Prevention of Future Deaths reports · 2023

Winbourne Charles

Regulation 28 report to prevent future deaths, reference 2023-0143, written 28 Apr 2023. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report28 Apr 2023
Reference2023-0143
DeceasedWinbourne Charles
CoronerGraeme Irvine
Coroner areaEast London
CategorySuicide (from 2015)
Sourcejudiciary.uk record · original PDF
Responses published2

The report

Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.

Action Plan Title:  Regulation 28 Report to Prevent Future Deaths, 1091 

Start Date: May 2023 

Action Plan Owner:  

Target Date: July 2023 

Priority:  High  
Business Unit:  Acute and Rehab Directorate 

Service/Team: 

Directorate:  ARD  

NELFT Action Plan 

     Clinical Audit 

Source:  Complaints 
Serious Incident        Medicines Management  
External Inspection 
Summary of the concerns of the Coroner:  

  Dashboard 

   Other  Regulation 28 

    External Inspection 

 Infection Control 

     Internal Inspection 
     H&S 

     QPS 

     Internal Audit 
     Serious Case Review 

     Safeguarding 

     Safety Thermometer 

1.  Risk assessment (lack of appropriate consideration of risks) – the Coroner found that poor record keeping and a failure to read electronic records 
meant that important information was not considered at a Multi-Disciplinary Team (MDT) ward round on 06 April 2021. The MDT arrived at a conclusion 
that Mr Charles’ risk of self-harm was “no risk”. A psychologist’s assessment on the clinical record that assessed Mr Charles risk of the self-hard as 
high on 31 March 2021 was neither read nor incorporated into the MDT discussion.  

2.  Risk management (inappropriate care plan) – the Coroner found that a decision to reduce observation frequency made by the MDT on 6 April 2021 

was not supported by the Trust Policy guidance which indicated that enhanced observations were appropriate.  

3.  Risk management (lack of adherence to care plan) – the Coroner found that observations between 16.00 and 17.00 on the day of Mr Charles’ death 

were suspended by the ward shift co-ordinator. The decision meant all patients subject to general observation on the ward were ignored.  

4.  Risk  management  (shortcomings  in  responding  to  the  emergency)  –  the  Coroner  found  that  the  Trust  did  not  respond  to  the  cardiac  arrest 
adequately, and that the Trust itself described the emergency response as chaotic, that Trust staff agreed that they “panicked” and did not follow policy; 
specific issues include; 

a.  A ward emergency bell was not sounded. 
b.  An anti-barricade key was not used to open Mr Charles’ door, instead the door was forced open causing risk of harm to Mr Charles. 
c.  A ligature cutter could not be used promptly as it was secured in a box with a combination lock – staff did not know the combination. 
d.  Duty doctors were not called promptly. 
e.  Oxygen administration was delayed. 
f.  An on-site defibrillator was not used by staff. 
g.  Staff could or would not provide clear and relevant history to paramedics. 

Regulation 28 action plan  

 
 
 
 
    
     
 
 
 
 
 
 5.  Poor record keeping – the Coroner found that: 

a.  Two Trust witnesses declined to answer questions put to them regarding whether their observation records were truthful. 
b.  Observation records appeared to have been created utilising a “cut and paste” function. 
c.  Records often inaccurately recorded the prescribed frequency of observation. 
d.  Factually inaccurate entries were made in the record following Mr Charles’ death. On 11 April 2021 an entry stated that Mr Charles was “Awake 
in his bedroom sitting on his bede (sic)” at 07.21. On 12 April 2021 two entries made at 9.48 and 11.40 recorded that Mr Charles was alive and 
well. Senior Trust witnesses characterised these entries as dishonest. 

