Prevention of Future Deaths reports · 2020

Lewis Francis

Regulation 28 report to prevent future deaths, reference 2020-0074, written 23 Mar 2020. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report23 Mar 2020
Reference2020-0074
DeceasedLewis Francis
CoronerNicholas Rheinberg
Coroner areaExeter and Greater Devon
CategoryMental Health related deaths · Suicide (from 2015) · State Custody related deaths
Organisation namedDevon Partnership NHS Trust · Birmingham and Solihull Mental Health NHS Foundation Trust
Sourcejudiciary.uk record · original PDF
Responses published2

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.  Devon  Partnership  NHS Trust  as lead for the  South  West Provider  Collaborative
(Devon Partnership  NHS Trust,  Cornwall  Partnership  NHS  Foundation  Trust,
Livewell  Southwest,  Somerset Partnership  NHS  Foundation  Trust, Elyslum
Healthcare,  Cygnet  Healthcare,  Avon & Wiltshire Mental  Health  Partnership'
NHS Trust and  Gloucestershire  Health  and Care NHS  Foundation  Trust)
2.  Devon  and  Cornwall Police, Avon and Somerset Police, Wiltshire Police  and

Gloucestersh ire Police
3.  Prison  and Probation  Service

CORONER

I am  Nicholas  Leslie  Rheinberg,  assistant  coroner  for the  coroner  area of Exeter  and
Greater Devon

CORONER'S LEGAL  POWERS

I make this report  under  parag raph 7 , Schedule  5, of the  Coroners  and  Justlce  Act 2009
and  regulations  28 and 29 of the Coroners  (lnvestigations) Regutations  2013.

1

I

3

INVESTIGATION and INQUEST

On 27th April  2017 an investigation  into the  death  of Lewis  Charles  Francis  aged  20 was
opened.  The investigation  concluded  at the  end  of the inquest  on lBth  March  2020.The
conclusion  of the inquest  was  that Lewis died  by suicide  as a result  of suspension by a
ligature.  Contributory  factors included  insufficient  collaboration,  communication and
ownership  between  and within  organisations  along  with  a lack of understanding  of the
deceased's  complex individual  needs  together  with insufficient  knowledge  of the process
and  implementation  of the Mental  Health Act.

4

CIRCUMSTANCES OF THE DEATH
Lewis  Francis  whilst acutely psychotic  stabbed  his Mother  on 15th February 2017.  He
was arrested  on suspicion  of attempted murder  and  taken  to Bridgwater  Custody  Suite.
His psychosis  continued at such  a level that  he was deemed unfit to be interviewed.
Although his condition mandated  a transfer  to a medium  secure  mental health  hospitat
for an assessment  and / or treatment under section  2 and / or 3 of the Mental Health Act
1983 no ready  facility existed  for such  a transfer  and  Lewis  Francis  was remanded  in
custody  to HM  Prison Exeter from where he was not  transferred  to a medium  secure
mental  health  hospital  under  the  provisions  of section  48 of the Mental Health Act  1983.
He died  at the prison  as a result  of self-inflicted  suspension  on 24th  Apnl2017  .

5

CORONER'S CONCERNS

During the  course  of the inquest  the  evidence  revealed  matters  giving rise to concern. ln
my opinion  there is a risk that  future  deaths  will occur  unless  action is taken. ln the
circumstances it is my statutory  duty to report to you.

The  MATTERS OF  CONCERN  are as follows. -
(1) At present  there is no mechanism  for the ready transfer of a person  in police custody
within  the police  areas of Devon and  cornwall,  Avon  and  somerset,  wiltshire  and
Gloucestershire  from police  custody  to a medium  secure mental  health  facility  for
assessment  / treatment under sections  2 and  3 of the Mental  Health  Act  1983  where

 such a person is suspected  of or charged  with  a serious  crime.  Such  an arrangement
exists  in the west Midlands  where  a Memorandum  of Understanding  has  been
developed  and agreed between  relevant  agencies.
(2) Evidence  at the inquest  suggested  that  there was an insufficient  understanding  of the
special  needs  and  vulnerabilities  of those prisoners  who are within  the autistic  spectrum

6

ACTION SHOULD  BE  TAKEN

ln my optnion  action should be taken  to prevent  future  deaths  and I believe  your
organisations  have  the power  to take  such  action  as follows:

(1) Evidence  at the inquest  suggested  that  steps were already being  taken by the
members  of the South  West Provider  Collective  to develop  a Memorandum  of
Understanding  between  relevant  organisations  and  agencies  so as to provide
for the transfer of mentally  ill prisoners  direct  from police  custody. Confirmation
of the action be taken in this regard together  with a time  frame  for
implementation  is required.

