Prevention of Future Deaths reports · 2024

Douglas Armstrong

Regulation 28 report to prevent future deaths, reference 2024-0440, written 12 Aug 2024. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report12 Aug 2024
Reference2024-0440
DeceasedDouglas Armstrong
CoronerDavid Lewis
Coroner areaLiverpool and Wirral
CategoryHospital Death (Clinical Procedures and medical management) related deaths · Community health care and emergency services 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

NOTE: This form is to be used after an inquest.

REGULATION 28 REPORT TO PREVENT DEATHS

THIS REPORT IS BEING SENT TO:

1 Medequip UK

1

CORONER

I am David LEWIS, Assistant Coroner for the coroner area of Liverpool and Wirral

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 17 January 2024 I commenced an investigation into the death of Douglas ARMSTRONG
aged 88. The investigation concluded at the end of the inquest on 12 August 2024. The
conclusion of the inquest was that:

On 16 December 2023 the Deceased had an unwitnessed fall at his home address. He
sustained a fractured neck of femur, but this was not identified either by two responders
from an agency or by the district nurse who attended. As a result his arrival at Arrowe Park
Hospital, Arrowe Park Road, Wirral hospital was delayed by around 18 hours, and it is likely
that his subsequent surgery was similarly delayed, adding slightly to the mortality risk. He
died at the hospital on 5 January due to aspiration pneumonia, which resulted from the
accidental injury sustained in the fall. It is unlikely that the delay in hospital admission
either caused or materially affected the timing of his death.

4

CIRCUMSTANCES OF THE DEATH

On 16 December 2023 the Deceased had an unwitnessed fall at his home address. He
sustained a fractured neck of femur, but this was not identified either by two responders
from an agency or by the district nurse who attended. As a result his arrival at Arrowe Park
Hospital, Arrowe Park Road, Wirral hospital was delayed by around 18 hours, and it is likely
that his subsequent surgery was similarly delayed, adding slightly to the mortality risk. He
died at the hospital on 5 January due to aspiration pneumonia, which resulted from the
accidental injury sustained in the fall. It is unlikely that the delay in hospital admission
either caused or materially affected the timing of his death.

5

CORONER’S CONCERNS

During the course of the investigation my inquiries 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:
(brief summary of matters of concern)

Following his fall at home the Deceased was visited by two representatives of the care
agency. They did not appreciate that he had suffered a fractured neck of femur. They
placed more reliance than was justified upon his assertion that he had not hurt himself and
was not in pain. The information supplied during their verbal communication with the

Regulation 28 – After Inquest
Document Template Updated 30/07/2021

 ambulance service did not result in the latter appreciating the need for a personal
attendance or visual assessment.

Fractured neck of femur is a common consequence of falls in the elderly and requires
prompt attention. Those providing a response system should have the skills, knowledge and
training necessary to identify the problem or to appreciate that they cannot do so, and to
communicate the limits of their diagnostic ability to the ambulance service. I was told that
the responders acted in accordance with their existing training and have had no additional
training since these events, nor was I told that any is planned. I am concerned that
responders attending a similar call might be unable to assist effectively and would
appreciate their employers addressing this by considering whether opportunities exist to
improve the situation.

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 October 07, 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.
COPIES and PUBLICATION

8

I have sent a copy of my report to the Chief Coroner and to the following Interested
Persons

I have also sent it to

who may find it useful or of interest.

I am also under a duty to send a copy of your response to the Chief Coroner and all
interested persons who in my opinion should receive it.

I may also send a copy of your response to any 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 time of your response about the
release or the publication of your response by the Chief Coroner.

9

Dated: 12/08/2024

David LEWIS
Assistant Coroner for
Liverpool and Wirral

Regulation 28 – After Inquest
Document Template Updated 30/07/2021

 Regulation 28 – After Inquest
Document Template Updated 30/07/2021

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 Medequip (PDF)
Medequip
Unit 2 The Summit Centre
Skyport Drive 
Harmondsworth
West Drayton 
UB7 0LJ

Tel:  

www.medequip-uk.com

PRIVATE AND CONFIDENTIAL 

Our ref: 
7th Oct 2024  

Sophie Davies 
The Coroner’s Office  
Liverpool and Wirral Area 
Gerard Majella Courthouse 
Boundary Street 
Liverpool 
L5 2QD 

RE: Your Ref:

Dear Sophie 

Following the coroner's inquest held on 12 August 2024, we have reviewed the matter referenced 
above  and are providing  our formal response in respect  to  Regulation 28  –  Preventing  Future 
Deaths. We have outlined the key actions taken to address the concerns raised: 

Action 1: Review and Update to Emergency Responder Procedures 

A  thorough review  of  Medequip’s  Responder  Service  procedures was  conducted following  the 
investigation  of  the  incident.  This  review  was  completed  on  1  July  2024  and  included  the 
implementation  of  a  new  digital  form  for  recording  responder  visits  and  conducting  risk 
assessments  for  both  service  users  and  the  environment.  These  updated  procedures  are 
designed to improve the safety and efficiency of responder visits. 

Action 2: Implementation of Digital Responder Forms 

To replace the previous paper-based system, we developed digital forms for responder visits in 
accordance  with  the  TEC  Services  Association’s  Quality  Standards  Framework.  These  digital 
forms incorporate a comprehensive risk assessment to ensure responders are effectively guided 
throughout their visit. They include follow-up actions, signposting, safeguarding measures, and 
detailed  recording  of  service  user  welfare.  Additionally,  the  digital  form  features  a  ‘top-to-toe’ 
physical assessment to help identify potential injuries more thoroughly. This system went live on 
1 July 2024, aligned with the revised procedures. 

Action 3: First Aid Training 

It  was  identified  that  all  responders  required  updated  First  Aid  training.  This  training  was 
completed and delivered to all responders by 1 April 2024 to ensure they are equipped to provide 
immediate care when necessary. 

Medequip Assistive Technology Ltd. Company Registration No: 4198824 
Registered Address: Unit 2, The Summit Centre, Skyport Drive, Harmondsworth, West Drayton, Middlesex, UB7 0LJ  

 
 
 
 
 Action 4: People Manual Handling Training for Responders 

A bespoke People Manual Handling Training program has been developed by Medequip Connect. 
This program, led by a dedicated and qualified trainer, has been designed to enhance the safety 
and effectiveness of lifting service users, as well as the safe operation of lifting equipment. The 
training was created in collaboration with Medequip Connect’s National Clinical Lead and includes 
accredited content. The roll-out of this training is currently underway, with full completion expected 
by the end of January 2025. 

We  trust  these  actions  address  the  concerns  outlined  in  the  inquest  and  demonstrate  our 
commitment to preventing future incidents. 

Yours sincerely,  

Head of Safety, Health, Environment, Quality (SHEQ), Governance and Training 

Medequip Assistive Technology Ltd. Company Registration No: 4198824 

Registered Address: Unit 2, The Summit Centre, Skyport Drive, Harmondsworth, West Drayton, Middlesex, UB7 0LJ

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