6.  Lack of learning from the incident – the Coroner found that: 

a.  A Datix incident report created on the evening of 10 April 2021 by a senior nurse and Modern Matron contained misleading information that 

suggested that emergency response policies were followed when in fact they were not. 

b.  The Datix failed to mention the observations had been suspended by the shift coordinator, a fact that was understood at that time. This obvious 

and significant piece of information that should have been escalated through the Trust governance team for action. 

c.  The Trust 72-hour report was written by the Modern Matron and was signed-off by an integrated care director on 15 April 2021. This document 

also failed to identify or escalate the significant issue of suspension of observation at 16.00 on 10 April 2021. 

d.  The Trust SI report presented to the inquest failed to address the poor risk assessment or inadequate Datix & 72-hour reports. 

Act
ion 
no. 
1. 

Concern raised by 
the Coroner 

1.  Risk assessment 
(lack of appropriate 
consideration of 
risks) – the Coroner 
found that poor 

Action (short form) 

Action  
(long form) 

Handovers and daily run through to 
take place using live RiO 

1.  Matrons, Ward Managers and 

Consultant Psychiatrists to be made 
aware that this needs to be in place 
2.  To be audited to ensure compliance 

By Whom 

By   When 

DON/AMD 

June 2023 

Regulation 28 action plan  

 
 
 
 
 
 
 
 
 
 
 2.  MDT/Ward Round to use live RiO 

1.  Matrons, Ward Managers and 

DON/AMD 

June 2023 

Care plans and risk assessments 
to be reviewed and updated as a 
result of this meeting 

Trust to move from current 
Assessment of suicide risk in 
mental health practice: shifting 
from prediction to therapeutic 
assessment, formulation, and risk 
management 

Consultant Psychiatrists to be made 
aware that this needs to be in place 
2.  To be audited to ensure compliance 
3.  To be audited through above audit 

process 

Matrons 

June 2023 

Task and Finish Group including Users 
of Service, Carers and Experts by 
Experience has been set up  

Executive Chief 
Nursing Officer  

December 2023 

3.  Observation training to be 

1.  Observation training available delivered 

DON/ADON 

June 2023 

refreshed to ensure this is explicit 

The Safe and Supportive 
Observations Policy includes this 
already but needs to be more 
explicit in training 

by DON and ADON 

2.  At a glance appendix from Safe and 

Supportive Observations to be shared 
again 

3.  Ward Managers to discuss in safety 

huddles and meetings 

4.  Medical staff to attend training 

Matrons 

June 2023 

AMD 

June 2023 

record keeping and a 
failure to read 
electronic records 
meant that important 
information was not 
considered at a Multi-
Disciplinary Team 
(MDT) ward round on 
06 April 2021. The 
MDT arrived at a 
conclusion that Mr 
Charles’ risk of self-
harm was “no risk”. A 
psychologist’s 
assessment on the 
clinical record that 
assessed Mr Charles 
risk of the self-hard 
as high on 31 March 
2021 was neither 
read nor incorporated 
into the MDT 
discussion. 

2.  Risk 
management 
(inappropriate care 
plan) – the Coroner 
found that a decision 
to reduce observation 
frequency made by 
the MDT on 6 April 
2021 was not 
supported by the 
Trust Policy guidance 
which indicated that 
Regulation 28 action plan  

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 enhanced 
observations were 
appropriate. 

Following the Inquest an 
independent review commissioned 
to review the clinical decision made 
by the MDT.  

Independent Review commissioned by the Chief 
Nursing Officer  

Chief Nursing 
Officer  

October 2023  

3.  Risk 
management (lack 
of adherence to care 
plan) – the Coroner 
found that 
observations between 
16.00 and 17.00 on 
the day of Mr Charles’ 
death were 
suspended by the 
ward shift co-
ordinator. The 
decision meant all 
patients subject to 
general observation 
on the ward were 
ignored.3. Risk 
management and 
record keeping. 

4.  Risk 
management 
(shortcomings in 
responding to the 
emergency) – the 
Coroner found that 
the Trust did not 
respond to the 
Regulation 28 action plan  

4.  The 

Safe 

Supportive 
and 
Observations Policy does not allow 
for  this  to  happen.  However,  if  this 
becomes  an  issue  due  to  teams 
being  short  staffed  then  escalation 
needs to be clearer 

1.  Review of Policy to encompass escalation 

DON 

May 2023 

process 
2.  Professional 

accountability, 

referrals 
made to professional board based on the 
new  information  which  came  out  during 
inquest.  

