David Wilson

Date: 31 August 2023 

Mr Kevin McLoughlin 
HM Senior Coroner 
West Yorkshire (Eastern District) 
HM Coroner’s Service 
71 Northgate 
Wakefield 
WF1 3BS 

Chief Medical Officer 
Trust Headquarters and 
Education Centre 
Pinderfields Hospital 
Aberford Road 
Wakefield 
WF1 4DG 

Dear Mr McLoughlin 

Re Inquest of David Barnet WILSON (dcd) – 26.03.1955 to 31.12.2022 – 

I am responding on behalf of Mid Yorkshire Teaching NHS Trust (MYTT; the Trust) to the 
Regulation 28 Report to Prevent Future Deaths that you issued on 8 June 2023 upon the 
conclusion of the abovenamed inquest. 

The Matters of Concern raised in your report were: 

1)  The Consent form signed by Mr Wilson was a standard pre-printed form. It did not attempt to 
provide any statistical rating for the risks identified, which would have enabled Mr Wilson to 
evaluate the risks.  

2)  No attempt was made to interpret or tailor the risks inherent in the procedure in the light of his 

extensive medical history and co-morbidities.  

3)  The Consent Form did not refer to the risks of death, which befell him. He was thus not in a 

position to make a truly informed consent to undergo the sigmoidoscopy.  

4)  The Consent Form did not identify those clinicians involved in discussing the decision with him, 

save for 
influence of morphine sedation. 

 who obtained his signature at a time when he was under the 

The objective of the Consent process should be to demonstrate a patient has made a truly 
informed decision at a time when he is able to evaluate the risks clearly. 

 
  
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 I would like to thank you for bringing these matters to MYTT’s attention.  We have carefully  
considered and discussed the concerns you’ve raised and their implications for the Trust.  
Following a review of our processes, we will implement a number of measured actions in 
response.   

Pre-printed consent forms and inclusion of statistical ratings of risks; advising patients of 
increased risks and the risk of death 

The Trust utilises a bank of consent forms for the most common procedures performed.  The 
consent forms used in MYTT are based on national guidance issued by the Department of Health 
and Social Care.  Of note, we currently have generic forms and hundreds of procedure-specific 
consent forms across all specialties.  The procedure-specific consent forms are pre-populated with 
the most frequently associated risks for the particular procedure.  The forms are reviewed and 
amended as required to align with contemporary medical knowledge and practice.   

Up to now, the Trust has typically not included the statistical chances of a specific risk occurring.  
However, as a form comes up for review, it will be updated to include whether the chances of a 
specific risk occurring is: very common (1 in 10); common (between 1 in 10 and 1 in 100); 
uncommon (between 1 in 100 and 1 in 1,000); rare (between 1 in 1,000 and 1 in 10,000); and very 
rare (between 1 in 10,000 and 1 in 100,000).  These ranges adopt World Health Organization 
classifications.1   

As it is proposed to include risk ranges, to a certain degree these will inherently account for 
varying medical histories and co-morbidities of patients.  But in instances where a specific risk is 
greater due to a particular patient’s unique circumstances, this medical advice will be clearly noted.  
We will also update and strengthen our consent process through our internal policy to reflect this 
requirement (see below). 

The Trust also appreciates that the risk of death is a possibility in every procedure that is 
undertaken, and that even if it is a remote possibility, the risk of death would be a material 
consideration for patients in assessing whether to go ahead with a procedure.2   

To date, it has been the Trust’s practice to leave the decision about discussing the risk of death to 
the clinical judgement of its clinicians when evaluating the specific circumstances of their patients.  
However, the Trust will work with clinical teams to encourage its clinicians to undertake these 
discussions at an earlier stage, and we will introduce an additional specific risk of death as a risk 
that is required to be canvassed as part of our consent process (see below).   

Identifying clinicians involved in the consent process; and capacity to consent 

I fully concur with your statement that “the objective of the Consent process should be to 
demonstrate a patient has made a truly informed decision at a time when he/she is able to 
evaluate the risks clearly”. 

1   Whilst these ranges will be a starting point for all consent forms, a specialty may choose to be more explicit in 

detailing the specific risks of a particular procedure. 
In accordance with Montgomery v Larnarkshire Health Board [2015] SC11 [2015] 1 AC 1430 

2  

 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 As you are aware, the process of consenting a patient for a procedure is an ongoing one that 
starts with a conversation with the patient about treatment options and culminates with the signing 
of the consent form.  The form itself is merely the final “ok” from the patient to go ahead after a 
number of steps have taken place over a length of time, to obtain fully informed consent from the 
patient.   

The consent process regularly involves a number of staff from the clinician undertaking the initial 
conversation with the patient about the procedure and placing the patient on a waiting list; to 
others providing follow-up advice, e.g. in response to pre-procedure questions from the patient 
after reading the relevant patient information leaflet; to those involved in the pre-admission 
process; and finally to the clinician and/or assistant who will perform the procedure on the day.   

As these are all clinical conversations, the Trust expects staff to have appropriately documented 
an accurate record of them in the patient’s medical notes, which would also include a note of any 
patient information leaflets that have been provided.  When reviewing the patient’s records pre-
procedure, this documentation provides assurance to the clinician performing the procedure that 
the patient understands, and is fully cognisant of the risks and benefits of the procedure, and has 
consented to it. 

Ideally the final consent form would list all MYTT staff who have been involved throughout the 
entire consenting process of the patient for a particular procedure.  Unfortunately, time and 
resource constraints make this suggestion impracticable for implementation by the Trust. 

In relation to the capacity to consent, the Trust will work with clinical teams to ensure that as part 
of the consent process, the question of a patient’s capacity – regardless of the circumstances – is 
considered, taken into account, and properly documented.  The issues surrounding capacity will 
also be further highlighted in the Trust’s internal policy (see below). 

Other actions 

Of course, the Trust regularly offers training to staff on consent as well as having an internal policy 
that provides guidance on consent to examination and treatment.  The consent policy undergoes a 
planned review every three years unless it is updated earlier, i.e. “refreshed”, when new guidance 
becomes available.  Previous iterations have incorporated, amongst other matters, refusal of 
treatment and advance decisions; consent for transfusion; the Montgomery ruling; and latterly the 
General Medical Council’s Guidance on professional standards and ethics for doctors: Decision 
making and consent (November 2020).  

Overall, I concur that the matters of concern you’ve raised regarding how we consent our patients 
require action on our part and I thank you for bringing these to the Trust’s attention.  Accordingly 
we undertake to address these matters (as outlined above) and “refresh” our consent policy ahead 
of its triennial review, currently scheduled for March 2024.     

In closing, I acknowledge that your concerns arose out of your investigation into the death of Mr 
Wilson, and on behalf of Mid Yorkshire Teaching NHS Trust, I would like to take this opportunity to 
offer our sincere condolences once again to Mr Wilson’s family in relation to his sad death. 

 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Yours sincerely 

Chief Medical Officer