Avoidant Personality Traits 

• Substance Misuse 

iv)   During  her  stay  she  exhibited  volatile  behaviour  initially  and  with  the 

1 

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 support of staff she began to make progress.  There were incidents of self 
harm and also evidence of aggressive behaviour. 

v)  On the 19 September 2017 at around 02.30am, she found in her room   with 
a  plastic  bag  over  her  head  which  had  been  tied  round  using  shoe  laces.  
She  was  taken  to  City  Hospital  in  Birmingham  and  despite  medical 
treatment she sadly died on the 21 September 2017. 

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 my statutory duty to report to you. 

The MATTERS OF CONCERN are as follows.  –  

1.  Evidence emerged during the inquest that there was a previous incident on the 
27 July 2017 where she had placed a plastic bag over her head.  Plastic bags 
were then restricted for a short time and then blanket restrictions were removed.  
This  was  due  to  a  change  in  policy  in  procedure  and  in  line  with  reducing 
restrictive practice policy and procedure. 

6 

ACTION SHOULD BE TAKEN 

In my opinion action should be taken to prevent future deaths and I believe you have the 
power to take such action.  

1. 

I note that blanket restrictions to access plastic bags to safeguard patients have 
now  been  revisited  and  the  policy  updated  to  reflect  this  from  October  2017.  
However I have concerns that it still remains unclear the length of time blanket 
restrictions  will  remain  in  place  and  national  guidance  suggests  that  monthly 
reviews should take place. 

2.  You  may  wish  to  consider  further  reviewing  the  guidance  and  also  confirm 
for  all  patients 

items  are  restricted 

whether  plastic  bags  and  similar 
notwithstanding their individual risk assessments. 

7 

YOUR RESPONSE 

You are under a duty to respond to this report within 56 days of the date of this report, 
namely by 9 April 2018. 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. 

8 

COPIES and PUBLICATION 

I  have  sent  a  copy  of  my  report  to  the  Chief  Coroner  and  to  the  following  Interested 
Persons; Family. 

I 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 

2 

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 response, about the release or the publication of your response by the Chief Coroner. 

9 

 13 February 2017                                                   

Mr Zafar Siddique
Senior Coroner 
Black Country Area 

3 

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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 Cas (PDF)
VT Eehaviourai

HealTh

73rd March 2018

The Senior Coroner
Black Country Coroners Court
Jack Judge House
Halesowen Street
O1dbur
West Midlands B69 2AJ

Dear Sir

Inquest into the death of Natasha Ford — Regulation 28 report

ith reference to the Regulation 28 report to prevent future deaths that you made following
I vJite
the Inquest into the death of Ms Ford. The contents of this letter has been approved by the Chief
Executive of CAS Behavioural Health.

You ha e expressed concerns in section 5 of your report on the basis of the evidence you heard at
the Inquest “that there was a previous incident on 27 July 2017 where [Miss Ford] had placed a
plastic bag over her head. Plastic bags were then restricted for a short time and then blanket
restrictions were removed. This was due to a change in a policy in procedure and in line with
Reducing Restrictive Practice Policy and Procedure”.

in her evidence at the inquest on behalf of CAS Behavioural Health
As stated by Ms
and as reflected in the report that she provided to you for the purposes of the Inquest, at the time of
the incident in July 2017 risk items were then restricted and removed from Ms Ford’s possession
but later reintroduced once the Clinical Team assessed the risk as having reduced. This was in
accordance with the CAS Policy and Procedure on Reducing Restrictive Practice in place at the
time. this Policy reflecting the relevant provisions of the Mental Health Act Code of Practice that
provides at chapter 26.37 that restrictions:

•
•
•

be used for no longer than necessary to prevent harm to the person or to others;
be a proportionate response to that harm, and
be the least restrictive option.

After the incident on 19 September 201 and the subsequent sad death of Ms Ford. C.AS
Beha\ ioural Health re ie ed the approach taken in its Polic and Procedure on Reducing
In doing so, it has taken into account guidance published b the Care Quahty
Restricthe Practice.
Commission entitled “Brief Guide’ The E se of “Blanket Restrictions” in Mental Health Wards”.
Whilst the CQC Guidance adopts the approach of the \lental Health Act Code of Practice. it does
ackno ledge that all mental health inpatient sen ices hake some prohibited or “contraband” items
and that certam prohibited items, including plastic bags, should not he challenged b the QC for
breaking the approach to blanket restrictions in the Code of Practice.

Raglan House, Raglan Road, Smethwick, B66 3ND
C C C5C589

C E 53 C

—

C

r

a’

——

r

r

 Behav ural

HealTh

Follo ing the review of the re1e ant Policy. CAS Behavioural Health has introduced a blanket
policy restricting the use of plastic bags in all their hospitals. This Policy was put in place in
October 2017 and a copy is enclosed. As a result of this Policy, no patients in any CAS hospitals
are permitted to hae access to plastic bags in hospital. This applies to all patients. notithstanding
the risk assessments undertaken in respect of each patient.

location that

All patients in hospitals operated by CAS Behavioural Health have in place a reducing restrictive
practice plan that is reviewed monthly for the individual patients. There is a similar plan for the
is reiewed three monthly. These plans detail why the relevant
hospital/unit
restrictions imposed on patients are necessary and what actions are being undertaken to reduce the
restrictions. Again, this reflects the approach of the Mental Health Act Code of Practice, but I must
it does not apply to the use of plastic bags as these are nov
emphasise that. as stated abo’e.
restricted by

ay of a blanket policy.

CAS Beha ioural Health intend to maintain the blanket ban on plastic bags in all their hospitals.

CAS Behavioural Health and i, on behalf of Raglan House. consider that this fully addresses the
concerns that you expressed in your Regulation 28 report. Floeer, if you have any further
questions, please do not hesitate to contact me.

Yours sincerely

hospital Director
Raglan House

ai House R gin RoadSrnet[w

B66 3ND

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