Keith Hankin

Karen Henderson 

HM Assistant Coroner for West Sussex, Brighton and Hove. 

Parkside Chart Way 

Horsham 

RH12 1XH 

11 November 2025 

Dear HM Assistant Coroner Karen Henderson, 

Regulation 28 Report following the inquest into the death of Mr Keith James Hankin 

Thank you for bringing the Regulation 28 Report to our attention following the inquest into 
the death of Mr Keith James Hankin at Worthing Hospital on 11 September 2023. We 
acknowledge the concerns raised and appreciate the opportunity to respond. 

We would like to express our sincere condolences to Mr Hankin’s family and loved ones 
following his death. 

We have noted the matters of concerns listed below: 

1.  Lack of clinical governance in the Community Urology Service (CUS) by the 
Integrated Care Board (ICB) who commissioned the service and Sussex 
Medical Chambers (SMC) who were responsible for providing the service.  

2.  Lack of integration of the Community Urology Service with NHS Hospital 

Urology Services. 

3.  Lack of appraisal and mandatory assessment of clinicians employed by CUS. 
4.  Practicing Privileges in the private sector. 
5.  Learning from Mr Hankin’s death. 
6.  Management of Mr Hankin at Goring Hall Hospital. 

While the Care Quality Commission (CQC) has statutory powers to regulate providers of 
health and social care services, we do not hold regulatory authority over Integrated Care 
Boards (ICBs). Responsibility for the oversight, governance, and performance of ICBs lies 
with NHS England.  

In response to the points raised. 

1.  Lack of clinical governance in the Community Urology Service (CUS) by the 
Integrated Care Board (ICB) who commissioned the service and Sussex 
Medical Chambers (SMC) who were responsible for providing the service.  

 
 
 
 The Integrated Care Board contracted Sussex Medical Chambers to provide a 
Community Urology Service through any qualified provider in 2015 and renewed 
the contract through a competitive tendering process twice subsequently. The ICB 
used a generic contract supplied by NHS England to contract the service. Neither 
the ICB nor SMC were able to provide any evidence of robust clinical governance 
or multi-disciplinary team processes to ensure best practice of urology services 
from inception to date. 

We are unable to comment on the aspects of this concern that relate to the Integrated Care 
Board (ICB) as it falls outside of the scope of our regulatory responsibilities. The Integrated 
Care Board (ICB), as a named respondent in this case, would be best placed to address this 
point and provide further clarification. 

We have responded to the aspects relating to Sussex Medical Chambers (SMC). 

We use regulations when we assess if a provider is safe, effective, caring, responsive and 
well-led. Regulations for service providers and managers - Care Quality Commission 

The lack of robust clinical governance arrangements and multidisciplinary team (MDT) 
assessment within the Community Urology Service (CUS) provided by SMC is covered 
under the following regulation: 

•  Regulation 17: Good governance 

To meet the regulation, providers must have effective governance, including assurance and 
auditing systems or processes. These must assess, monitor and drive improvement in the 
quality and safety of the services provided, including the quality of the experience for people 
using the service.  

We last inspected Sussex Medical Chambers (SMC) in November 2022. At the time, 
governance structures, processes, and systems were clearly defined and understood. 
Leaders held regular update meetings, supported by an effective staff meeting structure for 
cascading information. Service-specific team meetings reviewed standing agenda items 
such as complaints, incidents, and patient feedback, with minutes circulated to all staff. 
Quarterly clinical governance meetings assessed service delivery and, where necessary, 
individual patient care to optimise outcomes and share learning. 

The provider maintained an incident and complaints log to identify risks, investigate issues, 
and implement corrective actions. Incidents were reviewed in team and governance 
meetings, with reporting processes fostering openness and transparency. Timely actions 
were taken to address issues. 

As an NHS-commissioned provider, SMC monitored and reported key performance 
indicators (KPIs) such as infection rates, patient satisfaction, safety incidents, complaints, 
and waiting times. The provider worked closely with commissioners to review service quality 
and patient outcomes, supported by documented meeting minutes and audits aligned with 
agreed KPIs. 

However, we acknowledge that this inspection took place approximately 1 year prior to the 
death of Mr Hankin.  

In response to the Regulation 28 report and as part of our regulatory response, we asked 
Sussex Medical Chambers (SMC) to tell us how they have responded to this element of the 
Regulation 28 report.  

 They submitted documentation of clinical governance meetings held regularly, 3 to 4 times 
per year, from 2020 to 2025. We reviewed the minutes and found that they demonstrated 
regular review of incidents, safeguarding concerns, and complaints related to all aspects of 
their service, including the Community Urology Service (CUS). The death of Mr Hankin was 
discussed at meetings on 1 November 2023, 7 March 2024, and 15 May 2025. Additionally, 
the records indicated that SMC engaged with Goring Hall Hospital (GHH), expressing 
willingness to participate in their investigation. Further correspondence was noted, 
requesting the investigation findings and seeking opportunities for organisational learning. 

Furthermore, the minutes reported on patient satisfaction, highlighting strong participation 
and high recommendation scores. They also documented SMC’s attendance at quarterly 
contract review meetings with the Integrated Care Board (ICB), where performance metrics 
including quality indicators and the achievement of Commissioning for Quality and 
Innovation (CQUIN) targets were met and discussed in accordance with the NHS Standard 
Contract. 

