Prevention of Future Deaths reports · 2019

George Twiddy

Regulation 28 report to prevent future deaths, reference 2019-0150, written 8 Apr 2019. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report8 Apr 2019
Reference2019-0150
DeceasedGeorge Twiddy
CoronerDavid Clark
Coroner areaPortsmouth and South East Hampshire
CategoryHospital Death (Clinical Procedures and medical management) related deaths · Mental Health related deaths
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.

ANNEX A

REGULATION 28: REPORT TO PREVENT FUTURE DEATHS

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

1. The Chief Executive, Hampshire County Council
2. The Chief Executive, Southern Health NHS Trust

1 | CORONER

| am David Clark Horsley, senior Coroner for the Coroner area of Portsmouth and South
East Hampshire.

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 21 November 2017 | commenced an investigation into the death of George Daniel
TWIDDY age 23. The investigation concluded at the end of the inquest on 28 March
2019. The conclusion of the inquest was cause of death: 1a. Hanging. Narrative
Conclusion: George Daniel TWIDDY took his own life whilst suffering from severe and
distressing psychiatric illness.

4 | CIRCUMSTANCES OF THE DEATH

At about 14:20 hours on Fifteenth November 2017 George Daniel TWIDDY was found
hanging from a tree in Warren Copse, Petersfield. He was taken to Queen Alexandra
Hospital, Portsmouth, where he was diagnosed to have suffered an un-treatable brain
injury. He died at the hospital at 05:08 hours on Seventeenth November 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. —

At George's Inquest | heard evidence that there was a lack of clarity in the days leading
up to his death as to which of the two agencies that had been involved in his care
(Hampshire AMHP Service and Southern Health NHS Trust's Early Intervention
Psychosis Team) were in a position to provide him with immediate assistance. His
parents were confused as where help would come from and practitioners from the two
agencies were unclear as to where the responsibility lay. Although an improved
explanatory leaflet for families about the responsibilities of the agencies is now in the
course of being finalised and liaison to clarify respective roles has now taken place
between senior managers of the agencies, it appears to me that a better understanding
of those roles would be achieved if the practitioners actually involved in patient care
themselves liaised more about what action and support should be made available to
patients and relatives in crisis situations such as that faced by George and his family in
the last days of his life.

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and | believe your
organisation 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 4" June 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 the Chief Coroner and to the following Interested

| 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.

08 April 2019

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 Southern Health NHS Trust (PDF)
Hampshire County Council & Southern Health Foundation Trust 

Response to the Regulation 28 report to Prevent Future Deaths (PFD), 
Coroner’s report touching the death of George Twiddy. 

1.0 

Introduction 

1.1  This  response  is  provided  on  behalf  of  Hampshire  County  Council  (HCC)  & 
Southern Health Foundation Trust (SHFT). Each organisation is responsible for 
the  deployment  of  professionals  involved  in  the  provision  of  health  and  social 
care services toward George Twiddy who died on the 17th November 2017.      

1.2   With direct evidence heard at the inquest, which is also recorded under a matter 
of concern from the PFD, the Coroner has highlighted the need for greater clarity 
on the role of each organisation in respect to the availability of mental health care 
and support for people in crisis. 

2.0  HCC and SHFT  

HCC  and  SHFT  share  an  equal  commitment  to  address  the  serious  concerns 
raised  by  the  Coroner.  HCC  &  SHFT  have  reviewed  the  PFD  report  findings 
together to plan how both agencies can adopt a more collaborative & effective 
approach, to support people in crisis as a result of their mental distress including 
where the Mental Health Act assessment process takes place. 

2.1  Section 140 of the Mental Health Act states:-  “it shall be the duty of every clinical 
commissioning  group  (CCG)  and  of  every  Local  Health  Board  (LHB)  to  give 
notice  to  every  local  Social  Services  Authority  for  an  area  wholly  or  partly 
comprised within the area of the CCG or LHB specifying the hospital (s) in which 
arrangements are from time to time in force - 

(a) 

For the reception of patients in cases of special urgency 

(b)  

For  the  provision  of  accommodation  or  facilities  designed  so  as  to  be 
especially suitable for patients who have not attained the age of the 18 
years”. 

