Prevention of Future Deaths reports · 2018

Ursula Keogh

Regulation 28 report to prevent future deaths, reference 2018-0370, written 21 Nov 2018. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report21 Nov 2018
Reference2018-0370
DeceasedUrsula Keogh
CoronerMartin Fleming
Coroner areaWest Yorkshire (West)
CategoryChild Death (from 2015)
Sourcejudiciary.uk record · original PDF
Responses published2

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.

IN THE WEST YORKSHIRE WESTERN CORONER’S COURT
IN THE MATTER OF:

The Inquests Touching the Death of Ursula Niamh MacEochaigh Keogh
_A Regulation Report — Action to Prevent Future Deaths

THIS REPORT IS BEING SENT TO:

Minister for Department Health .

NHS Calderdale Clinical Commissioning Group
Chief Executive Calderdale Council

CORONER
Martin Fleming HM Senior Coroner for West Yorkshire Western

CORONER’S LEGAL POWERS .

I make this report under paragraph 7, Schedule 5, of the Coroners and
Justice Act 2009 and Regulations 28 and 20 of the Coroners
(Investigations) Regulations 2013

INVESTIGATION and INQUEST

On 30/1/18 I opened an inquest into the death of Ursula Niamh
MacEochaigh Keogh who, at the date of her death was aged 11 years old.
The inquest was resumed and concluded on 15/11/18

I found that the cause of death to be: -

la. Head injury

Ib Fall from a height

l arrived at a narrative conclusion as follows:
On 22/1/18 Ursula Niamh MacEochaigh Keogh intended to take her own
life.

CIRCUMSTANCES OF THE DEATH

On 22/1/18 Ursula left her school at Lightcliffe Academy and boarded the
school bus in company with her friend. At approximately 3.30pm Ursula
got off a stop earlier than usual and made her way to the North Bridge in
Halifax from which she jumped. She was subsequently located at 6.20am
in the river approximately 100 yards away from the Shears Inn Public
House, 2km downstream from the North Bridge. When Ursula was
retrieved from the waters paramedics found that she had very sadly

RT3589 i]

| passed away and this was confirmed at the hospital.

5 | CORONER'S CONCERNS

During the inquest I heard that Ursula’s mother contacted Ursula’s GP at
spring Hall Medical Centre by telephone on 13/11/17 in order to discuss
her concerns about Ursula’s history of self-harm and that this resulted in
her mother being advised by a GP to get Ursula’s school involved.
Although the school subsequently advised Ursula’s mother to contact her
GP, during the telephone conversation of 14/12/17 to further discuss
Ursula’s self-harming, the GP advised her mother to contact the
Psychology Team attached to the school, so that Ursula could be assessed
for referral to Child & Adolescent Mental Health Team if necessary, in
accord with the protocol previously issued by Calderdale CAMHS
referral pathway, notwithstanding that at this time the school did not
have the services of a Psychology team to make the referral.

I further heard helpful evidence from TE 2:25 Asset
Manager, Calderdale Council), who told me about the current plans for
preventative measures at North Bridge, Halifax in order to deter further
like tragedies.

The MATTER OF CONCERN is as follows: -

e To review the current practice of referral by GP to the school for
consideration as to the appropriateness of referral to CAHMS

e Consider improving communications between professionals,
particularly health and education to eliminate contradictions
offered in the advice.

e Consider the appropriateness of fast tracking the implementation
of preventative measures currently under consideration at North
Bridge Halifax

6. | ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and I
believe that Minister for Department of Health, NHS Calderdale Clinical
Commission Group and Chief Executive for Calderdale Council have the
power to take such action specific to them. In the circumstances it is my
statutory duty to report to you.

RT3589 2

<a

YOUR RESPONSE
You are under a duty to respond to this report within 56 days of its date; I
may extend that period on request.

Your response must contain details of action taken or proposed to be.
taken, setting out the timetable for such action. Otherwise you must
explain why no action is proposed.

COPIES
Ihave sent a copy of this report to:

BE sn
— Head of Behaviour, Attendance and Safeguarding

Abbey Multi Academy Trust

-GP

Principal of Lightcliffe Academy

Chair of CSCB

He Chair of Serious Case Review and Learning
Lesson review panels — Calderdale Clinical Commissioning Group

HS - Public Health Consultant and Chair of child Death
Overview Panel

Eh oterim Business Manager of CSBC

e Chief Coroner

DATED this 21/11/18 _ Senior Coroner — West Yorkshire - Western Division

Md Fier,

RT3589 3

Responses

2 responses 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 Calderdale CCG (PDF)
Calderdale

Clinicat Commissioning Grour

rt 16 JAN 2019
M.D Fleming 4 a menggit
Senior Coroner eae. TR
City Courts

The Tyrls

Bradford

BD1 1LA

Date: 15/1/2019

IN CONFIDENCE
Dear Mr Fleming,

Re: Regulation Report on the Inquest Touching the Death of Ursula Niamh MacEochaigh
Keogh - Action to Prevent Future Deaths

Thank you for sending a copy of the above report, received on the 28" November 2018. We have
carefully considered the three matters of concern raised with us and worked in partnership with
Calderdale Council to agree a set of actions which we have attached as required.