We were satisfied that the evidence provided demonstrated acceptable arrangements under 
Regulation 17: Good Governance.  

2.  Lack of integration of the Community Urology Service with NHS Hospital 

Urology Services. 

The CUS provided community-based urology services with non-consultant grade 
urologists without any oversight or integration with hospital-based consultant led 
urology services. Whilst there was an opportunity for CUS to refer more complex 
patients to NHS Hospital Trusts the ‘silo’ effect of these 2 services was such that 
they effectively worked independently of each other. The absence of a robust 
multidisciplinary team assessment within the CUS and the lack of senior clinical 
oversight of community urology patients by NHS consultant clinicians leads to a 
concern that the urology service is fragmented and does not effectively support 
urology patients within the region to confirm best practice and optimal treatment.  

We are unable to comment on the aspects of this concern that relate to the Integrated Care 
Board (ICB) as it falls outside of the scope of our regulatory responsibilities. The Integrated 
Care Board (ICB), as a named respondent in this case, would be best placed to address this 
point and provide further clarification.  

We have responded to the aspects relating to Sussex Medical Chambers (SMC). 

In response to the Regulation 28 report and as part of our regulatory response, we asked 
Sussex Medical Chambers (SMC) to tell us how they have responded to this element of the 
Regulation 28 report.  

SMC told us that they understood this concern to have arisen from Mr Al-Singary’s decision 
to refer Mr Hankin to Goring Hall Hospital (an independent hospital) and not to Worthing 
Hospital (an NHS hospital) given his co-morbidities. They acknowledged the concern and 
introduced a Referral Risk Assessment Checklist, to be completed by clinicians within the 
Community Urology Service (CUS) for all surgical referrals. This checklist has been 
designed to support appropriate patient selection and ensure optimal treatment pathways 
and will be audited monthly. We have reviewed the checklist and concluded that it provides a 
clear and structured approach to aid clinicians in making appropriate onward referrals to 
suitable secondary care providers.  

 
 SMC provided evidence of multidisciplinary team (MDT) meetings where individual patients 
were discussed on 25 July 2024, 12 November 2024, 14 January 2025, and 10 May 2025. 
However, we acknowledge that Mr Hankin’s death occurred prior to these formally 
documented MDT meetings.  

SMC informed us that they have developed and implemented a Communication 
Improvement Plan to further address concerns raised regarding referral pathways and siloed 
working. The plan also responds to issues around the absence of a formal process for 
following up clinical incidents in collaboration with other agencies. 

They presented details of the staff engaged under practising privileges to provide the 
Community Urology Service (CUS). We cross referenced this information with the General 
Medical Council (GMC) register and confirmed that both lead urology consultants, along with 
3 of the 4 other Urologists, are listed on the GMC Specialist Register, indicating they are 
qualified to practise as consultants. The fourth urologist is registered with the GMC but not at 
consultant level. The registered nurse is listed on the Nursing and Midwifery Council (NMC) 
register with no restrictions on their practice. We noted that all but 1 of the clinicians held 
NHS roles as their primary employment.  

Based on this, we were satisfied that the service was consultant-led and that action has 
been taken to address referral concerns and silo working through the introduction of the 
Referral Risk Assessment Checklist and Communication Improvement Plan.  

3.  Lack of appraisal and mandatory assessment of clinicians employed by CUS. 

There was an absence of any appraisal and/or mandatory assessments within the 
CUS or the ICB and SMC for the associate specialist clinicians who were working 
extra-contractually outside of their NHS work. No evidence was provided as to their 
experience and competency. This gives rise to a concern that their working practices 
are insufficiently assessed and fails to fulfil GMC ‘good practice’ guidelines. Likewise, 
no evidence was provided regarding regular morbidity and mortality reviews of 
complications by the ICB, CUS and SMC such as when patients re-present to NHS 
hospitals with complications arising from the CUS.  

We are unable to comment on the aspects of this concern that relate to the Integrated Care 
Board (ICB) due to it being outside of the remit of our regulatory scope. The ICB as a named 
respondent in this case, would be best placed to address this point and provide further 
clarification. 

However, we have responded to the aspects relating to Sussex Medical Chambers (SMC). 

We use regulations when we assess if a provider is safe, effective, caring, responsive and 
well-led. Regulations for service providers and managers - Care Quality Commission 

The concern regarding the lack of appraisal and mandatory assessment of clinicians 
employed by CUS is covered under the following regulations: 

•  Regulation 17: Good governance 
•  Regulation 18: Staffing 
•  Regulation 19: Fit and proper persons employed 

To meet the regulation, providers must provide sufficient numbers of suitably qualified, 
competent, skilled and experienced staff to meet the needs of the people using the service 
at all times and the other regulatory requirements set out in this part of the above 

 
 regulations. Staff must receive the support, training, professional development, supervision 
and appraisals that are necessary for them to carry out their role and responsibilities. They 
should be supported to obtain further qualifications and provide evidence, where required, to 
the appropriate regulator to show that they meet the professional standards needed to 
continue to practise. 