(2) Further  evidence at the inquest  suggested  that an initiative  was already

underway  through  the good  offices  of Avon  and  Somerset Police  to cooperate
with  the South  West Provider  Collaborative  in the  development  of the
Memorandum  of Understanding  detailed  above.  Confirmation  on behalf  of the
named  police  forces is required  that they  are wilting  to work towards  the
development of such  a Memorandum  of Understanding.

(3) lt appeared desirable  that  training  with regard  to the special needs  and

susceptibilities  of those prisoners  within  the  autistic  spectrum be provided  for
prison  officers,  support  staff  and  newly appointed prison  officers undergoing
training both  in the form of face  to face  training  and the provision  of information
through prison  intranet  systems.

7

YOUR RESPONSE

You are under  a duty  to respond  to this report within 56 days  of the  date  of this report,
namely  by 2gtn  May 2020 l, the  coroner,  may extend  the period.

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

B

COPIES  and PUBLICATION

I have sent  a copy of my report to the  Chief  Coroner  and to the following lnterested
Persons  namely  the legal  representatives  of the interested  persons  participating  in the
inquest.

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

--.

or

2020

SIGNED

Assistant Coroner

2

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 Avon and Somerset Police (PDF)
HM Assistant Coroner for Exeter & Greater Devon 

Your Ref: PCS/NR/VTVL  

Your File no: 3935 

12th June 2020 

Re: Inquest into the death of Lewis Charles Francis, Regulation 28 Report 

Dear Mr Rheinberg, 

I am responding on behalf of the Chief Constable of Avon & Somerset Police further to the 
Report to Prevention Future Deaths under paragraph 7, Schedule 5 Coroners and Justice Act 
2009 and Regulation 28 Coroners (Investigations) Regulations 2013, issued by you on 16th April 
2020. 

Specifically in respect of the ‘Actions Should be Taken’, the Chief Constable can confirm: 

Action 1: Evidence at the inquest suggested that steps were already being taken by the 
members of the South West Provider Collective to develop a Memorandum of 
Understanding between relevant organisations and agencies so as to provide for the 
transfer of mentally ill prisoners direct from police custody. Confirmation of the action 
be taken in this regard together with a time frame for implementation is required.  

Response: 

The actions taken to date include:  

1.  Review and communication within the Provider Collaborative: 

•  Communication has been undertaken setting out the process for out of hours admissions to 
all secure inpatient unit across the region. This has clarified that admissions can occur out of 
hours if an urgent admission is clinically indicated – 5 March 2020; 

•  A review of the national specifications and contracts with our Providers across the region has 
been undertaken, with confirmation made to Providers that services are commissioned to 
admit out of hours if there is a clinical indication of urgency.  

2.  Development and implementation of South West Provider Collaborative 24/7 Support to the 
secure inpatient service providers, enabling these services to progress admissions which are 
considered to be clinically appropriate. Consultation was undertaken through March 2020 and 
implementation commenced on the week commencing 13 April 2020.  

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 3.  Work has been undertaken for the mapping of key organisations, individuals, and relevant 

organisations and agencies to ensure the right people are involved in the final production of the 
Memorandum of Understanding. This work was undertaken between 22 April 2020 and 15 May 
2020. 

4.  There has been engagement with those directly involved in the drafting of the Memorandum of 

Understanding (those considered ‘relevant organisations and agencies’): 

•  Key clinical leads within the Provider Collaborative co-opted as a clinical advisory group – 20 

and 27 May 2020; 

•  Police (Inspector

2020; 

 Avon and Somerset Police) – 19 May and planned on 11 June 

•  Her Majesty’s Court and Tribunal Service 

Legal Team Manager (Business) 

Devon, Cornwall & Dorset South West Region) – 19 May and planned on 11 June 2020; 

•  Crown Prosecution Service 

 Senior District Crown Prosecutor, CPS South 

West) – 19 May and planned on 11 June 2020. 

Agreement was reached that the above mentioned individuals will represent their organisation or agency 
across the South West footprint. 