3.  Refresh  of  training  to make  this  process 

explicit.  

DON 

DON  

May 2023 

June 2023  

5.  Resus drills which include all of 
these elements are taking place 
monthly. 

1.  Resus drills to take place monthly 

Matrons 

May 2023 

2.  Review of the quality of Resus Drills 

3.  Review of action plans following Resus 

drills 

4.  Refresh staff on Cardiac checklist as part 

of the above 

Resus 
Officer/DON 

DON 

July 2023 

June 2023 

 
 
 
 
 
 
 
 
 
 
 5.  Refresh staff as part of the above on 
whereabouts of Ligature cutters (2 on 
each ward) 

6.  Coordinator would provide all clinical 
details to paramedic on their arrival. 

Matrons 

Matrons 

June 2023 

June 2023 

Matrons 

June 2023 

6.  The ERT alarm should be sounded 
in all ward emergency situations 
and the ERT team will respond 

1.  Roll call which happens daily will pick 

this up and remind staff that this includes 
medical emergencies 

2.  To ensure ERT response is robust and 

timely 

Matrons /Duty 
Coordinators 

June 2023 

7.  All bunches of keys have an anti 

1.  Anti barricade keys to be picked up in 

Matrons 

June 2023 

barricade key on them. Key audits 
have taken place in 2023 

Resus drills 

2.  Audits of staff awareness of anti 

barricade key function to take place  

July 2023 

8.  There are 2 ligature cutters on 

1.  Ligature cutter training to be refreshed 

every ward, one in a combination 
box and one in the grab trolley 

2.  To be identified as part of the monthly 

Resus Drill 

DON/Clinical 
Effectiveness 
Team 

Matrons 

July 2023 

June 2023 

9.  Duty Dr should be alerted as a 
result of the ERT alarm 

1.  Medical staff to be reminded of response 

AMD 

June 2023 

in relation to the ERT alarm 

cardiac arrest 
adequately, and that 
the Trust itself 
described the 
emergency response 
as chaotic, that Trust 
staff agreed that they 
“panicked” and did 
not follow policy; 
specific issues 
include; 

a. A ward emergency 
bell was not sounded. 

b. An anti-barricade 
key was not used to 
open Mr Charles’ 
door, instead the door 
was forced open 
causing risk of harm 
to Mr Charles. 
c. A ligature cutter 
could not be used 
promptly as it was 
secured in a box with 
a combination lock – 
staff did not know the 
combination. 
d. Duty doctors were 
not called promptly. 

Regulation 28 action plan  

 
 
 
 
 
 
 
 
 
 e. Oxygen 
administration was 
delayed. 

f. An on-site 
defibrillator was not 
used by staff. 

g. Staff could or 
would not provide 
clear and relevant 
history to paramedics. 

10.  This is already in ILS training which 
is mandatory for all ward staff 

11.  This is already in ILS training which 
is mandatory for all ward staff 

1.  Resus drills to be carried out monthly 

Matrons 

June 2023 

1.  To be addressed in Resus drills monthly  Matrons 

June 2023 

12.  The use of the SBARD tool is 

1.  To be addressed in Resus drills monthly  Matrons 

June 2023 

included in ILS training and is a 
recognised method of handing over 
patients. 

The Adult Cardiac Checklist is in all 
the grab bags and included in ILS 
training and provides another 
framework for handing over cardiac 
incidents. 

5.  Poor record keeping – the Coroner found that: 

13.  Staff involved were exercising their 

1.  Revisit original evidence provided to the 

DON/HR 

June 2023 

SI report. 

2.  Review if disciplinary criteria met. 
3.  Referral to NMC 

legal right not to self-incriminate 
when answering questions at an 
inquest. 

In relation to the NMC Code of 
Conduct this does not meet the 
criteria of Professional and Honest 
in relation to the Registered 
Nurses. 

a. Two Trust 
witnesses declined to 
answer questions put 
to them regarding 
whether their 
observation records 
were truthful. 

