Thomas Barton

From Helen Whately MP 
Minister of State for Care 

39 Victoria Street 
London 
SW1H 0EU 

Ms Alison Mutch 
HM Senior Coroner, Greater Manchester South 
HM Coroner’s Court 
Mount Tabor 
Stockport 
SK1 3AG 

16 May 2024 

Dear Ms Alison Mutch, 

Thank you for your Regulation 28 report to prevent future deaths of 21 July 2023 about 
the  death  of  Thomas  Barton.  I  am  replying  as  Minister  with  responsibility  for  Adult 
Social Care and hospital discharge. 

Firstly, I would like to say how saddened I was to read of the circumstances of Thomas 
Barton’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. 

The  report  raises  concerns  over  the  delayed  discharge  of  Mr  Barton  from  hospital 
which  was  due  to  the  challenges  of  putting  an  appropriate  social  care  package  in 
place. Delayed discharge is a risk for frail elderly patients. 

In preparing this response, Departmental officials made enquiries with NHS England 
and  the  Care  Quality  Commission.  The  Integrated  Care  Board  (ICB)  advised  that 
Trafford Council have redesigned the homecare offer with local providers on a locality 
model to ensure there is capacity in areas that experience difficulties in recruiting staff. 
The Council has identified barriers to timely hospital discharges and capacity gaps in 
care provision.  In addition, Greater Manchester (GM) ICB have undertaken a capacity 
and demand modelling of home care.  I understand the ICB will be  sharing learning 
across the system and stakeholders as well as monitoring of key learning points and 
recommendations. 

It  is  our  priority  to  ensure  that  all  patients  receive  safe  and  timely  discharges  from 
hospital.  The Hospital Discharge and Community Support Guidance published by the 
Department of  Health  and  Social  Care,  sets out  how the  discharge process  should 
operate in practice, and how NHS bodies and Local Authorities should work together 
to plan and implement hospital discharge, recovery and reablement in the community. 
NHS bodies and local authorities have a statutory duty to cooperate in exercising their 

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 respective functions, including as they relate to hospital discharge. In addition, where 
a  relevant  trust  is  responsible  for  an  adult  hospital  patient  and  considers  that  the 
patient  is  likely  to  require  care  and  support  following  discharge  from  hospital,  the 
relevant trust, must, as soon as is feasible after it begins making any plans relating to 
discharge, take any steps that it considers appropriate to involve the patient and the 
carer of the patient. 

We put in place £500million for the 2022/2023 Adult Social Care Discharge Fund and 
this enabled more people to be discharged from hospital in a timely manner. We have 
since increased the Fund to £600million for the 23/24 and to £1billion for 24/25. This 
funding has so far been used to deliver additional care packages and beds, provide 
equipment to support people in returning home, and boost the social care workforce. 
Local authorities  and NHS  integrated  care boards  have the flexibility  to  spend  their 
allocations in ways they deem most appropriate for their local area. Funding must be 
spent on measures which seek to free up the maximum number of hospital beds and 
reduce  bed  days  lost,  for  example  short-term  packages  of  care,  community-based 
reablement capacity, or building the workforce capacity needed to continue to support 
care users. We have published an evaluation of the 2022/23 discharge fund which has 
explored  how  local  areas  spent  their  funding.  We  found  evidence  that  funding  was 
associated with a positive impact on delayed discharge with  local areas reporting a 
reduction in delayed discharges, and improved flow through the system. 

In January 2023, NHS England published the Urgent and Emergency Care Recovery 
Plan. This year, and in line with the commitments in this plan, we continue to work with 
the NHS and local authorities to roll out care transfer hubs in every part of the country 
to  manage  discharges  for  patients  with  more  complex  needs.  These  hubs  bring 
together  professionals  from  the  NHS  and  local  authority  to  manage  discharges  for 
people with more complex needs, who need extra support when being discharged. 