HCC  and  SHFT  are  committed  to  producing  a  s140  policy  to  ensure  greater 
understanding for all frontline staff who have a role in supporting the person and 
their families, while undertaking a Mental Health Act assessment.   

Wednesday 29 May 2019  
Response to the Reg 28, GT 

Page 1 of 3 

 
 
 
 
 
 
 
 
 
 
 
 3.0  Partnership working:  

3.1   Both agencies have agreed to embark on a programme of joint work to organise 
Acute Mental Health Team staff (AMHT/ SHFT)  to accompany the AMHP (HCC) 
and the Doctors as the assessing team members, so they can agree a support 
plan if admission to hospital is not deemed to be necessary and to be available 
at the time of the Mental Health Act assessment as required.    

3.2  A range of joint work is already in evidence relating to the following aspects of 

service delivery including: - 

  Development of shared processes to support people with their discharge 

planning from hospital 

  Development  of  a 

joint  programme  of  work 

to 

improve 

the 

accommodation choices for people  

  Pan-Hants  s136  meeting  –  including  multi-organisational  review  all 

breaches / incidents reported 

  Weekly Hospital Meetings/ Telephone Calls 
  Monthly Strategy Meeting with Senior Managers from HCC / SHFT 

4.0  Opportunities for multi-disciplinary training and shared learning 

4.1 

To focus on areas of Mental Health, Mental Health Act & practice issues, which 
will be supported by Senior Managers and Clinicians in HCC & SHFT. 

4.2  HCC  and  SHFT  have  agreed  to  meet  on  a  monthly  basis  to  implement  a 

programme of work which will aim to: 

 

Improve joint working which will include improvements to services for 
people in crisis 

  Continue a shared approach to supporting people in need of hospital 

admission and discharge planning 

  Support  the  individual  and  their  carers  to  live  as  independently  as 

possible. 

5.0  Mental Health Act Information and Advice 

5.1  Design and publication of digital and paper information and advice is underway 

in consultation with people using services 

6.0  Governance and Accountability for completion of actions 

6.1  Care  Governance  Board  (Adults  Health  and  Care)  will  provide  oversight  to 

ensure monitoring and completion of actions for HCC. 

6.2 

The Quality and Safety Committee will provide oversight to ensure  monitoring 
and completion of actions for SHFT

Wednesday 29 May 2019  
Response to the Reg 28, GT 

Page 2 of 3 

 
 
 
 
 
 
 
 
 Improvement Plan Agreed by HCC & SHFT - May 2019 

Action 

By Whom 

By When 

Evidence of 
completion 

Progress 

Status (RAG) 

Implement a s140 
Policy 

Opportunities to 
attend inter – 
agency training  

Strategic 
development plans 
to deliver 
integrated 
pathways  
Mental Health Act 
information digital 
information and 
leaflet 

Collaborative 
working with 
AMHPs & AMHT 

1. 

2. 

3. 

4. 

5. 

HCC AMHP Service 
Manager & SHFT 
Associate Director of 
Capacity & Flow 

HCC & SHFT 

End July 2019  Publication of 
written policy 

Discussed and agreed to 
creating joint policy by 
Senior management  

 Draft policy being  
Written & shared with 
relevant agencies by mid 
July 2019 

End of October 
2019 

AMHPs & SHFT 
EAST have 
attended practice 
workshops 
together 
Finalised 
Programme of 
work 

Additional future dates 
have been agreed, and 
Learning will be shared 
across all areas 

Monthly Strategic 
workshops are held 
monthly to develop plan 

October 2019 

October 2019 

Senior Management 
from SHFT & HCC 

October 2019 

AMHP Service 
Manager 

End of July 
2019 

Publication of 
leaflet 

Draft form near to 
completion 

Consultation required once 
draft leaflet is in proposed 
print. Completion date July 
2019 

HCC & SHFT 

End of July 
2019 

Rota’d 
arrangements 

Staff shadow 
arrangements in place 

July 2019 

Wednesday 29 May 2019  
Response to the Reg 28, GT 

Page 3 of 3

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