Prevention of Future Deaths reports · 2021

Malcolm Dixon

Regulation 28 report to prevent future deaths, reference 2021-0396, written 25 Nov 2021. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report25 Nov 2021
Reference2021-0396
DeceasedMalcolm Dixon
CoronerChris Morris
Coroner areaManchester South
CategoryMental Health related deaths · Hospital Death (Clinical Procedures and medical management) related deaths · Suicide (from 2015)
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.

REGULATION 28: REPORT TO PREVENT FUTURE DEATHS.

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

Rt. Hon. Sajid Javid, Secretary of State for Health and Social Care.

| CORONER

| am Chris Morris, Area Coroner for Greater Manchester (South).

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.

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

| INVESTIGATION and INQUEST

On 11th March 2020, Alison Mutch OBE, Senior Coroner for Greater
Manchester (South), opened an inquest into the death of Dr Malcolm

| Dixon who died on 29th December 2019 at the Priory Hospital,
| Altrincham. The investigation concluded at the end of the inquest which I
| heard between 1st and 5th November 2021.

| The consultant pathologist who undertook the post mortem examination
| determined Dr Dixon died as a consequence of:

At the end of the inquest, | recorded a narrative conclusion that Dr Dixon
took his own life whilst his state of mind was adversely affected by a
severe depressive illness.

CIRCUMSTANCES OF THE DEATH

During autumn of 2019, Dr Dixon became unwell with what was later
diagnosed as a severe depressive illness.

Dr Dixon was admitted to the Priory Hospital, Altrincham as an informal,
voluntary patient and was treated by means of medication, observation by
and interaction with staff, and participation in activities sessions.

Dr Dixon died on 29th December 2019 at the hospital, as a consequence
0° te

This was an impulsive act undertaken within the context of an episode of
severe mental illness.

CORONER'S CONCERNS

The MATTERS OF CONCERN are as follows. —

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 MATTER OF CONCERN is as follows. —

The Court heard it was likely that an observation chart, designed to
record regular observations, had been pre-populated by a staff member
to show when observations were intended to be taken as opposed to
recording when they actually took place.

Additionally, the Court heard that the automatic timings generated by the
electronic care record system in use at the Priory could be over-written
manually, thus leading to inaccurate times being recorded in the records.
The following concerns arise from the above:

1. Given the particular importance of documented observations being
taken at specific intervals on mental health wards, it is a matter of
concern that standardised observation charts (together with
accompanying standard rules as to how they should be completed) are
not in use across these settings both in the NHS and private sectors;

2. For similar reasons, it is a matter of concern that automatic time-
stamps generated by electronic care records systems can be overwritten
by users without the corresponding record showing clearly that this has
happened, whilst also recording of the actual time an entry has been
made.

3. It is a matter of concern that, where record keeping on a ward is
undertaken by unregistered staff such as Nursing Assistants and
Healthcare Assistants, such individuals are not subject to professional

requirements in respect of documentation, such as those which exist for
doctors and nurses.

6 | ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and |
believe you and your organisation 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 20th January 2022. |, 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

| have sent a copy of my report to the Chief Coroner and Broudie Jackson
Canter solicitors on behalf of Dr Dixon's family.

| have also sent a copy to Browne Jacobson LLP on behalf of the Priory
Group Ltd., and the Care Quality Commission, 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 your response by the Chief Coroner.

oa
Dated: 25th November 2021.

Signature:

Chris Morris HM Area Coroner, Manchester So

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 Dhsc (PDF)
Our Ref: PFD - 1379232 

Chris Morris 
Area Coroner 
Coroner Service Team 
1 Mount Tabor Street 
Stockport 
SK1 3AG 

Dear Mr Morris,  

1 September 2022 

Thank you for your letter of 25 November 2021 to the then Secretary of State for Health and 
Social Care, Sajid Javid, about the death of Dr Malcolm Dixon.  I am replying as Minister with 
responsibility  for  Primary  Care  and  Patient  Safety,  and  thank  you  for  the  additional  time 
allowed.  

Firstly,  I  would  like to  say  how  saddened  I  was to read  of  the  circumstances of  Dr  Dixon’s 
death and I offer my sincere condolences to his family and loved ones.  The circumstances 
your report describes are very concerning and I am grateful to you for bringing these matters 
to my attention.  

In preparing  this  response,  Departmental  officials  have  made  enquiries with NHS  England, 
NHS Digital and the Care Quality Commission (CQC).  

You may wish to know that CQC has a key responsibility in the overall assurance of safety 
and quality of health and adult social care services.  Under the Health and Social Care Act 
20081  all  providers  of  regulated  activities,  including  NHS  and  independent  providers,  must 
register with CQC and follow a set of fundamental standards of safety and quality below which 
care should never fall.  All providers of CQC-regulated activity have a duty to ensure that their 
staff have the skills, knowledge and experience for the work undertaken. 