At  the  time  of  Mr Barton’s admission  to  hospital in  November 2022,  the  health  and 
social care systems were experiencing increased pressures due to a rise in hospital 
admissions  related  to  COVID-19  and  seasonal  flu.  In  the  seven  days  to  30th 
November 2022, the time of Mr Barton’s admission, the average number of patients 
with  delayed  discharges  (no  longer  meeting  the  criteria  to  reside  but  remaining  in 
hospital) reported by the Greater Manchester Integrated Care Board was 910. This 
had decreased to 703 for the average of the seven days to 30 November 2023  and 
was 665 for the average of the seven days to 31 March 2024. We recognise there is 
still more to do, and it is a government priority to continue to drive forward a decrease 
these numbers. 

I hope this demonstrates we are taking active steps to reduce delayed discharges and 
to avoid the adverse impacts they can cause to patients, as highlighted in this case. 
Thank you again for bringing these concerns to my attention. 

Yours, 

HELEN WHATELY 

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Date: 29th Nov 23 

Ms A Mutch  
HM Senior Coroner 
Coroner Area of Greater Manchester South 

Dear Ms Mutch, 

Re: Regulation 28 Report to Prevent Future Deaths – Thomas Barton 27th January 2023 

Thank you for your Regulation 28 Report dated 21/07/2023 concerning the sad death of Thomas Barton 
on 27/01/2023. On behalf of NHS Greater Manchester Integrated Care (NHS GM), I would like to begin 
by offering our sincere condolences to Mr. Barton’s family for their loss. 

Thank you for highlighting your concerns during Mr. Barton’s Inquest which concluded on 27th of June 
2023. I apologise that you have had to bring these matters of concern to our attention.  We recognise it 
is very important to ensure we make the necessary improvements to the quality and safety of future 
services.   

Following the inquest, you raised concerns in your Regulation 28 Report to NHS GM that there is a risk a 
future death will occur unless action is taken. The main areas of concern are linked to the demand and 
availability of social care, so we have connected with Trafford Local Authority. 

I hope the response below demonstrates to you and Mr. Barton’s family that NHS GM has taken the 
concerns you have raised seriously and will learn from this as a whole system.  

The inquest heard that the delayed discharge of Mr Barton from hospital was due to the 
challenges of putting an appropriate social care package in place. The evidence before the 
inquest was that delayed discharges such as Mr Barton’s put the lives of frail elderly patients at 
risk as it is far more likely that they will become deconditioned and develop and infection if they 
spend unnecessary time in hospital. The evidence was that delayed discharges such as Mr 
Barton’s were not uncommon due to the demand on social care and the availability of suitable 
care. The evidence was that speedier discharges would occur if there was improved availability 
of social care and that this would improve outcomes for elderly patients and reduce the risk of 
preventable deaths occurring. 

Response from Trafford locality: 
In Trafford, we plan all the year round to ensure capacity in the market. Historically, the Council has 
struggled with both residential and homecare capacity around winter, in particular January and February, 
Easter and the summer holidays. Every bank holiday brings with it increased numbers of discharges too. 
This means that the Council does not just look at winter but at capacity all the year round.  

The Council has redesigned the homecare offer with local providers on a locality model to ensure there 
is enough capacity in the harder to staff areas. The Council has also looked at different ways of 
supporting homecare as a whole, and in one area where public transport is a barrier to delivering care, 
we have funded a minibus from additional grant monies to maximise the capacity and ability to deliver 
care hours. 

4th Floor, Piccadilly Place, Manchester  M1 3BN   
Tel: 0161 6257791  www.gmintegratedcare.org.uk 

 
  
 
 
 
 
 
 
 
 
 
 
 
 
  
 During winter 2022/23, the Council had sufficient homecare capacity because of the measures already in 
place and the high vacancy level in care home beds. However, not all of these vacancies met the needs 
of patients being discharged and the Council had to source specialist placements elsewhere. The pace 
and number of people being discharged requires funding which is in excess of the identified budget and 
any winter funding has been used to enhance capacity to support hospitals through rapid responses to 
requests for discharge. 

In addition, the Council has identified several barriers to timely discharge from hospital, such as housing, 
minor repairs and 1:1 capacity. The Council has used additional winter funding both to manage these 
gaps and to enhance the support required to source placements in a timely manner and manage the flow 
from hospital into Discharge to Assess beds and then back home with appropriate support. 

