Terence Talbot

HMAC Ms Sonia Hayes 
Cantium House  
Sandling Road 
Maidstone 
ME14 1XD 

Dear Ms Hayes, 

Caxton House 
Tothill Street 
London 
SW1H  9NA 

11 February 2022 

RESPONSE TO REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

Introduction 

I  write  on  behalf  of  the  Department  for  Work  and  Pensions’  (“DWP”)  in  response  to  HM 
Assistant Coroner Sonia Hayes’ Prevention of Future Deaths Report made under Regulation 
28 of the Coroners (Investigations) Regulations 2013.   

That report dated 3 December 2021, was served on the DWP by HM Assistant Coroner on 
20  December  2021  following  the  conclusion  of  an  inquest  touching  on  the  death  of  Mr 
Terence Talbot on 19 October 2021. On behalf of DWP, I would like to express my deepest 
condolences to the family of Mr Talbot.  

I thank the HM Assistant Coroner for allowing DWP until 14 February 2022 to respond to the 
report. I would also like to thank the HM Assistant Coroner for providing relevant material 
relating to the inquest by which the DWP could consider and prepare this response to HM 
Assistant Coroner’s concerns, namely: 

“The Department of Work & Pensions required Terence Talbot to attend in person to make 
a claim for benefits rather than accept an electronic claim. I heard from all the doctors and 
a senior nurse in this case who have a considerable experience across a range of specialties 
and across several different NHS Trusts that they have never experienced nor heard of a 
case where a severely ill inpatient was required by the Department of Work & Pensions to 
leave hospital to attend its offices in person to make a claim for welfare benefits. Terence 
Talbot was suffering with a mental disorder and an exceptionally rare and complex disease 
with  a  risk  of  death  and  suffering  severe  exfoliative  dermatitis  that  rendered  him  very 
vulnerable to infection.” 

DWP  was  not  an  Interested  Person  to  these  proceedings.  For  the  avoidance  of  doubt,  I 
confirm that the DWP was not aware that inquest proceedings were taking place in relation 
to Mr Talbot’s untimely death, nor was the DWP  asked to provide evidence to assist HM 
Assistant Coroner within the substantive proceedings or on matters relating to the prevention 
of future deaths.  

 I  also  note  that  HM  Assistant  Coroner  made  no  findings  that  DWP’s  actions  in  any  way 
caused or contributed to Mr Talbot’s death within her conclusions. 

However, HM Assistant Coroner is not limited to such matters when exercising her duty to 
issue a prevention of future deaths report. As such, DWP is providing this response, helped 
by the HM Assistant Coroner providing relevant material. 

DWP Response 

This response is structured in two parts. The first describes the process in place for making 
a claim to Universal Credit (“UC”) in January 2020 when Mr Talbot made his claim for UC, 
adjustments  available  to  UC  claimants  in  verifying  their  identity  (“ID”),  and  Mr  Talbot’s 
interaction with the DWP. The second part explains measures the Department has in place 
to support vulnerable claimants in accessing benefits.    

Universal Credit – the process in place at the time of Mr Talbot’s claim 

UC is a social security benefit  which  is designed to support people who have a  low 
(or  no)  income  with  their  basic  living  expenses  and  housing  costs.  It  is  a  highly 
variable  payment  which  takes  into  account  different  aspects  of  an  individual’s 
personal circumstances, such as employment income received, and housing costs. A 
standard  allowance  is  paid,  with  additional  elements  being  payable  dependent  on 
individual circumstances.  

The standard process for making and maintaining a UC claim is by online self-service 
via the gateway on GOV.UK. If a claimant needs support to do this, help is available 
by the following means:  

telephone 
face to face support from a partner organisation 
in the office 

• 
• 
• 
•  exceptionally, through a home visit 

Where a claimant is unable to claim online, they can claim by phone through the UC helpline. 
GOV.UK provides details on how to claim, including information about claiming by phone 
and  signposting  to  additional  support  available  from  the  Citizens  Advice  Help  to  Claim 
Service.   

