Christine Booker

Dorset County Hospital 
Williams Avenue 
Dorchester 
Dorset 
DT1 2JY 

10 June 2024 

PRIVATE AND CONFIDENTIAL 

Mr B Allen 
H M Assistant Coroner for Dorset 
The Coroner’s Office for the County of Dorset 
Town Hall 
Bournemouth 
BH2 6DY 

Dear Mr Allen, 

Thank  you  for  your  letter  dated  28  May  2024,  in  relation  to  the  inquest  into  the  death  of 
Christine Rita Booker. I would like to take this opportunity to express my sincere condolences 
to Mrs Booker’s family.  

I  am  extremely  sorry  for  the  family’s  loss,  and  I  am  mindful  that  this  will  have  been  more 
distressing  for  the  family  due  to  the  circumstances  that  led  to  Mrs  Booker’s death,  and  the 
subsequent inquest.  

Your  report  details  one  matter  of  concern  in  relation  to  there  being  no  provision  of  out  of 
hours interventional radiology at Dorset County Hospital. 

You are concerned that patients requiring this potentially urgent and life-saving intervention, 
who live in West Dorset require transfer to Royal Bournemouth Hospital for treatment. Your 
concern  is  that  this  exposes  them  to  a  potentially  considerable  delay  in  treatment  and 
therefore an increased risk of death. 

We  have  reviewed  the  findings  of  the  inquest,  and  the  recommendations  as  stated  in  the 
Preventing  Future  Deaths  report  and  can  confirm  that  the  Trust  does  not  provide  a  24/7 
emergency  service  for  specialist  interventional  radiology  for  embolization.    This  is  a 
specialised service commissioned by NHS England, provided by University Hospitals Dorset 
from  their  site  at  the  Royal  Bournemouth  Hospital  for  both  Dorset  County  Hospital  and 
Salisbury  Hospital.    24/7  specialised  interventional  radiology  services  are  not  available  in 
every local hospital because they are delivered by specialist teams who have the necessary 
skills,  experience  and  volume  of  work  to  maintain  safe  standards  of  care  across  wider 
geographical areas. 

The  commissioned  pathway  of  care,  for  those  requiring  emergency  specialist  interventional 
radiology  who  attend  Dorset  County  Hospital,  is  for  ‘blue  light  transfer’  to  the  Royal 
Bournemouth  Hospital,  or  other  tertiary  centre,  via  the  ambulance  service  or  in  time  critical 
situations by helicopter.   

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
     
 
 
    
 
 
 
 
      
 
 
 
 
 
 
 
 
 
 
 
 Therefore we understand that the regulation 28 notice sent to Dorset County Hospital should 
be  addressed  to  NHS  England  as  the  service  commissioner,  and  we  have  also  made  them 
aware  of  this  (NHS  England’s  regional  medical  director  is  also  copied  into  this  response 
letter). 

The Trust is committed to continuous learning from any incident to strengthen the services for 
which it is responsible.  Therefore we are carrying out an investigation of the management of 
this case as it pertains to Dorset County Hospital and will request sight of the report from the 
Winterborne Circle Hospital.  In conjunction with UHD we are auditing the transfer times for 
interventional radiology between the two sites and our compliance with  ‘decision to transfer’ 
standards.  We will continue to monitor the service to ensure timely clinical decision making 
and access to services are in place for all current and future patients. 

I  hope  that  the  arrangements  detailed  provide  you  with  assurance  that  the  Trust  has 
mechanisms  in  place  to  learn  from  and  monitor  our  services  as  well  as  clinical  decision 
making, so that we ensure patients have access to timely and safe care. 

Finally,  I  would  like  to  end  by  reiterating  our  sorrow  and  condolences  to  the  family  of  Mrs 
Booker for their loss. 

