Prevention of Future Deaths reports · 2024

Joseph Miller

Regulation 28 report to prevent future deaths, reference 2024-0142, written 14 Mar 2024. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report14 Mar 2024
Reference2024-0142
DeceasedJoseph Miller
CoronerAlison Mutch
Coroner areaManchester South
CategoryAlcohol, drug and medication related deaths
Sourcejudiciary.uk record · original PDF
Responses published1

The report

Text extracted from the PDF text layer. 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:  Secretary of State for Health and Social Care 

1 

CORONER 

I am Alison Mutch, Senior Coroner, for the coroner area of South Manchester 

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 

3 

INVESTIGATION and INQUEST 

On 6th June 2023 I commenced an investigation into the death of Joseph 
Michael Miller. The investigation concluded on the 2nd February 2023 and the 
conclusion was one of narrative: Died from the complications of a seizure 
contributed to by the use of cocaine. The medical cause of death was 1a) 
Hypoxic Brain Injury 1b) Cardiac Arrest on the background of a seizure and 
cocaine use 

4 

CIRCUMSTANCES OF THE DEATH 

On the 31st May 2023, Joseph Michael Miller was seen by a neighbour to be 
fitting in the garden of his home address. A call was made to the ambulance 
service that was initially categorised as category 1 but downgraded to category 
3 when it was reported that he was no longer fitting. A further call was made 
when he had another seizure and became unconscious. Ambulance crews 
attended. The initial Rapid Response Team were there within eight minutes. He 
did not return to consciousness despite extensive efforts to resuscitate him. He 
was transferred to Tameside General Hospital where tests on the 3rd June 
confirmed severe hypoxic brain injury and he was declared dead on 5th June. 

1 

 
 
 
 
 
  
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 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 will 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.  The inquest heard evidence that different ambulance services use 
different pathways that can impact how calls are categorised 
/downgraded. The consequence of this is that how the ambulance 
services across England deal with a call varies depending on where you 
live. As an example in this inquest, because of where Joseph lived, calls 
can go to EMAS or NWAS depending on which mobile telephone mast 
the call pings on. The initial call went to EMAS who on being told he was 
no longer fitting downgraded the call, in line with their pathway. The 
inquest was told that had the call been dealt with by NWAS they would 
not have downgraded the call to a category 3 in this situation because 
that was not how their pathway operated. 

2.  The consequence of these different pathways is that there is not a 

consistent approach to call categorisation across the country which can 
have a significant impact on the dispatch of potentially lifesaving 
attendance by the ambulance service. 

6 

ACTION SHOULD BE TAKEN 

In my opinion action should be taken to prevent future deaths and I believe you 
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 9th May 2024. 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 

2 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Interested Persons namely 
may find it useful or of interest. 

 on behalf of the Family, who 

I 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. 

9 

Alison Mutch 
HM Senior Coroner 

14.03.2024 

3

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 Department of Health and Social Care (PDF)
From Minister Helen Whately  
Minister of State for Care 
39 Victoria Street 
London 
SW1H 0EU 

Alison Mutch, 
Senior Coroner for South Manchester 
Coroner’s Court 
1 Mount Tabor Street 
Stockport 
SK1 3AG 

14 June 2024 

Dear Ms Mutch,  

Thank you for your letter of 14 March 2024 to the Secretary of State for Health and Social 
Care Victoria Atkins, about the death of Joseph Michael Miller. I am replying as Minister with 
responsibility for urgent and emergency services.  

Firstly,  I  would  like to say  how  deeply  sorry  I  was  to read  the  circumstances  of  Mr  Miller’s 
death  and I  offer  my  sincere  condolences to  his  family.  It  is  vital that  where Regulation  28 
reports  raise  matters  of  concern  these  are  looked  at  carefully  so  that  NHS  care  can  be 
improved. I am grateful to you for bringing these matters to my attention.  

Your report raised concerns about the two call triage systems in use by NHS ambulance trusts, 
and the potential for patients to be given a different ambulance categorisation depending on 
the system used. The Department’s officials have shared your report with the East Midlands 
Ambulance  Service  (EMAS),  North  West  Ambulance  Service  (NWAS)  and  NHS  England 
(NHSE) as the body responsibly for oversight of NHS ambulance services.  

Ambulance  services  are  required  to  use  an  approved  triage  system  to  aid  initial  999  call 
prioritisation – the two approved systems are the Advanced Medical Dispatch Priority System 
(AMPDS) and the NHS Pathways system. These systems are approved on the basis of being 
able  to  determine  (as  far  as  possible)  differing  levels  of  acuity,  from  immediately  life-
threatening emergencies to patients with an urgent care need. 

In considering the concerns raised about the potential for variation between categorisation, 
NHSE  has  advised  the Department  that  it  has  in  place  a  process  to  appropriately  map the 
outcomes of 999 call triage systems against ambulance response time categories. NHSE has 
responsibility for the production, maintenance, review and revision of the dataset used in these 
systems,  which  is  managed  by  the  NHSE-chaired  Emergency  Call  Prioritisation  Advisory 
Group  (ECPAG).  ECPAG  keeps  the  categorisation  of  calls  under  continual  review,  and 
ambulance services support this process through providing evidence and expertise to reduce 
unwarranted  variation  across  services,  helping  ensure  appropriate  prioritisation,  equity  of 
access and uniformity of response across England.  

Thank you once again for bringing these concerns to my attention. 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Yours,  

HELEN WHATELY

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