Regulation 28 action plan  

 
 
 
 
 
 
 14. 

b. Observation 
records appeared to 
have been created 
utilising a “cut and 
paste” function. 

Cut and paste should not be used 
in any part of the EPR 

15.  Record keeping training is 

available and audits take place 

1.  Observation records to be revisited in 

DON/Matron 

June 2023 

this case and any actions to be reviewed 
in relation to staff 

2.  Observation training to be explicit 
3.  Review of Electronic Observation 

functionality 

1.  Observation training 
2.  Audits of records by Matrons 
3.  To be addressed in supervision 
4.    Review of Electronic Observation     
functionality 

DON/Matron 

June 2023 

16. 

1.  To be reviewed and action to be taken 

DON/HR 

June 2023 

HR action to be reviewed. 

on staff who completed these 

2.  Disciplinary process 
3.  Referral to NMC if required 

c. Records often 
inaccurately recorded 
the prescribed 
frequency of 
observation. 

d. Factually 
inaccurate entries 
were made in the 
record following Mr 
Charles’ death. On 11 
April 2021 an entry 
stated that Mr 
Charles was “Awake 
in his bedroom sitting 
on his bede (sic)” at 
07.21. On 12 April 
2021 two entries 
made at 9.48 and 
11.40 recorded that 
Mr Charles was alive 
and well. Senior Trust 
witnesses 
characterised these 
entries as dishonest. 

Regulation 28 action plan  

 
 
 
 
 
 
 
 
 6.  Lack of learning from the incident – the Coroner found that: 

a. A Datix incident 
report created on the 
evening of 10 April 
2021 by a senior 
nurse and Modern 
Matron contained 
misleading 
information that 
suggested that 
emergency response 
policies were followed 
when in fact they 
were not. 
b. The Datix failed to 
mention the 
observations had 
been suspended by 
the shift coordinator, 
a fact that was 
understood at that 
time. This obvious 
and significant piece 
of information that 
should have been 
escalated through the 
Trust governance 
team for action. 

c. The Trust 72-hour 
report was written by 
the Modern Matron 
and was signed-off by 
an integrated care 
director on 15 April 
Regulation 28 action plan  

17. 

Review of SI report and HR 
processes. 

1.Revisit original evidence provided to the SI 
report. 
2.Review if disciplinary criteria met. 
3.Referral to NMC if required 

SI team 

July 2023 

DON  

May 2023 

18.  The suspension of safe and 

supportive observations is not an 
agreed response in any situation. 
Where providing observations is 
challenged by short staff or other 
issues this should be escalated 
through line management 
structure. 

19.  The 72 hour report is what is 

known about an incident at that 
point in time, the investigation 

1.  Safe and Supportive Observations policy 
has been reviewed to make escalation of 
this clear, to be shared through 
Leadership Team meetings, team 
meetings and individual supervision 

DON 

June 2023 

1.  Review of SI processes 

SI Team 

July 2023  

SI Team  

June 2023 

 
 
 
 
 
 
 
 
 
 
 
 
 report SI or local is the method of 
identifying further learning. 

2.  Implementation of new PSIRF 

framework, all 72hr reports will be 
reviewed and signed off by the panel. 

20.  To be addressed by the SI team 

        1.Review of SI processes 

SI Team 

July 2023. 

        2.Implementation of new PSIRF framework 

2021. This document 
also failed to identify 
or escalate the 
significant issue of 
suspension of 
observation at 16.00 
on 10 April 2021. 

d. The Trust SI report 
presented to the 
inquest failed to 
address the poor risk 
assessment or 
inadequate Datix & 
72-hour reports. 