Health Care Assistants (HCAs) and Assistant Practitioners (APs) have a duty of care and a 
legal  responsibility  to  the  patients  they  see  and  care  for.    HCAs  are  not  registered  with  a 
professional body, However, they are accountable to their employer to follow their contract of 
employment.    Accordingly,  employers  have  a  responsibility  to  train,  supervise  and  have 
oversight of their HCAs.  It is vital that employers make sure employees only work within the 
limits of their competence.  Employers also accept vicarious liability for their employees and 
are accountable for the actions and omissions of the employee. 

If a registered nurse is responsible for delegating tasks to an HCA or AP, the registered nurse 
is responsible under the Nursing and Midwifery Council (NMC) Code of Conduct2 for the safe 
delegation of that task.  The NMC code states that registered nurses must: 

• 
• 

• 

only delegate tasks and duties that are within the other person's competence; 
make  sure  that  everyone  they  delegate  tasks  to  is  adequately  supervised  and 
supported; and  
confirm that the outcome of any task they have delegated to someone else meets 
the required standard. 

I have been made aware that since its registration with the CQC, Priory Hospital Altrincham 
has been inspected five times and all wards have received routine visits from Mental Health 

1 https://www.legislation.gov.uk/ukpga/2008/14/contents  
2 https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf  

 
 
 
 
 
 
 
 
 
 
 
 Act Reviewers.  The hospital has a permanent registered manager who has been in post for 
four years.  Regular engagement meetings take place with the registered manager, with the 
most  recent  meeting  taking  place  in  November  2021.    I  have  been  informed  that  at  this 
meeting,  CQC  had  noted  positive  plans.   Furthermore,  Priory  Hospital  Group  had  changed 
ownership in 2021, and is currently owned by a large European healthcare provider.   They 
have committed to invest in the hospital sites, including replacing the current computerised 
record keeping system.  

More  generally,  NHS  Digital’s  jurisdiction  is  limited  to  operating  nationally  specified 
requirements, with deployment of systems that meet such requirements supported by national 
assurance.  This may take the form of independent assurance or through a framework of self-
declaration  against  mandated  requirements.    NHS  Digital  does,  for  example,  operate  the 
Digital  Care  Services  catalogue  supporting  eligible  users  to  buy  assured  digital  tools  and 
systems  through  approved  frameworks.    However,  the  use  of  these  is  not  mandatory  and 
providers remain responsible for: i) assessing whether the functionality is fit for their purposes; 
ii) training and ensuring staff use such systems as intended; and iii) ensuring the clinical safety 
of their patients.   

NHS Digital’s remit does not include the specification of IT systems used within Mental Health 
Settings.    However,  from  a  clinical  perspective  it  is  agreed  that  electronic  patient  record 
systems should allow users to edit automatically-generated time stamps to accurately reflect 
when an observation actually took place as often it will not be contemporaneous, and that an 
associated  audit  trail  should  show  the  time  the  record  entry  was  made  and  subsequent 
changes to it. 

Pursuant  to  section  250  of  the  Health  and  Social  Care  Act  20123,  NHS  Digital  publishes 
information standards, including DCB0129: Clinical Risk Management: its Application in the 
Manufacture of Health IT System4 and DCB0160: Clinical Risk Management: its Application 
in the Deployment and Use of Health IT Systems5, which establish a clinical risk management 
framework to support the safe development and use of health IT systems for health and adult 
social care purposes in England.  These should be complied with by both the supplier of the 
system  (DCB0129)  in  question  and  the  care  provider  (the  Priory)  using  it  (DCB0160).  
Organisations  must  consider  how  failure  or  misuse  of  the  systems  could  impact  the 
management  or  delivery  of  care  to  the  patient/service-user,  estimate  the  risk  and  where 
necessary control it to an acceptable/accepted level.  Evidence of this work having been done 
must be recorded in a Clinical Safety Case Report.  

I hope this response is helpful, and I thank you for bringing these issues to my attention.  

Yours sincerely,  

JAMES MORRIS MP  
Minister for Patient Safety and Primary Care 

3https://www.legislation.gov.uk/ukpga/2012/7/section/250#:~:text=250Powers%20to%20publish%20in
formation%20standards&text=(1)The%20Secretary%20of%20State,and%20publish%20an%20inform
ation%20standard.  
4 https://digital.nhs.uk/data-and-information/information-standards/information-standards-and-data-
collections-including-extractions/publications-and-notifications/standards-and-collections/dcb0129-
clinical-risk-management-its-application-in-the-manufacture-of-health-it-systems  
5 https://digital.nhs.uk/data-and-information/information-standards/information-standards-and-data-
collections-including-extractions/publications-and-notifications/standards-and-collections/dcb0160-
clinical-risk-management-its-application-in-the-deployment-and-use-of-health-it-systems

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