Upon confirmation of eligibility to claim UC, claimants will complete their application 
online  and  agree  the  legal  declaration  and  terms  and  conditions  of  UC  prior  to 
submitting  the  application.  Following  completion  of  the  final  declaration,  some 
claimants  can  use  GOV.UK  Verify  to  verify  their  ID  online.  The  claimant  can  either 
choose to use GOV.UK Verify to complete the information required o r elect to verify 
their ID at the Jobcentre. 

At the point when Mr Talbot was making his UC claim in January 2020, claimants who 
were  unable  to  verify  their  ID  on  GOV.UK  Verify  or  elect  to  verify  their  ID  at  the 
Jobcentre,  were  automatically  directed  to  telephone  the UC helpline to book an Initial 
Evidence Interview (IEI). Claimants must verify their ID to claim UC. This is to confirm 
that the right person is linked to the right claim and to help reduce ID fraud. 

 
 
 Serco  are  an  outsourced  Provider  Agent  (“PA”)  who  work  in  partnership  with  DWP 
delivering telephony services for all UC claimants. The PA was responsible for booking 
IEI appointments for all UC claimants. When a call was received from a claimant, the PA 
would  complete  a  telephone  ID  check  before  proceeding  to  check  and  confirm 
evidence/documents which the claimant had declared they will take with them to the IEI. The 
PA would ask questions to identify if the claimant requires additional support or alternative 
options before agreeing the date and time of the appointment.  

Through their initial contact with claimants, PAs may have found that some claimants 
had complex needs which could mean that they require extra support. Any information 
regarding  a  claimant’s  complex  needs  (provided  by  the  claimant)  before  the  IEI 
appointment would be noted in the special requirement field.  

Some claimants may have indicated that they were unable to attend a DWP Jobcentre 
for  their  IEI  and,  for  example,  request  a  home  visit.  In  these  cases,  the  PA  would 
complete an information gather, including asking additional questions. A  Serco team 
leader  would  then  contact  the  DWP  Jobcentre’s  Provider  Agent  Contact  (“PAC”)  to 
pass  on  the  information  the  PA  has  gathered.  It  would  then  have  been  the  PAC’s 
responsibility to contact the claimant to arrange the appointment.   

As is still the case now, where a claimant was unable to attend a DWP Jobcentre in person 
due to a disability or health condition, reasonable adjustments could be made. To support 
our most vulnerable claimants, DWP Visiting are able to undertake home visits. Home visits 
are offered in exceptional circumstances to claimants who are unable to complete their new 
claim through any of the available channels. Alternatively, a third party biographical check 
may be considered when a claimant is unable to attend an ‘in Jobcentre’ appointment and 
a home visit cannot be conducted. For example, the claimant is in hospital. A biographical 
check  involves  the  validation  of  information  provided  by  the  claimant.  This  information  is 
then checked with third parties. Claimants who are mentally or physically incapacitated and 
cannot manage their own affairs can also nominate an appointee to make a new claim on 
their behalf. 

People  claiming  UC  must  show  that  they  have  a  right  to  reside  in  the  UK  and  are 
habitually resident. 

A  claimant  is  only  entitled  to  UC  once  they have  accepted a  Claimant  Commitment.  The 
purpose  of  the  First  Commitments  meeting  is  to  complete  an  information  gather  and  a 
diagnosis of a claimant’s circumstances, identify the work a claimant is expected to look for 
and  be  available  for,  establish  work  search  requirements,  establish  work  preparation 
activities required, and confirm ongoing contact requirement and a forward plan of action for 
the  claimant.    A  claimant  can  still  claim  UC  if  they  are  homeless  or  do  not  have  a 
permanent  address.  Where  a  claimant  is  entitled  to  claim  there  are  a  number  of 
options available to them. They can use a ‘care of’ address, such as the address of a 
family member or trusted friend. If they are staying at a hostel, they can use the hostel 
address,  or  in  exceptional  circumstances,  they  can  use  their  local  DWP  Jobcentre 
address.  

Appointees and representation by a third party 

A claimant may need an appointee if they are incapable of managing their own affairs 
because of a mental incapacity or severe physical disability. An appointee can be an 
individual or an organisation. When a request to be an appointee is received, it must 
be decided whether it is appropriate in the circumstances.  

