Prevention of Future Deaths reports · 2020

Amy Hogan

Regulation 28 report to prevent future deaths, reference 2020-0147, written 31 Jul 2020. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report31 Jul 2020
Reference2020-0147
DeceasedAmy Hogan
CoronerChristopher Morris
Coroner areaManchester South
CategoryAlcohol, drug and medication related deaths · Community health care
Sourcejudiciary.uk record · original PDF
Responses published1

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: The Right Hon. Matt Hancock MP, 
Secretary of State for Health and Social Care; Sir Simon Stevens, Chief 
Executive, NHS England. 

1  CORONER 

I am Chris Morris, Area Coroner for Greater Manchester South. 

2  CORONER'S LEGAL POWERS 

I 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. 

http://www.legislation.gov.uk/ukpga/2009/25/schedule/5/paragraph/7 
http://www.legislation.gov.uk/uksi/2013/1629/part/7/made 

3 

INVESTIGATION and INQUEST  -

On 1 Slh April 2020, Alison Mutch OBE, Senior Coroner for Greater 
Manchester South, opened an inquest into the death of Amy Hogan who 
died at Tameside General Hospital, Ashton under Lyne on 21 st January 
2020, aged 23 years. The Investigation concluded at the end of the 
inquest, which I heard on 2nd July 2020. 

A  post mortem examination determined Miss Hogan died as a 
consequence of:-

1 )a) Hypoxic !brain injury; 
b) Pulmonary embolism; 
c) Deep vein thrombosis 

II Oral contraceptive pill, obesity. 

I 

The inquest concluded with a narrative conclusion to the effect that Miss 
Hogan died as a consequence of complications of a deep vein 
thrombosis. Whilst this Is a natural cause of death, it is likely her 
death was contributed to by a recognised complication of the oral 
contraceptive pill. 

4  CIRCUMSTANCES OF THE DEATH 

I 

I 

From around September 2019, Miss Hogan began to report sporadic and 
non-specific symptoms of feeling unwell. Having initially attended the 
Pennine Medical Centre in Mossley as a visiting patient, Miss Hogan 
registered with that oractice. Miss Hoaan received treatment from doctors 

 at the practice for depression and anxiety, and continued to be prescribed 
the oral contraceptive pill following a  risk assessment by the practice 
pharmacist. 

On 2011h January 2020, Miss Hogan attended the out of hours doctor at 
Oldham Primary Care hub, reporting a 3 day history of feeling light-
headed, weak and drained. Whilst Miss Hogan had told others she had 
experienced breathlessness and leg pain,'this information was not 
conveyed to the out of hours doctor. Whilst Miss Hogan disclosed to the 
doctor details of the anti-depressant medication she had been prescribed, 
he was not informed she was taking the oral contraceptive pill. 

I 
I 
I 

I 

The following day, Miss Hogan became acutely unwell and collapsed at 
her home. She was taken to hospital by ambulance where she died. 

5  CORONER'S CONCERNS 

During the course of the inquest the evidence revealed matters giving rise  1 
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)  The inquest heard evidence from Miss Hogan's regular GP 
that, despite being requested, the General Practice records 
from her previous practice never arrived. It is a matter of 
concern that delayed, incomplete or non-existent transfer of 
patient data from one practice to another on moving places an 
unfair burden on patients to accurately recall and relay their 
own medical histories. It is a matter of particular concern that 
such issues create particular problems for vulnerable patients, 
who simply may not be in a position to do so; 

2)  Notwithstanding numerous previous initiatives as to 

information-sharing and digitisation of patient data, it is a matter 
of concern that the out of hours GP reviewing Miss Hogan had 
no electronic access to her regular GP records. Access to such 
records would have revealed, amongst other things, Miss 
Hogan was prescribed the oral contraceptive pill, which is likely 
to have led the doctor to ask additional questions about her 
symptoms. Again, it is a matter of particular concern that an 
inability to access regular GP records in the out of hours setting 
raises additional risks for vulnerable patients. 

6  ACTION SHOULD BE TAKEN 

I 

In my opinion action should be taken to prevent future deaths and I 
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 25th  September 2020.  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 

8 

COPIES and PUBLICATION 

I have sent a copy of my report to the·Chief Coroner and to Miss Hogan's 
parents. I have also sent a copy of my report to Dr-

and Dr • 

who may find it useful or of Interest. I have also sent it to 

Tameside CCG. 

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. 

