Prevention of Future Deaths reports · 2020

Joseph Hargreaves

Regulation 28 report to prevent future deaths, reference 2020-0227, written 9 Nov 2020. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report9 Nov 2020
Reference2020-0227
DeceasedJoseph Hargreaves
CoronerAlison Mutch
Coroner areaGreater Manchester South
CategoryCare Home Health related deaths
Organisation namedStockport 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.

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REGULATION 28: REPORT TO PREVENT FUTURE DEATHS

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

THIS REPORT IS BEING SENT TO: The Secretary of State for Health
and Social Care

CORONER'S LEGAL POWERS

CORONER

| 1am Alison Mutch, Senior Coroner, for the Coroner Area of Greater
| Manchester South

| 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

| INVESTIGATION and INQUEST

On 24" April 2020 | commenced an investigation into the death of Joseph
| Hargreaves. The investigation concluded on the 29 November 2020 and
the conclusion was one of Narrative: Died as a consequence of the

The medical cause of death was 1a) Sepsis; 1b) Aspiration Pneumonia |
! on a background of chronic swallowing difficulties; Il) Congestive
Cardiac Failure, Ischaemic Heart Disease, Hypertension

4

| CIRCUMSTANCES OF THE DEATH

On 17th April 2020, Joseph Hargreaves had an unwitnessed fall at his
care home. The precise circumstances are unclear. He was admitted to
Stepif Hill Hospital where he was treated for sepsis due to aspiration
pneumpnia, caused by poor swallowing. He appeared to improve initially’ |
but deteriorated rapidly when transferred. He died at Stepping Hill |
Hospital on 17th April 2020.

| 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 induest heard that Mr Hargreaves was a long-term rebident of the

care home with significant swallowing issues and poor mobility. Following
fockdown his family, who had been visiting most days, could no longer

-——~| complications of underlying swallowing difficulties

senor kaa anaemia

aan canmare wenn

| hospital and they were unclear about the events in the home leading up
to his admission.

The provision of information, about the events leading up to his
admission; his baseline and underlying health issues, to treating clinicians
was reduced. In his case it did not impact the outcome however it was
clear from the evidence that it could in other circumstances cause
significant challenges in delivering effective treatment quickly to
vulnerable patients.

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.

TYouR RESPONSE

You are under a duty to respond to this report within 56 days of the date
| of this report, namely by 4°" January 2021. |, the coroner, may extend the
period.

Your response must contain details of action taken or proposed to be

why no action is proposed.

4 ane

taken, setting out the timetable for action. Otherwise you must explain

8 cores and PUBLICATION

| | have sent a copy of my report to the Chief Coroner and to the following
Interested Persons, namely daughter of the deceased,
and the management of Bankfield House Care Home, 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 youl response by the Chief Coroner.

Alison Mutch
HM Senior Coroner
09.11.2020

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 Dept. of Health and Social Care (PDF)
From Nadine Dorries MP 
Minister of State for Patient Safety, 
Suicide Prevention and Mental Health 

39 Victoria Street 
London 
SW1H 0EU 

2 February 2021 

Your Ref:
Our Ref: 

Ms Alison Mutch 
HM Senior Coroner, Manchester South 
HM Coroner's Court 
1 Mount Tabor Street 
Stockport SK1 3AG 

Dear Ms Mutch, 

Thank you for your letter of 9 November 2020 to Matt Hancock about the death of Joseph 
Hargreaves.  I am responding as Minister with responsibility for hospital care quality and 
patient safety and I am grateful for the additional time in which to do so.  

First, I would like to offer my deepest condolences to the family and loved ones of Joseph 
Hargreaves.  I am truly sorry that the circumstances surrounding Mr Hargreaves’ death 
during the emergency period of the COVID-19 pandemic, meant that they were unable to 
visit Mr Hargreaves at his care home or to accompany him to hospital.  I understand how 
deeply upsetting this must be.   

I have noted and appreciate your concern about the potential impact this could have on 
outcomes for vulnerable people where clinicians have reduced information available to 
them.   

Patient safety is our top priority, which is why the NHS has stringent infection control 
measures in place to prevent the spread of coronavirus to vulnerable hospital patients.  
This includes managing visits in a safe and COVID-secure way.  

On 13 October 2020, NHS England revised its guidance on how NHS organisations may 
choose to facilitate visiting across healthcare inpatient, outpatient and diagnostic service 
settings during the COVID-19 pandemic1.  Visiting is subject to local discretion by NHS 
trusts and other NHS bodies, and will take the local prevalence of COVID-19 into account. 