 
 
 A representative can act on behalf of, or make enquiries for, a claimant. This can be 
at any stage of a claimant’s UC claim. Where it is clear that a claimant with complex 
needs  faces  clear  and  significant  risks  to  their  welfare  or  safety,  DWP  staff  are 
empowered  to  proactively  disclose  information  to  the  relevant  body  without  the 
claimant  providing  explicit  consent.  Additionally,  a  third  party  may  give  DWP 
information about a claimant where there  has been no explicit  consent given by the 
claimant.  

Mr Talbot’s case  

Mr Talbot made his claim for UC electronically on 24 January 2020 and I understand, from 
the evidence adduced at inquest, that he was assisted by a discharge nurse to complete his 
online  application.  Mr  Talbot  disclosed  on  his  application  that  he  had  been  admitted  to 
hospital on 12 December 2019 and was receiving emollient application four times daily to 
his whole body. He also declared that he had Bipolar Affective Disorder and Drug Rash with 
Eosinophilia and Systemic Symptoms (“DRESS Syndrome”).  

According to our records, this was the first time that Mr Talbot had ever applied to the DWP 
for benefits. At the time the online application was made, DWP was not aware of the severity 
of Mr Talbot’s illness nor held any evidence to suggest that Mr Talbot had previously been 
sectioned  under  the  Mental  Health  Act.  This  information  was  not  included  in  his  online 
application form and we hold no evidence which suggests that Mr Talbot’s physical condition 
was  considered  to  be potentially  life-threatening  at  that  time.  I  also  understand,  from  the 
evidence  adduced  at  inquest,  that  the  discharge  nurse  who  assisted  Mr  Talbot  with  his 
online application was not aware that his condition was potentially life-threatening, or that it 
could  potentially  relapse.  Mr  Talbot,  as  assisted  by  the  discharge  nurse,  also  responded 
“No” to a question on the online application form which asked “Has your doctor said you 
might have less than 6 months to live due to any of your conditions?”. 

Following submission of his online application on 24 January 2020 and in the absence of Mr 
Talbot completing the online GOV.UK Verify process, Mr Talbot was automatically directed 
to contact the UC helpline to book a face-to-face appointment in the Jobcentre to verify his 
ID. A call was received via the UC helpline (operated by Serco) on 24 January 2020 and an 
appointment  was  booked  for  Mr  Talbot  to  attend  Maidstone  Jobcentre  at  1:00pm  on  28 
January 2020. It was noted under the ‘special requirements’ field that Mr Talbot required a 
wheelchair. Due to DWP’s audio recording retention policy the record of that call has been 
deleted and we are therefore unable to confirm the details of the discussion that took place. 
However, on  the  information  currently available  to  the  DWP,  we  received no  evidence  to 
suggest that Mr Talbot was unable to attend that appointment on account of his illness, or 
otherwise. Had we (or Serco) been aware of any concerns about Mr Talbot’s ability to attend 
that meeting then alternative appointment channels could have been considered.  

In January 2020 the remit of PAs was purely IEI appointment booking and rebooking. 
At this time Serco had limited access and remit to look at any further customer information 
other  than  to  confirm  the  customer’s  ID.  There  was  no  obligation  or  remit  to  view  claim 
disclosure prior to the booking of the appointment. All necessary information regarding the 
customer’s attendance would have been taken verbally from the customer. If Mr Talbot had 
stated that he could not attend the Jobcentre in person, the PA should have sent a referral 
form  to  the  Jobcentre  for  them  to  arrange  a  home  visit  or  to  consider  other  alternatives. 
Serco  guidance  includes  asking  additional  questions  when  a  home  visit  or  out  of  hours 

 
 
 
 appointment is requested. PAs will contact the PAC in the Jobcentre to make the necessary 
arrangements. 

Following Mr Talbot’s IEI appointment on 28 January 2020, a note was placed on Mr Talbot’s 
claim for his next appointment (First Commitment) to be conducted via telephone. This was 
in  recognition  of  Mr Talbot’s  health  conditions.  All  subsequent  appointments  he attended 
with DWP were by telephone as opposed to face-to-face. 