We last inspected Sussex Medical Chambers (SMC) in November 2022. At that time, we 
found that the service had systems for regular reviews of individual staff performance. Staff 
participated in routine one-to-one meetings with their clinical line managers and received 
annual appraisals. Those who had completed their probationary period underwent a formal 
probationary review. Clinical staff working on a sessional basis were required to provide 
evidence of their external professional appraisal summaries to the provider. The service held 
records confirming that medical professionals were registered with the General Medical 
Council (GMC) and were up to date with their revalidation requirements. 

However, we acknowledge that this inspection took place approximately 1 year prior to the 
death of Mr Hankin.  

In response to the Regulation 28 report and as part of our regulatory response, we asked 
Sussex Medical Chambers (SMC) to tell us how they have responded to this aspect of the 
Regulation 28 report.  

SMC informed us that they had previously provided your office with an explanation of the 
appraisal process, as outlined in the Managing Director’s statement dated 27 June 2025. 
The same information was subsequently shared with us. 

They informed us that all clinicians working within the Community Urology Service (CUS) 
hold primary clinical roles elsewhere, typically within NHS Trusts, and work with their 
organisation in a secondary capacity. Their primary employers are responsible for 
conducting annual appraisals, which include reviewing previous appraisals, verifying 
continuing professional development (CPD) and mandatory training, considering feedback, 
and assessing any serious incidents or complaints. They explained that it is standard 
practice for the primary appraiser to seek input from CUS, which they consistently provide 
upon request. They also confirmed that they receive and review each clinician’s appraisal 
documentation annually as part of their internal governance process. 

In addition, the provider conducts its own annual review with each clinician, tailored to their 
role and seniority. This includes compliance checks, confirmation of up-to-date mandatory 
training and CPD, and a review of patient feedback. 

We were satisfied that this demonstrated that appraisals were performed in line with 
nationally recognised arrangements for individuals working in the independent sector.  

4.  Practicing [sic] Privileges in the private sector. 

[sic] set up and led the CUS under the auspices of SMC. The ICB 

contractually required this service to be run by a consultant urologist. 

 [sic] had not held a formal consultant urologist position within the NHS 
prior to tendering for this work. It remains unclear as to how
 [sic] 
was provided with practicing [sic] privileges at a private hospital as a consultant 
and was therefore able to practice independently and without scrutiny. This gives 
rise to a concern that there is a lack of robust assessment and guidelines, both 
locally and nationally, as to how clinicians are given practicing [sic] privileges to 

 
 work independently outside of the NHS to the potential detriment of patient care. It 
also gives rise to a concern that patients are not being fully informed of the 
relevant experience of such clinicians thereby breaching the statutory duty of 
candour responsibility of all hospitals.  

We are unable to comment on the aspects of this concern that relate to the Integrated Care 
Board (ICB) due to it being outside of the remit of our regulatory scope. The ICB as a named 
respondent in this case, would be best placed to address this point and provide further 
clarification. 

We recognise that the General Medical Council (GMC) is responsible for ensuring that all 
doctors, physician associates (PAs), and anaesthesia associates (AAs) practising in the UK 
have the appropriate knowledge, skills, qualifications, and experience. They fulfil this role by 
maintaining official registers of these professionals. We are unable to comment on the GMC 
regulatory responsibilities. The GMC is best placed to respond to this aspect of this question. 
However, we note that the GMC is not a named respondent. 

When we inspect independent providers, we check that they have processes for managing 
practising privileges, including that they have processes for checking that doctors, physician 
associates (PA) and anaesthesia associates (AA) are registered with the GMC. We 
understand from our review of the GMC Register that the individual referenced has been 
registered as a consultant on the GMC Specialist Register (Urology) since 2008.  

When we last inspected Goring Hall Hospital (GHH) in December 2021, we found that 
consultants working under practising privileges were required to submit appraisal 
documentation to the registered manager prior to commencing work and annually thereafter. 
The Medical Advisory Committee (MAC) was responsible for overseeing clinical governance, 
approving and renewing practising privileges, and monitoring patient outcomes.  

However, we acknowledge that this inspection took place approximately 2 years prior to the 
death of Mr Hankin. 

When we inspected Sussex Medical Chambers (SMC) in November 2022, we found staff 
had the appropriate skills, knowledge, and experience for their roles. Induction and training 
were well structured, with protected time for learning. Practising privileges were granted to 
experienced consultants across multiple specialties. Records of qualifications and training 
were generally well maintained. Staff performance was regularly reviewed through one-to-
one meetings, probationary reviews, and annual appraisals. Sessional clinical staff 
submitted external appraisal summaries. The service held records confirming that medical 
professionals were registered with the GMC and up to date with revalidation. 

However, we acknowledge that this inspection took place approximately 1 year prior to the 
death of Mr Hankin. 

In response to the Regulation 28 report and as part of our regulatory response, we asked 
Goring Hall Hospital (GHH) and Sussex Medical Chambers (SMC) to tell us how they have 
responded to this aspect of the Regulation 28 report.  

Goring Hall Hospital (GHH) informed us that, while they did not consider this concern to be 
specifically directed at their organisation, they understood it was prompted by the use of the 
title “consultant” by Mr Hankin’s treating surgeon at GHH when he had not held a consultant 
post in the NHS. They clarified that the surgeon in question had worked in the NHS for 18 
years prior to retiring to focus on his private practise.  