Regulation 28 action plan
Also filed under 2023-0143: Winbourne-Charles-Prevention-of-future-deaths-report-2023-0143_Published.pdf
MR G IRVINE 

SENIOR CORONER 

EAST LONDON 

REGULATION 28:  REPORT TO PREVENT FUTURE DEATHS (1) 

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS 

THIS REPORT 15 BEING SENT TO: 

• 

Foundation Trust 

  Acting  Chief  Executive  Officer,  North  East  London 

•  Rt Hon Steve Barclay MP, Secretary of State for Health & Social Care 

1 

CORONER 

I am Graeme Irvine, senior coroner, for the coroner area of East London 

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. 
htt12:LLwww.legislation.gov.ukLuk12gaL2009L25Lschedu1eLSL12aragra12hL7 
htt12:LLwww.legislation.gov.ukLuksiL2013L1629L12artL7Lmade 

3 

INVESTIGATION and INQUEST 

On 11 th  April 2021  this Court commenced an investigation into the death of Winbourne 
Gregory Charles, aged 58.  The investigation concluded at the end of the inquest held 
before a jury between the 17th and 21 st April 2023. The Court returned a conclusion of: 

"Suicide, contributed  to by neglect,  to which  failures  in  medical  intervention contributed 
and to which failures to respond to an obvious risk of self-harm contributed." 

Mr Charles' medical cause of death was determined as; 

 
 
 
 
 
 1a Suspension 

4 

CIRCUMSTANCES OF THE DEATH 

Winbourne Gregory Charles was a admitted into hospital under section 2 of the Mental 
Health Act 1983 in November 2020 following an attempt to take his own life. In 
December 2020 on a diagnosis of depressive illness incorporating psychotic symptoms, 
Mr Charles was made subject to an order under section 3 of the Mental Health Act 1983. 

On 10111  April 2021  Mr Charles was found unresponsive, suspended 

 on the mental health ward. 

5 

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 could 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.  A failure to adequately assess risk of harm - Poor record keeping and a failure 
to read electronic records meant that important information was not considered 
at a Multi-Disciplinary Team ("MDT") ward round on 6th April 2021 . The MDT 
arrived at a conclusion that Mr Charles' risk of self-harm was "no risk".  A 
psychologist's assessment on the clinical record that assessed Mr Charles risk 
of self-harm as high on 31/3/21  was neither read nor incorporated into the MDT 
discussion. 

2.  A decision to reduce observation frequency made by the MDT on 6/4/21  was not 

supported by the Trust Policy guidance which indicated that enhanced 
observations were appropriate. 

3.  A failure to ensure that a treatment plan was followed - observations between 
16.00 and 17.00 on the day of Mr Charles' death were suspended by the ward 
shift co-ordinator. The decision meant all patients subject to general observation 
on the ward were ignored. 

4.  Failures to  respond to an emergency adequately - The Trust described the 

emergency response as chaotic . Staff agreed that they "panicked" and did not 
follow policy, specific issues include; 

a .  A ward emergency bell was  not sounded, 
b.  An anti-barricade key was not used to open Mr Charles' door, instead 

the door was forced open causing a risk of harm to Mr Charles. 

C.  A ligature cutter could  not be used promptly as it was secured in a box 

with a combination lock - staff did not know the combination, 

d .  Duty doctors were not called  promptly, 
e.  Oxygen administration was delayed, 
f.  An on-site defibrillator was not used by staff 
g.  Staff could or would not provide a clear and relevant history to 

paramedics. 

5.  The credibility of evidence provided by Trust staff. 

a.  Two Trust witnesses declined to answer questions put to them 
regarding whether their observation records were truthful. 

b.  Observation records appeared to have been created utilising a "cut and 

2 

 
 paste" function. 

C.  Records often inaccurately recorded the prescribed frequency of 

observation. 

d .  Factually inaccurate entries were made in the record following Mr 

Charles' death. On 11 th April 2021  an entry stated that Mr Charles was, 
"Awake in his bedroom sitting on his bede (sic)" at 07.21 .  On 12th  April 
two entries made at 9.48 and 11 .40 recorded that Mr Charles' was alive 
and well. Senior Trust witnesses characterised these entries as 
dishonest. 