Appointees and representation by a third party 

According to our records, the DWP did not receive a request from anyone seeking to act as 
an appointee on behalf of Mr Talbot. During a telephone call on 29 January 2020 we were 
advised by a discharge nurse of Mr Talbot’s ill health and their concerns surrounding his 
mental health and ability to participate in appointments. Further contact was requested to 
be directed via the discharge nurse who was acting as a facilitator.  

Mr Talbot’s First Commitments meeting was completed by telephone on 03 February 
2020. Both elements of Mr Talbot’s claimant commitment (work availability and work 
search and preparation) were switched off. This was in recognition of his reported health 
conditions and the impact of these on his ability to be available for work, and to look and 
search for work. 

Habitual Residence Test (HRT)  

As part of his online application, Mr Talbot disclosed that he had been out of the UK for more 
than 4 weeks at a time. This prompted a check to determine whether a HRT interview was 
needed. I understand, from the evidence adduced at inquest, that there was a suggestion 
that  the  reason  Mr  Talbot  was  asked  to  attend  a  DWP  Jobcentre  was  due  to  HRT 
requirements. This is not the case. Claimants are notified of the need to have a HRT when 
first attending the Jobcentre for their IEI as part of the usual process of making a claim. Mr 
Talbot was required to attend in person to verify his ID as he had not completed this online 
via GOV.UK Verify. Had DWP been made aware of concerns about Mr Talbot’s ability to 
attend a DWP Jobcentre in person, a referral could have been completed for a home visit 
or support visit. 

Evidence  was  gathered  from  Mr Talbot  during  his IEI  on  28  January 2020.  The  outcome 
from the PYCA service indicated that Mr Talbot could be fast-tracked. This means that the 
case could be sent straight to a decision maker without needing to book a full HRT interview. 
A decision was made on 11 February 2020 that Mr Talbot was entitled to UC as he was a 
British Citizen or national of the Common Travel Area. This decision was communicated to 
Mr Talbot via his online journal on 11 February 2020. Mr Talbot was entitled to the standard 
allowance of UC and was paid from 24 January 2020. His payments continued until after his 
death.  

Homelessness  

Mr Talbot disclosed on his online application that he was in temporary accommodation that 
had  been  provided  to  him  by  the  local  authority.  As  Mr  Talbot  was  in  temporary 
accommodation and had made a new claim to UC, he was not entitled to receive an amount 
for his housing costs through his UC claim. In order to receive housing costs support, Mr 
Talbot needed to claim Housing Benefit from his local authority. Mr Talbot was still entitled 
to receive a standard allowance. 

 
 
 Measures for vulnerable claimants in accessing benefits  

The  DWP  is  committed  to  improving  the  service  we  provide  to  all  our  customers,  and  is 
continually looking at ways to support vulnerable claimants. This is to ensure claimants with 
complex needs are identified and supported appropriately.  

The  standard  process  for  making  and  maintaining  a  UC  claim  is  by  online  self-service. 
Where a claimant has someone with them who can help with their claim, online or by phone, 
it may not be reasonable for a DWP Visiting referral to be completed. A degree of judgement 
is applied to each situation when considering whether a referral to DWP Visiting is required. 
Where deemed reasonable and appropriate, a visiting officer is able to assist claimants by 
communicating answers provided by a claimant to the Service Centre Agent by phone.  

Assisted  Digital offers a  number of  support options  if  an  online  claim  cannot be made  or 
maintained  independently,  even  with  help  from  a  friend,  family  member  or  a  third  party. 
Assisted Digital support covers: 

•  coaching,  challenging  and  motivating  claimants  to  become  more  digitally 
competent - helping them to create, maintain and use their digital account 
recognising  when additional support  is  required and taking appropriate action 
to coach or signpost to additional support 

• 

Changes to ID verification process since 2021 

In  November  2021  we  changed  our  processes  around  ID  verification.  The  revised 
process  helps  to  strengthen  the  ID  verification  to  reduce  fraud  and  error.  We  have 
introduced  two-factor  authentication  by  SMS  or  email.  The  online  identity  check 
verifies the claimant’s identity by cross-referencing their personal information against 
a variety of background sources. As UC is a digital service, we are aiming to provide 
a remote option to verify ID where possible and safe to do so.   