 As we had already identified, they clarified that the surgeon had been on the GMC Specialist 
Register since 23 April 2008, confirming that he meets GMC standards to “work at any grade 
in the NHS including consultant”. 

GHH also provided Circle Health Group (CHG) Practising Privileges policy which aligns with 
the Independent Healthcare Providers Network (IHPN) Medical Practitioners Assurance 
Framework (MPAF), refreshed in September 2022. They confirmed that the treating surgeon 
satisfied the requirements of the policy and holds practising privileges at GHH as a 
consultant urologist. 

They informed us that CHG policies are regularly reviewed under its medical governance 
framework to remain in-keeping with best practice. Having considered the coroner’s 
concerns carefully, CHG was satisfied that no additions or changes to its current processes 
were required, and that medical practitioners working within its facilities had the necessary 
qualifications and expertise to do so. 

GHH also provided CHG Responding to Concerns about Medical Practitioners policy which 
offered a clear, formal framework in order to address issues of concerns which arise in 
relation to medical practitioners who are working under practising privileges.  

We reviewed the response from GHH, both policies and the IHPN Medical Practitioners 
Assurance Framework (MPAF), reference by GHH. We were satisfied that both policies 
provided robust guidelines, aligned with national guidance. 

Medical Practitioners Assurance Framework (MPAF) refresh - Independent Healthcare 
Provider Network 

Sussex Medical Chambers (SMC) advised that they understood this concern to be directed 
 CV 
at Goring Hall Hospital (GHH) and had covered the aspects in relation to 
in their response to earlier concerns. We were satisfied that SMC had provided appropriate 
evidence in response to those earlier concerns. 

5.  Learning from Mr Hankin’s death. 

The ICB did not independently review the circumstances of Mr Hankin’s death to 
confirm if there was any learning or changes in practice to prevent further deaths. 
Likewise, SMC relied on 
 to inform them and investigate Mr Hankin’s 
death without considering the inherent conflict of interest in so doing. The lack of 
an independent review prevented any proactive learning and changes in practice 
following the death of Mr Hankin. This gives rise to a concern that the system 
within the ICB and SMC are insufficiently robust and could – as it was with Mr 
Hankin – prevent transparency and openness as to the circumstances of his death 
and limit any learning and or necessary changes in practice to prevent future 
deaths.  

We are unable to comment on the aspects of this concern that relate to the Integrated Care 
Board (ICB) due to it being outside of the remit of our regulatory scope. The ICB as a named 
respondent in this case, would be best placed to address this point and provide further 
clarification. 

We have responded to the aspects relating to Sussex Medical Chambers (SMC). As detailed 
in response to concern 1, the findings from our November 2022 inspection have already 
been addressed and are therefore not repeated here. 

 
 
 In response to the Regulation 28 report and as part of our regulatory response, we asked 
Sussex Medical Chambers (SMC) to tell us how they have responded to this aspect of the 
Regulation 28 report.  

SMC informed us that 
circumstances of Mr Hankin’s death were reviewed at a clinical governance meeting on 1 
November 2023 by the service director, 2 operations managers, the managing director, 

 did not unilaterally investigate Mr Hankin's death. The 

 and a consultant in renal medicine from University Hospitals Sussex NHS 

Foundation Trust. At this meeting, the circumstances preceding Mr Hankin’s death were 
formally examined. SMC acknowledged that Goring Hall Hospital (GHH) was undertaking its 
own investigation into Mr Hankin’s care and, in accordance with established protocol for 
cases involving multiple healthcare providers, SMC reached out to the hospital to offer input 
into their review. 

They told us that they have reviewed Mr Hankin's care more recently while responding to 
requests for information for the inquest. We understand they also requested a recording of 
the 4-day inquest along with Goring Hall Hospital’s serious incident review to support further 
learning and reflection.  

SMC told us that 
 has self-referred to the GMC and SMC has appointed a 
consultant urologist as Interim Clinical Governance Lead for the CUS until the GMC has 
concluded its inquiry. 
Interim Clinical Governance Lead while the GMC investigation is ongoing. 

 will be subject to monthly supervision sessions with the 

They informed us that they have developed a Communication Improvement Plan specifically 
to address the concerns around referral pathways and siloed working. The plan establishes 
a formal process for following up clinical incidents in collaboration with other agencies and 
includes a Referral Risk Assessment Checklist to ensure patients are referred to the 
appropriate secondary care provider. 

In addition, SMC has implemented a Managing Clinical Incidents Plan, which includes 
measures to reinforce existing policies, strengthen incident review processes, and promote 
confidence and learning among staff. 

We reviewed both documents and were satisfied that these actions demonstrate a clear 
commitment to improving referral processes, communication, and the management of 
clinical incidents. 

 6. Management of Mr Hankin at Goring Hall Hospital. 

There were multiple omissions in the pre-operative, intra-operative and post operative 
care provided by Goring Hall Hospital which individually and collectively contributed 
to Mr Hankin’s death. This included a failure to recognise Mr Hankin underlying 
medical co-morbidities rendered him unfit to have his operative procedure at the 
hospital. More specifically the post-operative assessment and support provided by 
the consultant anaesthetist and surgeon led to a delay in assessing and diagnosing 
sepsis and thereafter giving appropriate and timely antibiotics and facilitating an 
earlier transfer to the NHS Hospital for further management. This gives rise to a 
concern that there was a lack of understanding by the senior clinicians (in the 
absence of any local and national guidelines provided at the inquest) requiring them 
to remain responsible for the care of patients throughout their time in a private 

 
 hospital rather than delegating the care to a Resident Medical Officer who is more 
likely than not to be insufficiently experienced in managing such critical situations. 