Yours sincerely, 

Chief Executive 

Copy to: 

, Medical Director, NHS England South West 
, Chief Executive, NHS Dorset

Mr Brendan Joseph Allen 
Area Coroner  
Coroner’s Office for the County of Dorset 
BCB Civic Centre 
Bourne Avenue 
Bournemouth  
BH2 6DY 

National Medical Director  
NHS England  
Wellington House 
133-155 Waterloo Road  
London 
SE1 8UG 

24 December 2024  

Dear Coroner, 

Re: Regulation 28 Report to Prevent Future Deaths – Christine Rita Booker 
who died on 24 February 2023.  

Thank  you  for  your  Report  to  Prevent  Future  Deaths  (hereafter  “Report”)  dated  17 
October 2024 concerning the death of Christine Rita Booker on 24 February 2023. In 
advance of responding to the specific concerns raised in your Report, I would like to 
express my deep condolences to Christine’s family and loved ones. NHS England are 
keen to assure the family and the Coroner that the concerns raised about Christine’s 
care have been listened to and reflected upon.   

I am grateful for the further time granted to respond to respond to your Report, and I 
apologise for any anguish this delay may have caused to Christine’s family or friends. 
I realise that responses to Coroner’s Reports can form part of the important process 
of family and friends coming to terms with what has happened to their loved ones, and 
I appreciate this will have been an incredibly difficult time for them. 

Your Report raised the concern that there is no out of hours interventional radiology 
at Dorset County Hospital and that patients requiring this intervention who reside in 
the area must be transferred to the Royal Bournemouth Hospital, exposing patients to 
a potentially significant delay in the provision of urgent and life-saving treatment.  

In preparing this response, colleagues within the Clinical Reference Group (CRG) for 
Vascular Disease have been consulted.  

Orthopaedic procedures do sometimes lead to life-threatening complications such as 
bleeding, as they sadly did for Christine. They are also often being carried out in private 
hospitals where there is no vascular cover. It is important to identify such complications 
early,  resuscitate  and  arrange  transfer  to  a  site  where  definitive  and  life-saving 
vascular  intervention  can  be  performed.  The  transfer  should  be  to  a  site  (usually  a 
vascular hub) where 24/7 vascular intervention is available, and this should include 
both interventional vascular radiology and vascular surgery.  

Based on the information provided in your Report, NHS England is unable to provide 
further comment on the care provided to Christine following her procedure, and her 
transfer to Royal Bournemouth Hospital. It is not clear to NHS England whether the 
hip replacement procedure had been commissioned and funded by the NHS.  

                                                                                                                       
 
 
 
 
 
 
 
  
 
 
 
 
 
 
  
 My South West regional colleagues have been engaging with NHS Dorset Integrated 
Care  Board  and  NHS England  Direct  Commissioning South West, to  gather  further 
information in this matter.  

Dorset  Integrated  Care  Board  advise  that  there  is  a  well-practiced  hub  and  spoke 
model  with  the  Royal  Bournemouth  Hospital  for  vascular  services,  as  well  as  clear 
pathways for private provider transfer. They advise that a full interventional radiology 
service at Dorset County Hospital would likely be unsustainable.  

NHS England continues to seek further details on the issues surrounding Christine’s 
care and the matters raised in your Report from colleagues in the South West. We are 
happy to update the Coroner on the information received in due course. However, we 
remain  of  the  view  that  the  concerns  raised  by  the  Coroner  in  respect  of  the 
circumstances of Christine’s death are more appropriate for the Trusts to address. 

I  would  also  like  to  provide  further  assurances  on  the  national  NHS  England  work 
taking  place around  the  Reports  to  Prevent Future  Deaths.  All  reports  received  are 
discussed  by  the  Regulation  28  Working  Group,  comprising  Regional  Medical 
Directors,  and  other  clinical  and  quality  colleagues  from  across  the  regions.  This 
ensures  that  key  learnings  and  insights  around  events,  such  as  the  sad  death  of 
Christine, are shared across the NHS at both a national and regional level and helps 
us to pay close attention to any emerging trends that may require further review and 
action.   

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,  

National Medical Director