In 2022/23 Trafford Council delivered over 960,000 hours of homecare to 1,930 people with a long-term 
homecare plan. The Council additionally delivered short term homecare plans to 1,005 people, in the form 
of ‘Stabilise and Make Safe’ plans or additional support for current people with a care plan to support their 
discharge from hospital. Trafford has 27 framework providers that are split into two tiers, Tier one has 21 
providers  and  Tier  two  has  6  providers.  Tier  one  providers  are  lead  providers  that  work  across  the  4 
neighbourhoods, North, Central, West & South Trafford in a locality model. Tier two has 6 providers that 
are used to address system pressures and to maintain capacity and flow.  

The Council has the following identified capacity gaps: 

1.  Specialist dementia nursing and residential care 

The Council currently spot purchase these beds, usually outside of Trafford. Although these number 
are small the weekly costs are high. 
Numbers average 1 or 2 people a week totalling 60 last year. 

2. Extra care 

Extra care is an affordable housing option from not for profit social landlords offering self-contained 
homes for older people aged 55 or over.  It includes flexible and responsive services to enable them 
to maintain their independence and stay where they live if their care needs change. 

National modelling estimates the number of extra care units required in Trafford as being 96. 
Developers prefer to build care homes rather than extra care as the returns are more profitable. The 
Council is not able to develop the scale of extra-care provision required but is committed to work with 
partners to maximise relevant developments. 

3.  Therapy 

The Council’s Discharge to Assess and reablement provision is constrained by having no therapeutic 
input. This is an area which is under constant discussion with our acute trusts and the community 
health providers. 

As indicated above, there is a reasonable supply of homecare currently. 

The Council has an over provision of residential care within the borough. There is sufficient supported 
living – but the Council is moving away from 6/8 bedded models to more personalised housing models 

4th Floor, Piccadilly Place, Manchester  M1 3BN   
Tel: 0161 6257791  www.gmintegratedcare.org.uk 

 
  
  
  
  
  
  
  
 
 
  
  
  
 where people are supported to buy their own properties, live in ordinary properties with outreach support 
or share with friends in smaller properties. 

Response from NHS GM: 
Whilst we appreciate that during the period of time that Mr Barton was in hospital there was increased 
demand on care at home, we are confident that there is sufficient capacity to support timely discharges 
from hospital for people to return to their homes. Supported by NHS GM funding, localities have 
commissioned home from hospital support from voluntary/community organisations in addition to the 
independent care providers that provide substantive services.  

NHS GM have recently undertaken capacity and demand modelling of home care and care home 
markets. Localities are using the detailed modelling and analysis to inform development and shaping of 
their market, to ensure that it continues to meet the needs of current and future Greater Manchester 
residents.  

Actions taken or being taken to share learning across Greater Manchester: 

1.  Learning to be presented/shared with the Greater Manchester System Quality Group on the 21st 
of September 2023. This meeting is attended by commissioners, including commissioners of 
specialist services, localities, regulators, Healthwatch and NICE. Through sharing in this forum, 
we expect members to review and ensure learning is incorporated into their commissioned 
services. 

2.  Shared learning from this and similar cases at Greater Manchester and borough level will be 
cascaded to professionals through relevant governance and learning forums to ensure that 
learning is incorporated into their services. 

In conclusion, key learning points and recommendations will be monitored to ensure they are embedded 
within practice. NHS GM is committed to improving outcomes for the population of Greater Manchester.  

I hope this response demonstrates to you and Mr. Barton’s family that NHS GM has taken the concerns 
you have raised seriously and is committed to working together as a system including our service users, 
carers and families to improve the care provided.  

Thank you for bringing these important patient safety issues to my attention and please do not hesitate 
to contact me should you need any further information. 

Yours sincerely 

Chief Nursing Officer 
GM Integrated Care 

4th Floor, Piccadilly Place, Manchester  M1 3BN   
Tel: 0161 6257791  www.gmintegratedcare.org.uk