We have responded to the concerns relating to Goring Hall Hospital. 

On 11 September 2023, Goring Hall Hospital submitted a statutory notification to the Care 
Quality Commission (CQC) reporting the death of Mr Hankin.  

As the independent regulator of health and social care services in England, the Care Quality 
Commission (CQC) reviewed the circumstances surrounding Mr Hankin’s death in line with 
our statutory responsibilities. Our inspection team engaged with the provider, to understand 
the actions taken in response to the incident and to assess whether there were any 
breaches of fundamental standards or regulatory requirements. 

On 12 September, we requested further information from the provider, including investigation 
plans, immediate actions and the final investigation report, once available. By 14 September, 
the registered manager confirmed that a patient safety incident investigation (PSII) had 
commenced. No immediate actions had been implemented at that stage, but communication 
with the patient’s family and NHS trust was ongoing. 

We continued to monitor progress and followed up on 22 January 2024 for an update. On 23 
January, the provider reported that the draft patient safety incident investigation (PSII) had 
been completed and was under review by the Corporate Governance team. On 29 April, we 
formally requested the PSII, and the provider shared the final draft of the patient safety 
incident investigation report. The provider confirmed that the report had been shared with the 
patient’s family and the coroner, and that an inquest date was pending. 

On 1 May 2024, we reviewed the patient safety incident investigation (PSII) report in line 
with CQC’s Specific Incident guidelines.  

Under this guidance, Inspectors, supported by Operations Managers, undertake an initial 
assessment of specific incidents where there is reasonable suspicion that people using a 
regulated service have sustained avoidable harm or been exposed to a significant risk of 
avoidable harm. Two important questions are answered as part of the initial assessment. 

1.  Does the information about the specific incident raise concerns about ongoing risk of 

harm to users of the service which CQC should inspect?  

2.  Does the information about the specific incident suggest the harm sustained was 

avoidable and may have resulted from a registered person (Provider or Registered 
Manager) breach of a prosecutable fundamental standard? For example, a breach of 
Regulation 12(1) failure to provide safe care and treatment? If so, CQC should gather 
further evidence about the incident as part of a formal criminal investigation once that 
decision has been validated by CQC National Criminal Case Assessment and 
Progression Panel (CCAPP). 

We addressed question 1. We reviewed the provider’s investigation and action plan to 
assess the ongoing risk of harm and determined that the provider’s action plan was 
appropriate and proportionate to address the identified concerns. 

The provider’s action plan focused on strengthening pre-operative assessment and patient 
safety through measures such as auditing referral quality, revising admission information and 
health questionnaires, and introducing processes to validate patient data. A shared care 
record was implemented to improve access to linked NHS data, and admission criteria were 

 updated to include neutrophil thresholds. Point-of-Care Testing enabled rapid blood results, 
while consultant expectations were aligned for same-day reviews.  

Additional initiatives included a pre-assessment outcome tracker, reassessment of 
Registered Nurse (RN) competency in National Early Warning Score (NEWS2), integration 
of the Sepsis 6 pathway and scenarios into Critical Care Development Programme (CCDP) 
training, revisions to the anaesthetic chart, and a new checklist for reviewing and escalating 
blood results.  

We went on to address question 2. We noted a delay in the administration of IV antibiotics 
for suspected sepsis, which were delivered 55 minutes beyond the recommended one-hour 
window. However, records indicated that staff were engaged in other diagnostic procedures 
at the time, and training documentation confirmed familiarity with the Sepsis 6 protocol. 

We also examined concerns regarding the pre-operative assessment, where certain chronic 
health conditions had not been documented. The provider acknowledged this oversight and 
subsequently revised its assessment process. The consultant confirmed that these 
omissions would not have influenced the decision to proceed with surgery, given the 
patient’s ongoing risk of urinary tract infections. 

Based on the information available at the time, we concluded that the shortfalls were 
individual, rather than provider failings and that the incident did not meet the threshold for 
classification as a Specific Incident in line with CQC’s Specific Incident guidelines.  

CQC’s prosecutorial powers only extend to registered persons. A registered person means 
either the provider or their registered manager. Failures by individuals are not within our 
remit; therefore, we cannot pursue this matter any further.  

Since receiving the Regulation 28 Report, we have reflected on our regulatory response and 
have acknowledged that while the majority of actions had already been completed, we did 
not follow up with Goring Hall Hospital (GHH) to confirm full implementation of their actions. 
We have since asked GHH for their updated action plan to ensure full implementation. 

In addition, CQC have taken steps to strengthen support for inspection teams to ensure the 
Specific Incident process is consistently followed in future cases in line with CQC’s Specific 
Incident guidelines. To enhance our oversight of Specific Incidents, we have established a 
Specific Incident Progression Team. This team supports inspection staff in meeting our 
responsibilities for incident follow-up and ensures alignment with our enforcement powers. 
As you may be aware, since 1 April 2015, the Commission has held responsibility for 
prosecuting registered persons for failures to provide safe care and treatment where service 
users have been exposed to or sustained avoidable harm, under Regulations 12(1) and 22 
of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 

In response to the Regulation 28 report and as part of our regulatory response, we asked 
Goring Hall Hospital (GHH) to tell us how they have responded to this element of the 
Regulation 28 report.  

