Prevention of Future Deaths reports · 2018

Marcus Hance

Regulation 28 report to prevent future deaths, reference 2018-0173, written 7 Jun 2018. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report7 Jun 2018
Reference2018-0173
DeceasedMarcus Hance
CoronerGuy Davies
Coroner areaIsles of Scilly
CategoryHospital Death (Clinical Procedures and medical management) related deaths
Organisation namedCornwall Partnership 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

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS
THIS REPORT IS BEING SENT TO:
Chief Officer
NHS Kernow Clinical Commissioning Group, St Austell, Cornwall
2. Philip Confue

Chief Executive
Cornwall Partnership NHS Foundation Trust

1 | CORONER

lam Guy Davies, Her Majesty’s Assistant Coroner for Cornwall & the Isles of
Scilly

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 27" October 2017 | commenced an investigation into the death of Marcus
HANCE. The investigation concluded at the end of the inquest on 31% May 2018.
The conclusion of the inquest was as follows

Marcus HANCE died on 13th October 2017 at The Queens Head Inn, North
Street, St Austell from the synergistic effect of a reckless overdose of illicit and

therapeutic drugs, within the context of a history of drug abuse.

My conclusion as to the death is that it was Drug Related.

4 | CIRCUMSTANCES OF THE DEATH

Marcus Hance was found dead at his home address from a reckless overdose of
illicit and therapeutic drugs, including amphetamine and heroin.

Marcus had a complex medical history which included a diagnosis of borderline
personality disorder and a history of drug abuse. This was characterised as a
dual diagnosis, namely a personality disorder and drug dependency.

The evidence from the Cornwall Partnership NHS Foundation Trust (CPT)
concerned the role of the Mental Health Services. This included Community
Mental Health Team (CMHT) assessments which revealed a long history of
mental health difficulties and a diagnosis of Borderline Personality Disorder. The
CPT conclusion on a number of repeat referrals was that the drug dependency
should be addressed before any mental health treatment could proceed.

On the occasion that the deceased was referred to CMHT, Marcus was
discharged following two instances of non-attendance at CMHT appointments.

Addaction provided care and treatment from 2013 to 2017 in an attempt to
deal with the drug dependency. The only real engagement was from March
2017 but was problematic and progress was not sustained. The work by
Addaction did not involve any measures to address the mental health issues,
but was focused upon addressing the drug abuse. Marcus continued to abuse
drugs up until his death.

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) Marcus was in a position where he was getting support with his drug
dependency from the drug and alcohol team but was not able to access
support for the mental health issues which were associated with the
drug dependency.

(2) The approach to cases of dual diagnosis, that substance misuse should
be addressed before any mental health treatment could proceed.

(3) The discharge from CMHT on failing to attend two appointments.

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and | believe
your organisation has the power to take such action, namely

(1) To review the commissioning of services to support individuals who have
drug and alcohol dependency and associated complex mental health
issues.

(2) To review whether drug and alcohol agencies should have the support of
relevant mental health professionals to address issues of dual diagnosis,
and for appropriate referring pathways and assessments within these
agencies to ensure the appropriate support is being provided to increase
the prospects of rehabilitation.

(3) A review generally of the current pathway and provision for persons

with dual diagnosis.

(4) To review whether a joint approach can be facilitated by mental health
services and by drug and alcohol dependency services in cases of dual
diagnosis.

(5) To review the approach taken in cases of non-attendance at mental
health appointments, and whether attempts to contact service users
should be undertaken, or alternatively to involve the police if there are
concerns for the individual’s welfare.

YOUR RESPONSE

You are under a duty to respond to this report within 56 days of the date of this
report, namely by 2™ August 2018. |, 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

| have also sent it to the following persons who may find it useful or of interest.

Operations Director, Addaction.
, Co-coordinator, Cornwall drug action team.
lam 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.

7™ june 2018 Guy Davies

Lady
Also filed under 2018-0173: 2018-0173-Kernow-NHS-Trust.pdf
PRIVATE AND CONFIDENTIAL

Mr Davies

Cornwall Coroners’ Service
The New Lodge

Penmount

INHS i, @)

Kernow = 88
Clinical Commissioning Group

Jackie Pendleton
Chief Officer
Sedgemoor Centre
Priory Road

St Austell

Newquay Road
Cornwall

1 August 2018

Dear Mr Davies,
Thank you for your regulation 28 report to prevent future deaths pertaining to Marcus Hance.

In your report you identify a number of concerns and the action to be taken by NHS Kernow Clinical
Commissioning Group (NHSK) as commissioners of mental health services and the action that should
be taken,

The concerns you expressed were that;

1. Mr Hance was in a position where he was getting support for his alcoho! dependency but not
able to access long term psychological support.