6.  Governance process failings. 

a .  A datix incident report created on the evening of 10th April 2021  by a 

senior nurse and Modern Matron contained misleading information that 
suggested that emergency response policies were followed when in fact 
they were not. 

b.  The Datix failed to mention that observations had been suspended by 
the shift coordinator,  a fact that was understood at that time. This 
obvious and significant piece of information that should have been 
escalated through the Trust governance team for action. 

C.  The Trust 72 hour report was written by the Modern Matron and was 
signed-off by an integrated care director on 15th April 2021. This 
document also failed to identify or escalate the significant issue of the 
suspension of observation at 16.00 on 10th April 2021 . 

d.  The Trust SI report presented to the inquest failed to address the poor 

risk assessment or inadequate datix & 72 hr reports. 

6 

ACTION SHOULD BE TAKEN 

In my opinion action should be taken to prevent future deaths and I believe you 
[AND/OR 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 23/06/2023. 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 the following  Interested 
Persons, the family of Mr Charles; the Care Quality Commission; The Nursing & 
Midwifery Council; the General Medical Council; the Metropolitan Police Service. I have 
also sent it to the local Director of Public Health who may find it useful or of interest. 

Mr Charles' family . 

The Nursing and Midwifery Council 

•
•  The Care Quality Commission. 
•
•  The General Medical Council 
•  The Metropolitan Police Service 
•  The local Director of Public Health 

I am also under a duty to send a coov of your response to the Chief Coroner and all 

3 

 interested persons who in my opinion should receive it. 

I may also send a copy of your response to any other person who I believe may find it 
useful or of interest. 

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 tim 
the release or the publication of your response. 

f your response, about 

9 

[DA TE]  28/04/2023 

[SIGNED BY CORONER] 

4

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 Department of Health and Social Care (PDF)
From Maria Caulfield MP 
Parliamentary Under Secretary of State 
Department of Health & Social Care 

39 Victoria Street 
London 
SW1H 0EU 

10 May 2024  

Mr G Irvine  
Senior Coroner  
East London Coroner's Court  
Queens Road  
Walthamstow  
London  
E17 8QP  

Dear Mr Irvine,  

Thank you for your Regulation 28 report to prevent future deaths dated 28 April 2023 about 
the death of Winbourne Gregory Charles.  I am replying as the Minister with responsibility 
for mental health and patient safety.       

Firstly, I would like to say how saddened I was to read of the circumstances of Winbourne’s 
death and I offer my sincere condolences to his family and loved ones. The circumstances 
your report describes are concerning and I am grateful to you for bringing these matters to 
my attention. Please accept my sincere apologies for the significant delay in responding to 
this matter.  

Your report raises concerns over the provision and coordination of care that Winbourne 
received at North East London NHS Foundation Trust, which are mainly for the Trust to 
address. I understand that the Trust has already carefully considered the matters of 
concern in your report and has provided you with a comprehensive response as well as a 
copy of its action plan setting out the actions to be taken to improve care quality and patient 
safety.  

From a national perspective, I would add that we published a new 5-year Suicide 
Prevention Strategy for England on 11 September with over 130 actions that we believe will 
make progress towards our ambition to reduce the suicide rate within two and a half years. 
The strategy is a call to action for national and local government, the health service, the 
VCSE sector, employers and individuals to work together to help prevent suicides.  

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

Yours sincerely, 

MARIA CAULFIELD
Response from North East London Foundation Trust (PDF)
PRIVATE  & CONFIDENTIAL  

Mr Graeme Irvine  
HM Senior Coroner 
East London Coroners Court  
124 Queens Road 
Walthamstow, London 
E17 8QP 

Acting Chief Executive 
Trust Head Office 
West Wing 
CEME Centre 
Rainham 
Essex 
RM13 8GQ 

 22 June 2023 

Dear Sir 

Re: Inquest touching upon the death of Winbourne CHARLES  

I refer to your Regulation 28 report dated 28 April 2023, issued in respect of your concerns regarding the 
risk of future deaths. 