GHH clarified that as with all CHG sites, they operate a consultant-led care model, which is 
adopted across the independent sector. Consultants’ responsibilities are clearly and robustly 
identified in CHG’s practising privileges policy, which draws upon GMC’s Good Medical 
Practice and associated national guidance. The responsibilities are also made clear in other 
policies, including CHG’s Care of the Deteriorating Patient policy which explicitly sets out the 
expectations of both consultants and Resident Medical Officer (RMO) when managing 
patient deterioration and is entirely clear that consultants remain responsible for clinical care 

 through a patient’s stay in a CHG hospital. Furthermore, it mandates that a failure of a 
consultant to respond in line with their responsibilities must be escalated to the senior 
management team. It also makes explicitly clear the RMO responsibility and training and 
competence expectations.  

GHH clarified that consultant compliance with their responsibilities is monitored and ensured 
through a combination of incident reporting and monitoring, appraisal, biennial review, audit 
and Freedom to Speak Up. Any concerns about a consultants performance are addressed 
under CHG’s Responding to Concerns about Medical Practitioners policy.  

CHG ensures that policies are regularly reviewed under its medical governance framework 
to remain in-keeping with best practice. Having considered the coroner’s concerns carefully, 
CHG was satisfied that no additions or changes to its current processes and policies were 
required. 

We have reviewed CHG’s Care of the Deteriorating Patient policy (CHG NURpol33) and 
CHG’s Responding to Concerns about Medical Practitioners policy (CHG GOVpol35) and 
consider these to be clear and based on national guidance.  

We asked Goring Hall Hospital (GHH) for their updated investigation and action plan to 
ensure full implementation and have reviewed this. 

They told us that following the inquest findings, they reviewed their original action plan and 
undertook a comprehensive gap analysis between their initial findings and the coroner’s 
conclusions, which were issued nearly two years later. All of their original actions had been 
implemented as were the majority of their additional actions. 

As part of additional measures, the provider shared the coroner’s findings with governance 
committees and involved consultants, introduced documentation for recording antimicrobials 
during pre-operative optimisation, and updated patient materials to confirm medication 
changes. 

Consultant responsibilities for optimisation were clarified through reflection and shared 
learning sessions. A digital report summarising procedures and pre-assessment outcomes 
was implemented, alongside annual audits of NEWS2 accuracy and quarterly scenario 
assessments for deteriorating patients.  

Training was strengthened by reviewing escalation protocols and adding sepsis scenarios, 
while daily Medical Emergency Team (MET) meetings and ward rounds were established to 
monitor high NEWS2 scores. The clinical escalation SOP was promoted in line with the “Call 
to Concern” initiative (Martha’s Rule).  

I trust that the considered response provided, alongside the actions undertaken by the Care 
Quality Commission, offers the necessary assurance in accordance with our regulatory 
responsibilities. We will continue to monitor the provider’s compliance with regulatory 
standards and ensure that learning from this case is embedded into practice. We remain 
committed to supporting improvements in patient safety and care quality across all services. 

Yours sincerely,  

Interim Deputy Director

Dr Karen Henderson 
HM Assistant Coroner for West Sussex, Brighton and Hove 

1st Floor 
30 Cannon Street 
London 
EC4M 6XH 

circlehealthgroup.co.uk 

Tuesday 11 November 2025 

Dear Dr Henderson 

Response to Regulation 28 Report to Prevent Future Deaths  

I write on behalf of Goring Hall Hospital (GHH) and Circle Health Group (CHG) (which GHH forms part 
of)  following  the  conclusion  of  the  inquest  into  the  death  of  Mr  Keith  Hankin  and,  specifically,  in 
response to your Regulation 28 report dated 17 September 2025. 

At the outset, may I extend my deepest sympathies and condolences to Mr Hankin’s family for their loss. 
I recognise that this remains an extremely challenging time for them and I reiterate the commitment 
conveyed previously by my CHG colleagues to addressing, as far as possible, all areas for improvement 
identified through internal and coronial review of this case. 

In your Regulation 28 report, you identify two matters on which it is appropriate for CHG to respond, 
and  which  I  address  under  the  respective  headings  below.  I  do,  however,  wish  to  note  here  that  no 
enquiries were made of CHG to enable us to address these concerns at the time of the inquest hearings. 
This was disappointing as, had such an opportunity been provided, CHG would have readily supplied 
evidence to allay the concerns. I nonetheless recognise the importance of providing that information 
now,  and  hope  that  this  provides  full  reassurance  that  CHG  deploys  robust  systems  to  ensure  it  is 
operating safely and in line with best practice across the sector. 