Our response has been compiled in partnership with Calder iy’ i id Young
People’s senior managers and the CCG’s clinical lead, is also a GP

member of our Governing Body.

A meeting was convened to produce the attached action plan which we trust will provide you with
the necessary assurance that existing processes have been reviewed and revised with new
actions identified to prevent future deaths occurring.

Provided below is a brief response to the three recommendations raised in your report. Please
also see the attached action plan which sets out the existing and new actions identified.

1. To review the current practice of referral by GP to the school for consideration as to
the appropriateness of referral to CAMHS.

The group reviewed the existing Child and Adolescent Mental Health Service (CAMHS)
referral pathway-for GPs and schools (copy enclosed). Following a comprehensive
discussion, the group were satisfied with the accuracy of the process described. However,
the review highlighted some gaps in respect of external training and education about the
pathway which has resulted in the new actions set out in the attached.

2. Consider improving communications between professionals, particularly health and
education to eliminate contradictions offered in the advice.

Chair | Dr Steven Cleasby

ys Chief Officer | Dr Matt Walsh

JS — 5th Floor, F Mill, Dean Clough, Halifax, HX3 5AX
oe agg Ci
the peas T. 01422 307400 | E: ccgfeedback@calderdaleccg.nhs.uk | www.calderdalecca.nhs.uk

INHS
; Calderdale

Clinical Commissioning Grou

The group noted the widespread training and education programmes being delivered by
services to key partners, parents and carers in Calderdale. However, it also recognised the
importance of ongoing training, education and communication plans.

The multi-agency Open Mind Partnership (CAMHS) Steering Group will take ownership of
the attached action plan. The Steering Group will monitor delivery against this plan at its
monthly meeting, reporting into the CCG’s Quality Committee.

3. Consider the appropriateness of fast tracking the implementation of preventative
measures currently under consideration at North Bridge Halifax

A discussion has been held with Calderdale Council's Public Health Consultant (Lead for
Mental Health) and a full response will be provided by Calderdale Council on this
recommendation. Below is a summary of the response: 4

° A review was undertaken of North Bridge in January 2018 looking to prevent further
suicides at this location.

e This outlined the need for installation of anti-climb mesh affixed to horizontal rails.

° A resolution was passed by the Council for an application for listed building consent
and an application for planning permission is submitted to the Local Planning
Authority.

° The listed building application has been approved and consent has now been

granted with the works to be completed by the end of May 2019. The Council has
also installed an additional CCTV camera to provide coverage of North Bridge.

We hope that the above, together with the enclosed action plan, demonstrates the seriousness
with which we have viewed this case and ask that our sincere condolences be passed onto the
family.

Yours sincerely,

a

Dr Matt Walsh
Chief Officer
Enc.

Chair | Dr Steven Cleasby
Chief Officer | Dr Matt Walsh

5th Floor, F Mill, Dean Clough, Halifax, HX3 SAX
T. 01422 307400 | E: ccafeedback@calderdalecca.nhs.uk | wan calderdatecca nhs. it
Response from Department of Health and Social Care (PDF)
/. asi-18

ae

D tm t Parliamentary Under Sens Ge eee
ie ne inequalities and Suicide Prevention
of Healt!
Social Care aim ares
SW1H OEU
Your Ref: MDF-HK/251-2018 a Pac
Our Ref: PFD-1158450
Mr Martin Fleming
HM Senior Coroner, West Yorkshire (Western)
HM Coroners’ Office ,
City Courts
The Tyrls |
Bradford BD1 1LA
March 2019

Dra M- PRM,

Thank you for your correspondence of 26 November 2018 to the Department of
Health and Social Care about the death of Ursula Niamh MacEochaigh Keogh. I am
replying as the Minister with responsibility for child and adolescent mental health
services (CAMHS), and I am grateful for the extra time in which to do so.

Your report raises three matters of concern and is directed to NHS Calderdale
Clinical Commissioning Group (CCG) and Calderdale Council, as well as the
Department of Health and Social Care. I am aware that the Calderdale CCG has
responded to your concems from a local perspective, advising you of a series of
actions that are being undertaken in light of the report. We expect the local NHS to
take action to respond to concerns.and learn from deaths to ensure the safety of
healthcare services and I am encouraged that the local NHS is looking into these
matters carefully.