Concerns  

At the conclusion of the hearing into the death of Winbourne Charles, you expressed concern regarding 
the following matters: 

1.  A failure to adequately asses risk of harm - Poor record keeping and a failure to read electronic 

records meant that important information was not considered at a Multi-Disciplinary Team (MDT) 
ward round on 06 April 2021. The MDT arrived at a conclusion that Mr Charles’ risk of self-harm 
was “no risk”. A psychologist’s assessment on the clinical record that assessed Mr Charles’ risk 
of the self-hard as high on 31 March 2021 was neither read nor incorporated into the MDT 
discussion 

2.  A decision to reduce observation frequency made by the MDT on 6 April 2021 was not supported 
by the Trust Policy guidance which indicated that enhanced observations were appropriate.  

3.  A failure to ensure that a treatment plan was followed - observations between 16.00 and 17.00 on 
the day of Mr Charles’ death were suspended by the ward shift co-ordinator. The decision meant 
all patients subject to general observation on the ward were ignored.  

4.  Failure to respond to an emergency adequately - The Trust described the emergency response as 
chaotic,  that  Trust  staff  agreed  that  they  “panicked”  and  did  not  follow  policy,  specific  issues 
include; 

a.  A ward emergency bell was not sounded. 
b.  An anti-barricade key was not used to open Mr Charles’ door, instead the door was forced 

open causing risk of harm to Mr Charles. 

c.  A ligature cutter could not be used promptly as it was secured in a box with a combination 

lock – staff did not know the combination. 

www.nelft.nhs.uk 

 
 
 
 
 
 
 
 
 
 
 
 
 
  
  
 
 
 
 
  
                                     
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 d.  Duty doctors were not called promptly. 
e.  Oxygen administration was delayed. 
f.  An on-site defibrillator was not used by staff. 
g.  Staff could or would not provide a clear and relevant history to paramedics. 

5.  The credibility of evidence provided by Trust staff. 

a.  Two  Trust  witnesses  declined  to  answer  questions  put  to  them  regarding  whether  their 

observation records were truthful. 

b.  Observation records appeared to have been created utilising a “cut and paste” function. 
c.  Records often inaccurately recorded the prescribed frequency of observation. 
d.  Factually inaccurate entries were made in the record following Mr Charles’ death. On 11 
April 2021 an entry stated that Mr Charles was “Awake in his bedroom sitting on his bede 
(sic)” at 07.21. On 12 April 2021 two entries made at 09.48 and 11.40 recorded that Mr 
Charles  was  alive  and  well.  Senior  Trust  witnesses  characterised  these  entries  as 
dishonest. 

6.  Governance process failings.  

a.  A  Datix  incident  report  created  on  the  evening  of  10  April  2021  by  a  senior  nurse  and 
Modern  Matron  contained  misleading  information  that  suggested  that  emergency 
response policies were followed when in fact they were not. 

b.  The Datix failed to mention that observations had been suspended by the shift coordinator, 
a fact that was understood at that time. This obvious and significant piece of information 
that should have been escalated through the Trust governance team for action. 

c.  The  Trust  72-hour  report  was  written  by  the  Modern  Matron  and  was  signed-off  by  an 
integrated care director on 15 April 2021. This document also failed to identify or escalate 
the significant issue of suspension of observation at 16.00 on 10 April 2021. 

d.  The Trust SI report presented to the inquest failed to address the poor risk assessment or 

inadequate Datix & 72-hour reports. 

We have carefully considered your Regulation 28 report and by way of response, we attach a detailed 
action plan addressing the concerns raised by you.  

I would like to take this opportunity to thank you for raising your concerns as part of this inquest. We find 
learning  from  inquests  extremely  valuable  and  are  very  grateful  for  your  comprehensive  investigation, 
which benefits not only the families of the deceased, but also the Trust and its service users. 

I trust that the attached action plan reassures you that the Trust has taken this tragic death very seriously indeed, 
and that it reflects our commitment to improve care quality and patient safety.  

If I can further assist, please do contact my office on 

Yours sincerely  

Acting Chief Executive 

 Enc:   Regulation 28 action plan

www.nelft.nhs.uk

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