Practising privileges within the private sector 

You raised concerns that: 

• 

• 

there is a lack of robust assessment and guidelines, both locally and nationally, as to how clinicians are 
given  practicing  privileges  to  work  independently  outside  of  the  NHS  to  the  potential  detriment  of 
patient care; and 

that  patients  are  not  being  fully  informed  of  the  relevant  experience  of  such  clinicians  thereby 
breaching the statutory duty of candour responsibility of all hospitals 

Circle Health Group Limited | Registered number: 2164270 
Registered office: 1st Floor, 30 Cannon Street, London EC4M 6XH | Registered in England & Wales 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 While the first of the above listed concerns was not specifically directed to GHH, we understand it was 
prompted by the use of the title “consultant” by Mr Hankin’s treating surgeon at GHH when he had not 
held a consultant post in the NHS. As was clarified at the inquest hearing, the surgeon in question had 
worked in the NHS for approximately 18 years, prior to retiring to focus on his private practice. He has 
been registered on the GMC Specialist Register since 23 April 2008. The GMC-designated terms of the 
surgeon’s  registration  confirm  that  he  “may  work  at  any  grade  in  the  NHS  including  consultant”.  We 
therefore see no fair basis on which it can be deemed inappropriate for the surgeon to adopt the title of 
“consultant” for his private practice. 

It should also be noted that CHG has in place, and stringently applies, a Practising Privileges policy which 
requires  those  seeking  practising  privileges  to  provide  robust  evidence  of  their  qualifications, 
experience and competencies to ensure it is suitable for them to practise at our hospitals using the title 
of “consultant”. These include a requirement to provide evidence of: 

• 
• 

their inclusion on the GMC’s Specialist Register 
that they hold, or have held (within the last 5 years (at the date of application)), a substantive 
consultant post within the NHS, or have held a long-term locum post within the NHS, or can 
demonstrate experience of independent practice over a sustained period applicable to working 
in the independent sector 

•  all  procedures  to  be  performed  under  the  practising  privileges,  demonstrating  adequate 
numbers in line with the national clinical data for the specialty performed in each procedure 
over the previous two years and the competence to carry out the procedure(s) competently and 
effectively in their clinical practice. 

These  requirements,  and  others  set  out  within  CHG’s  Practising  Privileges  policy,  were  met  by  the 
treating surgeon and we remain satisfied that he appropriately holds practising privileges at CHG as a 
consultant. 

I can further confirm that CHG’s Practising Privileges policy, along with other relevant CHG policies and 
governance framework, aligns with the IHPN’s Medical Practitioners Assurance Framework (“MPAF”), 
refreshed in September 2022. By doing so, CHG is fully assured that its systems for the engagement and 
oversight of medical practitioners meet the appropriately high standards required. CHG ensures that 
these  policies  are  regularly  reviewed  under  its  medical  governance  framework  to  remain  in-keeping 
with best practice in the sector.  

Turning to the second part of the concern, which suggests a breach of the statutory duty of candour 
placed on all hospitals regulated by the CQC. This duty requires healthcare providers to be open and 
transparent with their patients. For the reasons stated above, I have found no basis on which it can fairly 
be asserted that CHG is breaching the statutory duty of candour or otherwise failing to be transparent. 
It should also be noted that CHG’s website publishes personal profiles for all consultants who provide 
services at CHG facilities. This is in addition to the detail provided on the GMC Specialist Register, which 
confirms  their  registration  and  any  restrictions  on  it.  Taking  the  example  of  the  treating  surgeon  in 
Mr Hankin’s  case,  the  personal  profile  on  CHG’s  website  is  detailed  and  fully  transparent  about  his 
extensive experience. 

Having considered your concerns carefully, CHG is satisfied that no additions or changes to its current 
processes are required, and that medical practitioners working within its facilities have the necessary 
qualifications, expertise and experience to do so, and that this is fully transparent to CHG patients.  

 
 
 
 
 
 
 
 
 
 Management of Mr Hankin at GHH 

Specifically,  you  raised  a  concern  that  “there  was  a  lack  of  understanding  by  the  senior  clinicians  (in  the 
absence of any local and national guidelines provided at the inquest) requiring them to remain responsible for 
the care of patients throughout their time in a private hospital rather than delegating the care to a Resident 
Medical Officer.” 

I can confirm that GHH, as with all CHG sites, operates a consultant-led care model which is adopted 
across  the  private  sector.  Consultants’  responsibilities  are  clearly  and  robustly  identified  in  CHG’s 
Practising Privileges policy, which draws upon the GMC’s Good Medical Practice and associated national 
guidance with which all doctors are expected to comply. CHG’s policy explicitly states: “The practitioner 
retains responsibility for patients they have treated during the patient’s entire clinical pathway in the relevant 
CHG hospital”. 

Consultants’ responsibilities are further reiterated within the comprehensive suite of clinical policies 
that are implemented across the CHG estate. Of particular relevance in this case is CHG’s Care of the 
Deteriorating Patient policy, which plainly sets out the expectations of both consultants and RMOs when 
managing patient deteriorations, and is incontrovertibly clear that consultants remain responsible for 
clinical care throughout a patient’s stay in a CHG hospital. Further, the policy mandates that a failure by 
a consultant to respond in line with their responsibilities must be escalated to the senior management 
team within the hospital. 