We recognise the importance of being able to visit family, friends and loved ones in 
hospital, particularly during this difficult time, and endorse the latest guidance which 
advises NHS bodies and trusts to take a more compassionate and caring approach to 
hospital visiting compared to the previous guidance published on 5 June 2020. 

1 https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0751-visiting-healthcare-
inpatient-settings-principles-131020_.pdf 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 The number of visitors is limited to one close family contact or somebody important to the 
patient.  However, where social distancing can be maintained throughout a visit, and 
where specific needs have been agreed with the clinical team, up to four visitors can be 
permitted.  The previous guidance limited this to two visitors. For example, partners of 
women in labour; individuals receiving end-of-life care; and, where the visit is from a 
familiar carer (parent or guardian, supporter or personal assistant). 

Other people in attendance to support the needs of the patient (e.g. familiar carer, 
supporter or personal assistant) should not be counted as an additional visitor. 

Where face-to-face visits are not practical, virtual visits should be supported and 
facilitated.  Visiting times may be staggered to accommodate visiting for all patients.   
For patients at the end of their life, the compassionate approach advised by this guidance 
is essential in balancing the importance of close family members and others important to 
the dying person, being able to spend precious time with them and say goodbye, with the 
need to manage infection risk and maintain the safety of the visitor(s), staff and other 
patients.  Organisations should, in conjunction with the local incident team, use their own 
risk-based assessment to decide to what extent more relaxed visiting arrangements can 
be facilitated. 

NHS England advises that clinicians continue to seek out new and improved ways to 
maintain open communication with families and relatives of those who are in hospital.   
Locally, I am advised that the Stockport NHS Foundation Trust established a patient 
liaison team on 25 April 2020, which remains in place, to facilitate better communications 
with relatives.   

In relation to care homes, in April 2020, we published, Admissions to Care Homes 
guidance, co-branded with Public Health England, the Care Quality Commission (CQC) 
and NHS England.  This set out advice on infection control procedures, for example, 
limiting visits to essential visits only, unless in exceptional circumstances, and providing 
advice on isolation, decontamination, cleaning and protective measures for staff.   

Following the publication of the Adult Social Care Winter Plan in September 2020, we 
published specific guidance on facilitating visits to care homes during the COVID-19 
pandemic.  This guidance enabled care homes to develop their own visiting policies based 
on a local dynamic risk assessment, taking a lead from their local Director of Public Health.  
On the introduction of Local Covid Alert Levels, we updated our guidance.  This update 
enabled visiting to continue as previously for care homes in Local Covid Alert Level 1 
(medium risk) but advised visits be limited to exceptional circumstances, such as end of 
life, in areas in Local Covid Alert Levels 2 and 3 (high and very high risk).  

On 1 December 2020, we published updated guidance to enable more meaningful indoor 
visits to take place for care home residents across all tiers.  This was enabled by providing 
testing to visitors, following a successful pilot scheme.  We began a roll-out of testing for 
visitors to all CQC-registered care homes in England, with a goal to have testing in place 
in all care homes by Christmas.  

 
 
 
 
 
 
 
 
 
 
 In light of the introduction of Tier 4 restrictions on 20 December 2020, we published 
updated guidance which enabled visits to care homes in Tier 4 areas to continue to take 
place with arrangements such as outdoor visiting, substantial screens, visiting pods, or 
behind windows.  Guidance for areas in Tiers 1-3 remained unchanged and continued to 
utilise testing to enable more meaningful indoor visits. 

Upon introduction of the national lockdown on 5 January 2020, we published updated 
guidance that expanded the Tier 4 visiting guidance, enabling the visits outlined above, 
nationally.  Close-contact visits are not currently enabled.  Visits in exceptional 
circumstances, such as end of life, should always be supported and enabled. 

We will be looking to ensure that a wider range of visiting arrangements are made 
available when it is safe to do so.  We will publish updated guidance as this period of 
national lockdown ends. 

We recognise how important it is to allow care home residents to meet their loved ones 
safely, especially for those at the end of their lives.  We appreciate the particular 
challenges visiting restrictions pose for people with dementia, people with learning 
disabilities and autistic adults, amongst others, as well as for their loved ones.  All of our 
guidance enables care home providers, families and local professionals to work together 
to find the right balance between the benefits of visiting on wellbeing and quality of life, 
and the risk of transmission of COVID-19 to vulnerable residents and social care staff.  

I hope this response is helpful.  Thank you for bringing these concerns to my attention.  

Yours sincerely, 

MINISTER OF STATE FOR PATIENT SAFETY, SUICIDE PREVENTION AND MENTAL HEALTH 

NADINE DORRIES

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