Prevention of Future Deaths reports · 2024

Matthew Gale

Regulation 28 report to prevent future deaths, reference 2024-0456, written 13 Aug 2024. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report13 Aug 2024
Reference2024-0456
DeceasedMatthew Gale
CoronerSimon Connolly
Coroner areaCounty Durham and Darlington
CategorySuicide (from 2015)
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

, Chief Executive, Tees Esk and Wear Valleys, NHS

Foundation Trust

1

CORONER

I am Simon CONNOLLY, Assistant Coroner for the coroner area of County Durham and
Darlington

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 24/03/2023 18:22an investigation was commenced into the death of Matthew Clive
GALE 11/10/1985 00:00:00. The investigation concluded at the end of the inquest on
23/05/2024 14:17. The conclusion of the inquest was that Matthew’s death occurred on
19th March 2023 at
health dating back to June 2017 including periods as a patient in West Park Hospital.

. Matthew had a history of mental ill-

Matthew had a schizoaffective episode in February 2023 and was admitted to Maple Ward
of West Park Hospital. Treatment plans were put in place but Matthew’s condition
deteriorated from 6th March 2023 and he was formally detained under the Mental Health
Act on that day.

He was granted Section 17 leave on the 8th March but there are no records to support this.
The conditions of his leave were widened and incorrect forms were used and the conditions
were not conveyed to Matthew’s family. The salient condition was that Matthew should not
be left alone and the failure to communicate contributed..

4

CIRCUMSTANCES OF THE DEATH

Matthew’s death occurred on 19th March 2023 at
had a history of mental ill-health dating back to June 2017 including periods as a patient in
West Park Hospital.

. Matthew

Matthew had a schizoaffective episode in February 2023 and was admitted to Maple Ward
of West Park Hospital. Treatment plans were put in place but Matthew’s condition
deteriorated from 6th March 2023 and he was formally detained under the Mental Health
Act on that day.

He was granted Section 17 leave on the 8th March but there are no records to support this.
The conditions of his leave were widened and incorrect forms were used and the conditions
were not conveyed to Matthew’s family. The salient condition was that Matthew should not
be left alone and the failure to communicate contributed.

5

CORONER’S CONCERNS

During the course of the investigation my inquiries revealed matters giving rise to concern.

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

 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)

At inquest, Matthew's mother gave evidence that she was never informed of the terms
upon which Matthew's section 17 leave had been authorised by those responsible for his
treatment and specifically that Matthew should never be left alone or unaccompanied whilst
on section 17 leave nor was she provided with a copy of Matthew's section 17 leave form.

The Trust acknowledged and admitted that there was no evidence in any records available
to it that such discussions had been had with Matthew's mother or that a copy of the
section 17 leave form had been provided to her. The Trust gave evidence of changes
implemented since Matthew's tragic death to avoid future recurrence and I requested
additional evidence from the Trust in relation to audited compliance data.

Notwithstanding changes already implemented and envisaged and by its own admission,
the Trust's compliance data is "inconsistent" generally but specifically in relation to the
provision of the section 17 leave form to a carer/ person accompanying a patient subject to
section 17 leave. That evidence demonstrated a 50% compliance rate in December 2023, a
52% compliance rate in March 2024 and a 76% compliance rate in May 2024, with a
compliance rate of 80% or above considered to be "good" by reference to the Trust's
compliance criteria.

Additionally and in relation to changes already implemented, the Trust's evidence at inquest
was that its revised section 17 leave policy for detained patients had removed the previous
requirement that the section 17 leave form ought tot be signed by the person
accompanying the patient, the explanation for this being the Trust's roll-out of a new
digitised system.

The inconsistent compliance audit data referenced above gives rise to a concern that there
is risk that future deaths could occur consequent to this change unless action is taken.

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 September 13, 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

Watson & Woodhouse Solicitors

I have also sent it to

who may find it useful or of interest.

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

 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: 13/08/2024

Simon CONNOLLY
Assistant Coroner for
County Durham and Darlington

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 Tees Esk and Wear Valleys NHS Foundation Trust (PDF)
Office of the Chief Executive 
West Park Hospital 
Edward Pease Way 
Darlington 
County Durham 
DL2 2TS 

11th October 2024 

Private and Confidential 
HM Assistant Coroner  
Mr Simon Connolly  
By email: 

Inquest into the death of Matthew Gale 

I am writing to you in response to the Report to Prevent Future Deaths (PFD), served on the Trust on 16 
August 2024, in relation to compliance audit data relating to Section 17 leave.  Our Chief Nurse has been 
working with the Care Group Directors of Nursing, Medical Directors and Directors of Therapy to ensure 
that the Trust have consistent oversight of daily performance and the improvement trajectory around 
Section 17 leave, which is reported to the Board of Directors.  