It may be helpful if I set out work undertaken nationally to help local services work
together to deliver improved outcomes for children and young people experiencing
mental health difficulties.

Future in Mind’, published by the Department and NHS England in 2015, set out a
consensus across the NHS, public health, local authorities, social care, schools and
youth justice sectors to work together to promote good mental health, prevention and
early intervention; improve access; and deliver a clear, joined-up approach. This led

oe etpeaomnnay

to the development of Local Transformation Plans that set out how local services
would work together to deliver improved outcomes. The Five Year Forward View
for Mental Health’, published in February 2016, reconfirmed the vision set out in
Future in Mind.

In Novernber 2018, the Department for Education produced an update to its guidance,
Mental health and behaviour in schools’, that includes risk and protective factors for
children and young people, including identifying children with possible mental health
problems. Guidance is also given on making referrals to CAMHS quickly and
efficiently, and allowing pupils to access CAMHS at school.

All health professionals, including GPs, are required to take account of guidance
issued by the National Institute for Health and Care Excellence (NICE). The NICE
Quality Standard for Self-Harm, QS34* was published in 2013 and includes guidance
that people, including those aged eight to 18, who have self-harmed, should have an
initial assessment of physical health, mental state, safeguarding concerns, social
circumstances and risks of repetition or suicide; and that people receiving continuing
support for self-harm have a collaboratively developed risk management plan.

Turning to your recommendations specifically, the Department agrees that
communication between health and education professionals needs to be improved.
Transforming Children and Young People’s Mental Health Provision: a Green
Paper’, jointly published with the Department for Education in December 2017,
brings together health and education to provide early intervention mental health
support for children and improve communication between health and education
professionals.

On 20 December 2018, the Government announced the first wave of 25 trailblazer
sites that will test the plans set out in the Green Paper. These new plans will
significantly increase the availability of mental health support to children and young
people, including creating new Mental Health Support Teams working in and near
schools and colleges to support children and young people with mild to moderate
mental health conditions. Mental Health Support Teams will provide brand new

? https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-F YF V-final.pdf

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/755135/Mental_healt
h_and behaviour _in schools pdf

4 https://www.nice.org.uk/; ‘guidance/qs34/resources

5 https://www.gov.uk/government/consultations/transforming-children-and-young-peoples-mental-health-provision-a-
green-paper

services situated in schools and colleges and are intended to offer earlier help and
intervention. For example, linking up with existing mental health services which
may include local troubled families’ coordinators; educational psychologists; school
nurses; health visitors; local children’s services; school counsellors; and voluntary
and community sector provision.

The Department agrees with your recommendation highlighting the importance of
preventative measures and I welcome the measures being taken by Calderdale
Council to install preventative measures at the North Bridge Halifax by the end of.
May 2019. One of the key areas for action in the cross-government Suicide
Prevention Strategy is to reduce access to the means of suicide which is known to be
one of the most effective methods of preventing suicide, and this includes those
places that we know about across the country that are frequently used for suicide.

You may also wish to note that the Government published the first cross-Government
Suicide Prevention Workplan in January 2019 which set out an ambitious programme
to reduce suicides, including in children and young people®. Furthermore, setting up
24/7 crisis care provision for children, young people and their families is a key
priority for the Government in the NHS Long Term Plan’, published on 7 January
2019. All children and young people experiencing crisis will be able to access crisis
care 24 hours a day, seven days a week by 2023/24 via NHS111.

Finally, although you do not raise this issue in your report, I am aware that Ursula’s
family have expressed concern about the role of harmful suicide and self-harm
content on social media in relation to Ursula’s death.

The Department is very concerned about the impact of this sort of content and is
working with the Department for Digital, Culture, Media and Sport (DCMS) and the
online sector to address this. Our ambition is to make the UK the safest place to be
online and we are working with internet and social media providers to tackle online
harms such as these.

You may be aware that the Secretary of State for Health and Social Care, Matt
Hancock, wrote to social media providers in January to express his concern about
suicide and self-harm content on their platforms. I also met social media providers in
February, alongside the Secretary of State, and they have committed to step-up their
efforts to protect their users from harmful suicidal and self-harm content online. We
are also taking action through the forthcoming joint DCMS and Home Office Online

G hitps://www.gov.uk/government/publications/suicide-prevention-cross-government-plan

7 https://www.longtermplan,nhs.uk/

Harms White Paper, which will set out a range of legislative and non-legislative
measures detailing how the Government will tackle online harms.

I hope this information is heipful. Thank you for bringing these concerns to my
attention.

JACKIE DOYLE-PRICE

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