Claimants who successfully verify their ID online may not be required to undertake  a 
full  IEI.  This  further  reduces  the  number  of  customers  that  we  ask  to  come  into  the 
Jobcentre.  

Where a claimant is unable to verify their ID online, they are no longer automatically 
directed to contact the UC helpline to book an appointment. Jobcentre agents are now 
responsible  for  booking  all  ID  appointments.  In  the  majority  of  cases,  claimants  will 
now be booked a biographical check by phone. Jobcentre agents have full access to 
the claimant’s account, including all answers provided by the claimant to the questions 
that  form  part  of  the  application  process.  Jobcentre  staff  are  trained  to  identify  and 
provide  support  to  customers  with  complex  needs.  If  a  claimant  indicates  that  they 
are in hospital, this should trigger the Jobcentre agent to invoke alternative processes 
for verifying ID.  

Conclusion 

The  Department  is  saddened  to  learn  of  Mr  Talbot’s  death.  As  a  Department  we  are 
committed to ensuring that claimants are given the right support at the right time. Where a 
claimant  is  unable  to  attend  a  DWP  Jobcentre  in  person  due  to  a  disability  or  health 
condition, reasonable adjustments can be made. This includes options such as a telephone 

 
 
 appointment, or requests for a home visit or support visit. Support visits can take place, for 
example, at a hospital.  

We are constantly reviewing the service we provide to claimants across all DWP services 
and  are  committed  to  improving  accessibility  for  all  our  customers,  especially  the  many 
vulnerable people who rely our services. As highlighted in our response, once we were fully 
aware of Mr Talbot’s circumstances, we made reasonable adjustments based on his needs. 
This was to enable Mr Talbot to manage and maintain his UC claim. Upon reviewing the full 
circumstances  of  this case  and  in  light  of  the  changes  made  in  November  2021,  we  are 
satisfied that the appropriate support is available to allow vulnerable claimants with complex 
needs to access benefits and, on that basis, we do not propose to take any specific actions 
or  make  any  changes  at  this  time  in  response  to  the  concerns  raised  by  HM  Assistant 
Coroner.    

Yours sincerely, 

DWP Area Director, Southern England

Sonia Hayes, 
Assistant Coroner 
Mid Kent and Medway  

Chief Executives Office  

Trust Headquarters 

Farm Villa 

Hermitage Lane 

Maidstone 

Kent 

ME16 9PH 

Website: www.kmpt.nhs.uk 

23 December 2021 

Dear Assistant Coroner Sonia Hayes 

Inquest into the death of Mr Terence Ronald Talbot 
Trust Response to the Regulation 28 Report to Prevent Future Death 

I write in response to the Regulation 28 Report dated 3rd December 2021, sent to Kent and Medway 
NHS Social Care Partnership Trust (KMPT) following the conclusion of the inquest into the very sad 
death of Mr Talbot on 9th April 2020. 

In your report to the Trust, you raised the following matter of concern: 

Chief Executive of Kent & Medway Social Care Partnership Trust on concerns relating to issues that 
Terence Talbot had begun to exhibit symptoms of a depressive phase of his Bipolar Affective Disorder just prior 
to his discharge back to psychiatric hospital at the end of November 2019. Issues relating to capacity to make 
specific decisions in relation to Terence Talbot’s care and treatment were not all subjected to formal Mental 
Capacity Act assessments when he was refusing medical interventions that were in his best interests in the 
clinical picture of an extremely rare and complex medical diagnosis that arose due to his reaction to prescribed 
medication to treat his mental disorder and evidence of increasing low mood and symptoms consistent with 
depression.  

As a Mental health organisation, we absolutely recognise the importance of looking after the physical 
health  needs  of  our  patients.  We  are  fully  committed  to  working  collaboratively  with  our  acute  trust 
colleagues to ensure our patients receive holistic care for their physical and mental health needs in an 
integrated manner from us and our partner organisations in Kent.   