9 

Chri~topher Morri 
HM ~rea Coroner, Manchester South 
31.07.2020

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 NHS England (PDF)
National Medical Director  
NHS England & NHS Improvement  
Skipton House 
80 London Road 
London 
SE1 6LH 

29th October 2020 

Mr Christopher Morris 
Coroner’s Court,  
1 Mount Tabor Street,  
Stockport  
SK1 3AG 

Dear Mr Morris, 

Re: Regulation 28 Report to Prevent Future Deaths – Miss Amy Hogan 21st 
January 2020 

Thank you for your Regulation 28 Report dated 31st July 2020 concerning the death 
of Miss Amy Hogan on 21st January 2020. Firstly, I would like to express my deep 
condolences to Miss Hogan’s family.  

The regulation 28 report concludes Miss Hogan’s death was a result of: 

1)  a)  Hypoxic brain injury 

b)  Pulmonary embolism 
c)  Deep vein thrombosis 

2) 

Oral contraceptive pill, obesity 

Following the inquest, you raised concerns in your Regulation 28 Report to NHS 
England relating to the transferring of GP records following registration at a new 
practice, and access to GP records in an out of hours setting. This response has 
been made with input from NHSX, the organisation responsible for NHS technology, 
digital and data - including data-sharing and transparency. 

Over recent months significant progress has been made around the access to GP 
records out of hours. As a response to the pandemic, we have enabled the use of 
GP-Connect across the whole primary care estate. This eases facilitation for 
authorised professionals in multiple care settings to directly access in a safe and 
secure manner GP records which are held at GP out of hours services, CCAS, 
Extended Access Hubs and NHS 111. 

We have also enabled wider access by authorised professionals to an enriched 
Summary Care Record with Additional Information (SCR-AI), which allow a health 
and care professional to see a patient’s medical history and helps to support older 
patients and those with complex comorbidities.  

Over 54 million patient records (90%) of the population in England, now include 
enriched summary care records. We are working with GP system suppliers and 

NHS England and NHS Improvement 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 continue to make progress. We are looking at ways to ensure that these changes 
can be retained for the future given the impact it has had for faster and better care. 

There is an ongoing programme of work to review and establish and reduce the root 
cause of electronic GP2GP (GP2GP is the formal term for the programme) record 
transfer failures. In March 2020 there was an increase applied by GP system 
suppliers to GP2GP transfer ‘file size’ from 50MB to 100MB, this will subsequently 
help to reduce the rate of failures further. Due to COVID-19 competing priorities, 
statistics are not yet available to demonstrate the effect this change has had. 
However, we anticipate analysis and collection of these metrics will resume as part 
of the recovery work. 

We continue to make progress on the digitisation of GP records, including the 
programme to digitise historic information held in the Lloyd George paper medical 
records.  

There are 4 main reasons for digitisation of Lloyd George records:  

- safer care for patients,  

- release of space within practices to provide additional consultation areas,  

- access to the full patient record at the point of care,  

- GP contract commitment to digitise all Lloyd George records by March 
2022.  

Lloyd George Paper Records Digitisation Project:  

Wave 1 Pilot sites: 

•  Sunderland - Digitised 17 of 38 practices with 132k patient paper records 
digitisation complete. On completion Sunderland will have digitised 284k 
patients paper records.  

•  Lancashire ICP (Morecambe Bay CCG) – Digitisation underway, on 
completion 350k patients paper records digitised across the CCG 

•  Birmingham & Solihull CCG – Digitisation underway, on completion 1.3m 

patients paper records digitised. 

In total – on completion Wave 1 pilots will have digitised 1.9m patient paper records. 

Wave 2 Pilots (Procurement Phase – work is underway and due to be completed by 
March 2022. digitisation of Lloyd George records is March 2022 Participation across 
all 7 regions 

o  North West – 1.9m 

o  North East & Yorkshire – 804k 

o  Midlands – 1.3m 

 o  East of England – 982k 

o  London – 1.4m 

o  South East – 1.6m 

o  South West – 1.1m   

In total – on completion Wave 2 have plans approved to digitise 9m patients paper 
records to be digitised. 

We sincerely hope that this provides reassurance that progress is being made 
around the digitisation and transfer of medical records, in order to prevent such 
tragic events reoccurring in the future.  

Thank you for bringing these important issues to my attention and please do not 
hesitate to contact me should you need any further information. 

Yours sincerely, 

Professor Stephen Powis 
National Medical Director

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