5.  Further engagement has also occurred in relation to wider stakeholders as follows: 

•  Head of Mental Health Section at the Ministry of Justice on 1 May 2020; 

•  South West Division of the Care Quality Commission on 5 May 2020; 

•  NHSE/I South West Specialised Commissioning Project Director 

 on 6 May 2020;  

• 

• 

 Clinical Director for Secure Services, Birmingham and Solihull 
Mental Health NHS Foundation Trust (Mental Health trust enacting the Memorandum of 
Understanding taken in expert evidence) on 28 April and 15 May 2020; 

 on 27 May 2020 (expert evidence to the Coroner’s Court). 

Communication with both 
hand understanding as to to the development, clinical application, and service impact of the 
Memorandum of Understanding. 

 has assisted considerably in enabling a first-

 and 

Progress 

We have met with our multi-agency partners, and agreed a high level set of principles (Appendix 1), 
which will guide our final Memorandum of Understanding  

As a result of this meeting, the partners have developed a suitable process, which is currently in final draft 
within the South West Provider Collaborative. Similarly, our multi-agency partners have also drafted a 
proposal. We are meeting again on 11 June 2020 to review how these dovetail, to ensure that we can 
implement the recommendations and introduce a region-wide Memorandum of Understanding. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 Next Steps 

1.  Agree, in the multi-agency forum, a final Memorandum of Understanding based on our agreed 

set of principles; 

2.  Final Memorandum of Understanding to be reviewed and approved by our respective 

organisations or agencies; 

3.  Agree an implementation plan to include communications within our organisations, agencies, and 

with key stakeholders. 

Implementation Plan and timescales 

1.  Trialling the draft clinical process within Devon Partnership NHS Trust on 2 cases as a test of 

change (May 2020); 

2.  Final agreement of Memorandum of Understanding by the end of August 2020; 

3.  Relevant organisation/agency approval – by the end of October 2020; 

4.  Communication to other key stakeholders – by the end of November 2020. 

It is acknowledged local areas will then develop operational procedures to support the practical 
implementation of the memorandum of understanding including provision of services run by local 
authorities and the adult MH services we work alongside in our organisations.  

On behalf of the South West Provider Collaborative we trust this provides you with the further assurance 
to the evidence provided to you during the inquest that you were seeking. 

Action 2: Further evidence at the inquest suggested that an initiative was underway 
through the good officers at Avon and Somerset Police to cooperate with the South West 
Provider Collaborative in the development of the Memorandum of Understanding 
detailed above. Confirmation on behalf of the named police forces is required that they 
are willing to work towards the development of such a Memorandum of Understanding.  

Response: 

I can confirm that Inspector 
 has been liaising with partner organisations within the 
South West Provider Collaborative on behalf of Avon & Somerset Police, and will continue to 
engage with the important work that is needed on the issues raised in your report. 

Action 3: It appeared desirable that training with regards to the special needs and 
susceptibilities of those prisoners within the autistic spectrum be provided for prison 
officers, support staff and newly appointed prison officers undergoing training both in 
the form of face to face training and the provision of information through prison intranet 
systems. 

Response: 

 
 
 
 
 
 
 
 
 
 
 
 
 
 We believe that this action is directed towards the Prison Service alone and therefore we 
understand that a response from the Chief Constable is not required on this particular issue.  

Yours sincerely, 

Lawyer 

Legal Services Directorate 
On behalf of the Chief Constable of Avon and Somerset Constabulary
Response from Wiltshire Police (PDF)
WILTSHIRE  POLICE 

RECEIVED  O 4 JUN  2020 
Mr N Rheinberg 
HM Assistant Coroner for Exeter and  Greater Devon 
County Hall 
Topsham Road 
Exeter 
Devon  EX2 40D 

Ref: CC/00696/AW 

Dear Mr Rheinberg 

Police Headquarters 
London Road 
DEVIZES 
Wiltshire  SN10 2DN 

Telephone: 101 
Ext: 774 33741
Direct Dial: 01380 861741 

3 May 2020 

Inquest into the death of Lewis Charles FRANCIS Regulation 28 Report -
Ref PCS/NR/VTVL File ref: 3935 

This letter is  in response to Regulation 28 Report dated 16 April 2020. 

-It has been  identified there is an  issue with the pathways within Mental Health Services and 
not within in the Police Service.  There are limited options using criminal justice powers and 
the Police are reliant on the NHS to divert from those.  In  line with  Recommendation 6 (2) of 
the Coroner's Regulation 28 report, Wiltshire Police is working1with other force areas and the 
South West Provider Collaborative to develop the proposed Memorandum of Understanding. 

Yours sincerely 

Chief Constable of Wiltshire Police 

Proud  to servo and protect our corn munities 

O O  CCJ1w 1ltshirepol1ce

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