We have identified a need for more joined  up  working  with Maidstone and Tunbridge Well NHS trust 
(MTW)  particularly  when  it  comes  to  accessing  care  for  physical  health  for  our  in-patients  at  the 
Priority  House  site  in  Maidstone.  Majority  (80%)  of  our  in-patients  are  detained  under  the  Mental 
Health Act (MHA) and present  with complex psychiatric  morbidity which puts further responsibility on 
us to ensure their  physical  health  needs are  met as often they are too unwell to recognise and seek 
appropriate help.  

We are proud to be smoke free                 

 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
  
 
 
 
 
  
 We have started to work in partnership with our acute hospitals in Kent to streamline pathways of care 
for this hugely complex cohort of patients requiring treatment at acute hospitals during their period of 
in-patient stay with us.  

We  are  also  very  cognisant  of  the  fact  that  it  is  extremely  important  for  us  to  thoroughly  assess 
capacity and to document it when any of our patients are refusing to accept treatment for their physical 
health  conditions.      More  importantly,  we  recognise  the  importance  of  engaging  with  families  and 
seeking their support with situations where the patient might appear to be refusing  care and treatment 
for a deteriorating physical health condition, in the same manner as we do for psychiatric conditio ns.  

We have made significant progress on the two areas; integrated physical and mental health care and 
capacity assessment for physical health interventions that had an adverse impact on the care provided 
to Mr Talbot. The steps taken and progress made since Mr Talbot’s death are described below:  

1)  A new initiative is being progressed, which will mitigate the risk of disjointed working with MTW, 
and  will  allow  for  seamless  communication  between  our  in-patient  services  and  MTW.  This 
initiative  is  being  jointly  developed  and  is  jointly  owned  by  KMPT  and  MTW  and  involves 
dedicated staff from MTW providing timely advice and guidance to  our staff on physical health 
conditions and a streamlined route for admissions to an MTW bed when required.  

2)  A robust monitoring of Mental Capacity Assessment of patients under our care is conducted via 
Mental Health Act Committee  (led  by the Chief Medical Officer and  reporting to Trust Board) 
thereby ensuring the  highest  level of scrutiny around  this. Assurance on this is provided via a 
Clinical  Quality check  (CLiQ check) process  across all our services particularly the in-patient 
services.  Since  September  2021  we  have  implemented  a  streamlined  process  for  Mental 
capacity  assessment  which  was  developed  using  Quality  Improvement  methodology  by  our 
Quality  Improvement  team.  This  has  resulted  in  significant  improvement  in  completion  and 
documentation of Mental Capacity Assessments and Best Interest decisions where capacity is 
lacking.  

3)  The Mental Capacity Act (MCA) training for the organisation is closely monitored, again via the 
Mental Health Act Committee. MCA training is  mandatory for all our clinical staff  and  we are 
currently at ninety percent completion rate for this training.  

4)  KMPT has signed a Service level agreement with MTW to support patients detained under the 
Mental  Health  Act  receiving  treatment  at  MTW  for  their  physical  health  needs.  A  training 
package is being delivered to MTW staff by the Mental Health Act  compliance manager. This 
will  significantly  improve  the  understanding  of  the  needs  of  patients  with  complex  psychiatric 
conditions admitted to MTW.  

We are sincerely sorry for the shortcomings in our care of Mr  Talbot and are committed to ensuring 
that the improvements we have made are sustained.  

I  hope  that  the  detailed  information  provided  offers  you  a  level  of  assurance  about  both  the 
seriousness  with  which  we  have  received  and  responded  to  your  concerns,  and  the  significant 
improvements we have made since the sad passing of Mr Talbot. 

 
 
 
 
 We are, as always, happy to provide further information or evidence if that would be helpful. 