As previously advised, following the May 2024 audit results the Trust implemented the following to improve 
Section 17 leave requirements: 

-  The weekly Fundamental Standards Group for all inpatient staff have amended its agenda to focus 

purely on quality assurance audit results to enable audit results to be discussed, with agreed actions 
identified for matrons and managers.  

-  Section 17 leave and communication with families/carers around the responsibilities of the 

accompanying role has been added to the Trust wide preceptorship package, which is required to be 
undertaken by every registered nurse who joins the Trust.  

-  The Trust continue to work with families to focus on the importance of carers, families and loved ones 

and their involvement in care.  

- 

In June 2024 a task and finish meeting was arranged to discuss the May audit results to develop a 
more frequent auditing process at ward level to monitor compliance with Section 17 leave 
requirements, develop a training package for all staff and to review the Section 17 leave policy. Since 
the development of this task and finish meeting, the Trust have done a significant amount of work to 
improve Section 17 leave compliance.  

The Section 17 leave policy has now been reviewed, amended and rolled out across the Trust, with a 
decision made that the Section 17 leave form and leave/time away from the ward monitoring form will 
remain in paper format, rather than going electronic.  Section 17 leave forms are required to be signed by 
both the patient and accompanying person, to ensure they are aware of the conditions of leave and each 
person is provided with a copy, with a copy now also kept within a leave folder on the ward to ensure that a 
copy is always available prior to any leave. The leave/time away from the ward monitoring form, has been 

Chief Executive: 
Chair: 

1 

 
 
                                                                                                                   
 
 
 
 
 
 
 
 
 
 
 
 
 amended and now includes sections to identify the name of the accompanying person and they now have 
to sign to confirm that they are aware of the leave conditions prior to each period of leave.  

The changes to the Section 17 leave policy has been discussed at Quality Board, which included a 
representative from the Integrated Care Board, NHS England and the Care Quality Commission, who all 
approved of the changes.  

The Associate Director of Nursing and Quality has developed and delivered targeted training to all 
Associate Directors of Nurses (ADONs) around Section 17 leave, including the changes to policy and 
procedures and the need to ensure that processes are being followed and documented.  This training is 
currently being disseminated across the relevant parts of the Trust with oversight of the ADONs.  Within the 
last three weeks, 957 (70%) of substantive ward staff within the Trust have been trained in the new Section 
17 leave policy.  In addition to this, Section 17 leave/time away from the ward training has been delivered to 
temporary workers, community staff, corporate services, and professional groups to ensure they are aware 
of the changes.  Compliance with training continues to be closely monitored by the ADONs to ensure the 
Trust captures all relevant staff.  

The ADONs have all been provided with a checklist to complete which requires them to confirm that the 
updated Section 17 leave policies have been shared with all relevant staff that they have responsibility for 
and that this has been included as a topic at multi-disciplinary team meetings, for a period of 2 weeks, to 
raise awareness of the changes in policy in addition to the requirements of staff to attend the Section 17 
training. 

In order to further assist staff with the requirements of Section 17 leave, staff have been provided with 
leave folder templates and contact cards, which are now in use across the relevant parts of the Trust.  At 
the front of the leave folders is a flowchart that has been produced to remind staff of the requirements of 
Section 17 leave.  The leave folder also contains a copy of the most recent Section 17 leave form and the 
leave/time away from the ward monitoring form to enable easy access.   Contact cards are now also given 
to the patient and the accompanying person, which have details of the ward contact details, any conditions 
of leave, a check that a copy of the section 17 leave form has been provided and details of time and date 
which patient is due to return.  

The Trust continue to audit the clinical records to assess the Trust compliance with Section 17 leave 
procedures and an assessment will be made to determine the impact of the Section 17 leave policy 
changes, which was approved on 10 September 2024 by the Trust's Executive Team.  

We hope that the above demonstrates that the Trust are continuously working to improve processes 
around Section 17 leave and will continue to monitor this closely to ensure the changes are embedded.  

Yours sincerely  

Chief Executive 

Chief Executive: 
Chair: 

2

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