Prevention of Future Deaths reports · 2018

Matthew Craven

Regulation 28 report to prevent future deaths, reference 2018-0365, written 22 Nov 2018. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report22 Nov 2018
Reference2018-0365
DeceasedMatthew Craven
CoronerAlison Mutch
Coroner areaManchester South
CategoryHospital Death (Clinical Procedures and medical management) related deaths · Mental Health related deaths
Organisation namedPennine Care 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: The Chief Executive of
Pennine Care NHS Foundation Trust

CORONER

| am Alison Mutch, Senior Coroner, for the Coroner area of
South Manchester

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 20° April 2018 | commenced an investigation into the death |
| of Matthew Gerard Craven. The investigation concluded on 1st |
November 2018 and the conclusion was one of Accidental
Death.

The medical cause of death was 1a) Pregabalin Toxicity
2) Codeine and Chlordiazepoxide use, Pulmonary |
Embolism due to Deep Venous Thrombosis

Matthew Gerard Craven was prescribed pregabalin for
his anxiety. Following his discharge from Stepping Hill
Hospital on 17th April 2018, he consumed pregabalin in
excess of the prescribed amount. He had done this

previously with no ill effect. On 19th April 2018, Matthew
Gerard Craven was found dead at his home address,

RE | 0Xicology showed that
he had a fatal dose of pregabalin in his system.

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. —

The inquest heard that:

He had long-term anxiety. Mental Health workers assessing
him had repeatedly felt he needed to be seen by a psychiatrist.
The referrals were rejected by the psychiatrist. There was no
challenge or escalation process within the trust to deal with the
situation.

A routine psychiatric out patient was offered after his mother
indicated she would make a formal complaint. The inquest
heard that there were no agreed target timescales for the
offering of routine appointments.

There had been a series of attendances at the emergency
department and RAID referrals. The inquest heard that there
was no documentation or rationale provided for why RAID did
not refer him to a psychiatrist.

On one admission to the acute hospital following an overdose,
he was seen by an alcohol worker from the Mental Health
Trust. There was no evidence that that worker had checked to
see or understand any previous engagements with Mental
Health Services. Information about that admission and
encounter was not shared with wider mental health services
even though they were part of the same trust.

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.

7 | YOUR RESPONSE

You are under a duty to respond to this report within 56 days of
the date of this report, namely by 17" January 2019. 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 ) to the
following Interested Persons namely he

deceased’s mother, who may find it useful or of interest.

| 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.

Alison Mutch OBE
HM Senior Coroner
22.11.2018 GN

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 Pennine Care NHS Trust (PDF)
10th January 2019

Strictly Private and Confidential
Alison Mutch

HM Senior Coroner

Coroner's Court

1 Mount Tabor Street

Stockport

SK1 3AG

Dear Ms Mutch

Re: Matthew Craven — DOD 19" April 2018

NHS

Pennine Care
NHS Foundation Trust

Service/Department Name
Trust Headquarters

225 Old Street
Ashton-under-Lyne
Lancashire

OL6 7SR

Telephone: 01614 716 3000

| write following the Inquest of Matthew Craven heard on the 15* November 2018.
Your concerns after hearing all the evidence had been brought to my attention and |

have subsequently reviewed the Regulation 28 letter.

| am writing to respond to the concerns raised into the circumstances surrounding
the tragic death of Matthew Craven. The matters of concern raised and the actions

we will take to address these concerns are as follows:

1. There is no challenge or escalation process within the Trust to deal with
situations where referrals are rejected by the psychiatrist.

We will develop a process and protocol for escalation to be used within the borough

of Stockport by the end of February 2019.

2. There are no agreed targeted timescales for the offering of routine

appointments

Following review with the Lead Consultant Psychiatrist the agreed target timescales
for routine appointments is 12 weeks. Clear communication of the target timescales

will form part of the action above.

3. There had been a series of presentations at the emergency department
and RAID referrals. The inquest heard that there was no documentation
or rationale provided for why RAID did not refer him to a Psychiatrist.

Whilst there were assessments in ED that didn’t result in a referral to a psychiatrist
the investigation completed by Pennine Care into the death of Matthew, identified
there is evidence on 9th April 2017 that the plan following the RAID team

Visit us at www.penninecare.nhs.uk.

assessment was to discuss his presentation and medication with the Consultant
Psychiatrist and a referral made. On 10 April 2017 the referral for an outpatient
appointment was not accepted but the consultant considered the information
presented and recommended an increase in medication. Stockport borough will
produce an escalation protocol for staff to use when there is disagreement regarding
the need for a face to face appointment with a psychiatrist. This will be completed by
the end of February 2019.

4. Matthew had one admission to the acute hospital following an overdose
and had been seen by an alcohol worker from the Mental Health Trust.
There was no evidence that there had been any checking of previous
engagements with mental health services. Information about this
admission had not been shared with wider mental health services within
the same trust.

Pennine Care's alcohol liaison practitioners are moving to be based at Stepping Hill
Hospital with the all age liaison mental health service and will form part of the same
team which will significantly reduce the likelinood of any such concern arising again.
The new model will be in place by the end of February 2019.

| hope that the information provided offers assurances that the findings of your
investigations and the areas highlighted for the prevention of future deaths have
prompted action and are a focus of our continuing commitment to improving mental
health services in Stockport.

Please do not hesitate to contact me should you require any further information.

Yours sincerely,

Executive Director of Nursing, Healthcare Professionals and Quality

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Visit us at www.penninecare.nhs,uk 25a

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