Yours sincerely 

Chief Executive

8th February 2022 

Private & Confidential  
Ms Sonia Hayes  
HM Assistant Coroner Mid Kent and Medway 

Sent via email: 
kentandmedwaycoroners@kent.gov.uk 

Dear Madam 

Chief Executive 
Maidstone and Tunbridge Wells NHS Trust 
Maidstone Hospital 
Hermitage Lane 
Maidstone, ME16 9QQ 

Response to Regulation 28 Prevention of Future Deaths Report: Mr Terence Talbot (Deceased) 
Conclusion of Inquest: 20th – 23rd September 2021 

I  write  further  to  the  above  Report  dated  3rd  December  2021  and  detail  the  Trust’s  formal 
response below.   

I hope that this reply will be helpful in detailing the actions taken to address the matters of concern in 
your report.  

As  you  will  be  aware  the  Trust  provided,  and  spoke  to  an  Action  Plan  at  the  Inquest  hearing  in 
September 2021 in response to the issues identified by the Court and the experts you had instructed. 
These  actions  have  been  recorded  in  the  Trust’s  Incident  Reporting  system  (DATIX),  to  ensure 
colleagues are sighted on the changes that have been and are being implemented (please see below). 
I hope the Court and the family of Mr Talbot take assurance from the commitments set out in the plan 
as well as those noted below. 

In addressing the concerns you have raised, the Trust have also taken additional steps to strengthen 
our existing multi-professional day to day working with Kent and Medway Social Care Partnership Trust 
(KMPT).  I have set out further detail on the steps being taken as part of our response to this report.   

 I will now respond in turn to the concerns raised regarding Maidstone and Tunbridge Wells NHS Trust 
(MTW).  

Concern 1: The lack of consideration of specialty dermatology referral with deteriorating severe 
exfoliative dermatitis in a rare and complex diagnosis.  

Response 
Awareness and escalation techniques form part of training that is delivered to nursing colleagues.   As 
identified  within  the  hearing,  the  Trust,  (albeit  not  in  a  timely  manner),  did  obtain  community 
dermatology  opinion  and  support  (the  Court  will  recall  that  the  Trust  does  not  provide  dermatology 
services itself). 

With regards to  referral pathways  and specialty dermatology referrals,  the Trust’s  Clinical  Director for 
specialist  medical  services  has  been  asked  to  nominate  a  lead  clinician  to  review  the  pathway  into 

 
 
 
 
 dermatology  services  for  critical  diseases,  to  ensure  there  is  clarity  regarding  urgent  and  non-urgent 
cases.    It  is  expected  that  the  identified  clinician  will  take  up  this  role  in  by  the  end  of  this  month. 
Scoping  the  option  of  including/contracting  East  Kent  Hospitals  University  Foundation  Trusts 
Dermatology Services into our current pathway will form part of this clinicians’ commission. Once this 
has been completed additional training will be commissioned by the Trust to increase the awareness to 
our staff regarding the services & pathways which are available. The objective of this training will be to 
ensure that there is Trust wide awareness of available support systems in relation to dermatology.   

To further support staff the Trust has Matron cover in place seven days a week, which ensures senior 
support and presence on site. This role supports staff within departments and includes assistance with 
referrals and escalation as required.   

The dermatology issues identified in this case have been fed back to the dermatology services.  In turn, 
the learning from this case is being used as an educational tool.  

Concern 2: There was a lack of regular dietitian input with malnutrition.  

Response 
The Court received evidence at the Inquest around the patient’s engagement with the Trust’s dietitians.   
The Court will recall that Mr Talbot was deemed by our staff to have capacity, however issues around 
capacity assessments were noted to have contributed to the lack of regular dietitian input.   

The Trust recognises the importance of adequate nutrition in order to promote patient recovery. 
With  regards  to  ensuring  vigilance  around  nutrition,  the  following  summary  sets  out  the  Trust’s 
assurance  in  respect  of  this  concern.    The  actions  noted  below  have  been  further  captured  on 
DATIX in order to promote awareness and learning and enable monitoring of implementation:  

▪  All patients continue to have a Malnutrition Universal Screening Tool (MUST) score completed on 
admission and weekly thereafter to detect any deterioration and ensure dietetic intervention;   

▪  An  electronic  patient  records  system  (Sunrise)  was  introduced  in  Summer  2020  with  the  electronic 

recording of MUST, this system allows for better monitoring of the findings of the MUST;  

▪  Ward  training  of  nursing  staff  by  the  Dietetics  Department  was  suspended  during  2020  due  to 

Covid pressures however, the Trust is now recommencing these training sessions; 

▪  Dietitians  have  been  attending  Clinical  Support  Worker  (CSW)  training  days  monthly  to  teach  MUST, 

escalation and outline support available; 

▪  Audits of MUST completion continue to be undertaken.  The next one is scheduled to be carried out in 

March 2022 to ascertain changes to practice and any further training required.  