2. The approach to cases of dual diagnosis, that substance misuse should be addressed before
mental health treatment could take place

3. The discharge from CMHT on failing to attend two appointments.
Therefore the action NHS Kernow should take was;

e Toreview the commissioning of services to support individuals who have drug and alcohol
dependency and associated complex mental health issues.

e To review whether drug and alcohol agencies should have the support of relevant health
professionals to address the issues of dual diagnosis and for appropriate referring pathways
and assessments within these agencies to ensure appropriate support is provided to increase
prospects of rehabilitation

e A review generally of the current pathway and provision for people with dual diagnosis.

Chair: Dr lain Chorlton
Chief Officer: Jackie Pendleton
Head office:

01726 627800
kecg.contactus@nhs.net
www.kernowccg.nhs.uk

o0e00

Sedgemoor Centre, Priory Road, St Austell,
Cornwall, PL25 5AS

/nhskernow

e To review the approach taken in cases of non-attendance at mental health appointments, and
whether attempts to contact service users should be undertaken or alternatively to involve the
police if there are concerns for the individuals welfare..

NHS Kernow are partners in the implementation of the existing Dual Diagnosis Strategy, along with
DAAT commissioners and Cornwall Partnership NHS Foundation Trust. The strategy requires that at
an operational and clinical level, services work together to ensure safe and seamless care for
individual’s most affected. The Crisis Care Concordat multi-agency group, Chaired by the GP Clinical
Lead for Mental Health, includes representation from the Drug and Alcohol Action Team (DAAT), and
is reviewing its local action plans with a view to setting out revised actions associated with Dual
Diagnosis. Cornwall Council are lead commissioners of drug and alcohol services, and there is a joint
commitment to establish meaningful, equitable and sustainable service change and promote joint
working across agencies.

NHS Kernow are reviewing interdependencies between Outlook SW and Cornwall Partnership NHS
Foundation Trust. This work includes a joint refresh of existing protocols in support of smooth referral
pathways and transitions between services and different service lines, a review of risk management
processes and information sharing arrangements. The intention is to conclude this work by December
2018.

NHS Kernow and Cornwall Partnership NHS Foundation Trust have agreed to commence a
formalised process to review a number of service specifications which will prioritise those services
currently subject to transformation. This will include the approach taken in cases of non-attendance at
mental health appointments,

This action will be led by the Mental Health commissioning team and will commence over the summer
and will be expected to be completed by December 2018. Cornwall Partnership NHS Foundation
Trust's progress will be reported monthly via the integrated assurance meeting hosted by NHS
Kernow with overall assurance reported to NHS Kernow’s Quality and Performance Committee

NHS Kernow recognises the value of sharing the learning from serious incidents to the wider health
community. The quality team will share the learning and associated actions related to this incident with
our partners in Devon, Somerset and Dorset via our Community of Practice and with NHS England
and NHS Improvement through our Quality Network.

| hope this action provides you with some comfort. Please do not hesitate to contact me if you require
anything further in relation to this case.

Yours sincerely

Li tbh (LE

Jackie Pendleton
Chief Officer

Page 2

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 Cornwall NHS Trust (PDF)
NHS)

Cornwall Partnership
NHS Foundation Trust

Phil Confue

Carew House

Beacon Technology Park
Dunmere Road

Bodmin PL31 2QN

Tel: 01208 834613

11" September 2018

Mr Guy Davies
Assistant Coroner for Cornwall and the Isles of Scilly

By Email only

cornwallcoroner@cornwall.gov.uk

Dear Mr Davies

Regulation 28 Report to Prevent Future Deaths - Marcus Hance deceased

| write in response to your Regulation 28 Report following the inquest of Marcus Hance.

Thank you for providing me with the response provided by NHS Kernow Clinical Commissioning
Group, commissioners of mental health services, confirming the on-going review in relation to the Dual
Diagnosis strategy; the review of the interdependencies between Outlook Southwest and the Trust

and the review of a number of service specifications between NHS Kernow and the Trust.

| fully endorse the response provided by NHS Kernow and confirm the Trust will be working in
partnership with NHS Kernow as outlined in their response. | hope this provides reassurance around
the action being taken.

| wish to extend my condolences to Mr Hance’s family.

Yours sincerely.

Phil Confue
Chief Executive ah
Bh en,
,
We are a research aclive trust, to get involved in a research project, please email
opn-\,CFTresearch@ahs.nel MINDFUL a
For information on mental health medication visit choiceandmedication.org/cornwall E M P LOYE R
Chair: Or Barbara Vann ~— Chief Executive: Phillip Confue
Head Office: Carew House, Beacon Technology Park, Dunmere Road, Bodmin, PL31 2QN Wifianh k
www.cornwallinns. ul

Tel: 01208 834600 Email: cpn-tr.enquiries@nhs.net

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