▪  Ward-based therapy assistants are being recruited.  Their focus will also include assisting patients with 

eating and drinking and speech and language therapy.  

In order to  ensure  comprehensive  learning from this matter,  and  as  part of the  MDT  discussions with 
our neighbouring mental health Trust, the Trust is committed to ensuring further vigilance with regards 
to the monitoring of food charts for inpatients with physical and mental health needs.   

Concerns  3:  The  evidence  was  the  focus  was  on  problems  relating  to  discharge  rather  than 
treatment during multidisciplinary meetings. 

Response 
The Trust has explored the improvement of treatment pathways of inpatient care when patients are 
under dual care of KMPT and MTW. A meeting has taken place between both Trusts to discuss safety 

Trust Headquarters: Maidstone Hospital, Hermitage Lane, Maidstone, Kent ME16 9QQ 

 
 
 
            
 
 
 
 
 
 
 
 
 
 
 
 
 netting, with further meetings planned.  To date, the following agreements have been discussed by the 
medical directors at each organisation: 

▪  The  Trust  will  work  with  KMPT  on  an  initiative  which  will  aim  to  strengthen  communications  and 
mitigate risks to patients who receive care from both organisations. This initiative will be developed 
and managed by both Trusts and will provide clarity regarding joint treatment pathways.    

▪  KMPT  has  signed  a  service  level  agreement  with  MTW  to  support  patients  detained  under  the 
Mental Health Act receiving treatment at MTW for their physical health needs. A training package is 
being  delivered  to  MTW  ward  based  nursing  and  medical  staff  by  KMPT  Mental  Health  Act 
compliance manager. This will significantly improve the understanding of the needs of patients with 
complex psychiatric conditions admitted to MTW.  

Concern 4: Issues relating to capacity to consent to, or refuse treatment were not all subjected 
to mental capacity assessments. 

Response 
The  Court  is  respectfully  advised  that  the  Trust  has  commissioned  an  audit  into  its  consent  and 
capacity practices.  The external Trust Auditor has found that the Trust is broadly performing well.  The 
recommendations from this review have been discussed by the Directorate leads and taken forward as 
part of the DATIX action plan noted above.   

Further, the Trust has introduced a new clinical advisor role as the lead clinician on capacity.  The Trust 
has also appointed a new Mental Capacity Act clinical practitioner who will be available to assist the 
wards in dealing with complex cases. These leads will strengthen our oversight in ensuring the 
appropriate considerations around capacity are comprehensively covered. 

Along with the above training, the Trust continues to provide tailored, bespoke training sessions to all 
staff  regarding  the  vital  importance  of  capacity  assessments.    Again,  regular  audit  and  monitoring  is 
being applied Trust wide. Such training is mandatory for each clinical member of staff.   

Thank you for bringing your concerns to my attention. Whilst I do not seek to detract from the concerns 
raised,  I  hope the  above detail  provides  assurance that the Trust  has  taken these  concerns  seriously 
and will continue to deliver the actions outlined in our response. In addition, the implementation of these 
actions will be monitored and any lessons learned will  be shared in order to improve the services we 
offer to all our patients. 

I am very happy to discuss or clarify any of the above points.  

With  the  Court’s  permission  I  would  like  to  share  this  response  with  Mr  Talbot’s  family  and  seek  the 
Court’s agreement to this. 

Yours sincerely 

Chief Executive 

Trust Headquarters: Maidstone Hospital, Hermitage Lane, Maidstone, Kent ME16 9QQ