Consultant compliance with their responsibilities is monitored and ensured through a combination of 
incident  reporting  and  monitoring,  appraisal,  biennial  review,  a  wider-reaching  and  robust  audit 
programme and Freedom to Speak Up escalation channels. Any concerns about consultant performance 
are addressed appropriately under CHG’s Responding to Concerns about Medical Practitioners policy. I can 
therefore confirm that CHG has given careful consideration to the concerns identified and is satisfied 
that its policies are clear, effective in their aim, and that no revision or further action is required at this 
time. As is the case with all policies and, as mentioned above, these are reviewed regularly to ensure 
ongoing compliance with best practice. 

Yours sincerely 

Chief Medical Officer

Minister of State for Health (Secondary Care) 

39 Victoria Street 
London 
SW1H 0EU 

HM Coroner Dr Karen Henderson 
Record Office,  
Orchard Street,  
Chichester,  
PO19 1DD 

14th November 2025 

Dear Dr Henderson,  

Thank you for the Regulation 28 report of 4th July 2025 sent to the Secretary of State for the 
Department  of  Health  and  Social  Care  about  the  death  of  Mr  Keith  James  Hankin.  I  am 
replying as the Minister with responsibility for secondary care.       

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

The report raises concerns over numerous issues, namely a lack of clinical governance of 
the Community Urology Service (CUS) by either the commissioning Integrated Care Board 
(ICB) or Sussex Medical Chambers (SMC) who provided the service; a lack of integration 
between  the  CUS  and  NHS  hospital  urology  services;  a  lack  of  mandatory  appraisals  or 
assessments of clinicians while working hours at CUS; how private hospitals decide who to 
give  practicing  privileges  to  and  whether  patients  are  being  misled  over  the  level  of 
experience medical staff and clinicians have; concerns about a lack of immediate external 
review of the CUS service following Mr Hankin’s death; and the management of Mr Hankin 
at Goring Hall, particularly post-operatively by the consultant anaesthetist and surgeon. 

In preparing this response, my officials have made enquiries with NHS England to ensure 
we adequately address your concerns.  

Regarding the commissioning of the CUS, Care Quality Commission (CQC) Regulation 17 
of  the  Health and  Social  Care  Act  2008  (Regulated  Activities) Regulations  2014  requires 
effective governance processes are in place to complete registration of a regulated service, 
and the ICB have a contracting checklist that confirms provider governance is in place. As 
such,  SMC  have  these  processes  in  place,  but  this  was  unfortunately  not  shared  at  the 
inquest. Their current overall CQC rating is good. 

NHS Sussex have issued a Contract Performance Notice which has now been closed, and 
governance processes which existed at the time of the incident have been reviewed. SMC 
remains in enhanced quality oversight with a further quality review in November 2025. 

 
 
 
 
 
 
 
 
 
 
 
 
 With  view  to  the  siloing  of  CUS  and  NHS  hospital  urology  work,  the  CUS  is  part  of  the 
Urology Pathway and manages “low risk” individuals. There are referral routes to the NHS 
pathway as clinically required. An issue was raised by the NHS Consultant giving evidence 
at the inquest for University Hospitals Sussex, but no formal concerns were raised to the 
ICB and this remains the case. The CUS service specification was met by the Provider, and 
all recruitment checks are managed by the Providers of the service. 

The safety of all patients, whether they are treated in the NHS or the independent sector, is 
a top priority for the government. All providers of healthcare are regulated by the CQC and 
follow a set of fundamental standards of safety and quality, below which care should never 
fall.   

Those providers in receipt of NHS contracts must meet additional requirements, including 
meeting the provisions of the NHS Provider License and the NHS Standard Contract. These 
additional measures put in place specific standards which must be met. Contracts to private 
providers  can  be  and  are  terminated  where  these  are  not  met.  ICBs  are  responsible  for 
enforcing contracts with providers, including independent sector providers in their area, and 
are best placed to ensure providers are meeting the needs of their patients. 

The  General  Medical  Council  (GMC)  is  responsible  for  ensuring  that  doctors  have  the 
necessary skills and knowledge to join its UK registers.  All doctors must register with the 
GMC, and meet the expected standards set out in the GMC’s Good medical practice to work 
in 
the  UK:  https://www.gmc-uk.org/professional-standards/professional-standards-for-
doctors/good-medical-practice. Doctors must also hold a licence to practice medicine.  

Good medical practice states that doctors must recognise and work within the limits of their 
competence, and must provide a good standard of practice and care. The GMC’s guidance 
on Trust and Professionalism states: “You must always be honest about your experience, 
qualifications, and current role. You should introduce yourself to patients and explain your 
role in their care.” Failure to uphold and adhere to the principles within Good medical practice 
and related guidance will put a professional’s registration with the GMC at risk.    

The Medical Profession (Responsible Officers) Regulations 2010 defines designated bodies 
and  sets  out  connections  for  doctors  to  a  designated  body.  The  regulations  state  that 
designated  bodies,  including  those  independent  of  the  NHS,  should  ensure  that  regular 
appraisals are carried out on doctors connected to them, and the appraisal should consider 
all the work carried out by the doctor, including work for any other organisations. Any fitness 
to practise concerns should be recorded by the designated body, with procedures in place 
to investigate any concerns, and recommendations made to the GMC.   

Cases where appraisals are not carried out for doctors who have prescribed connections 
with a designated body should be referred to the responsible officer for the designated body. 

The responsible officer has a role in helping ensure the designated body fulfils its clinical 
governance legal obligations. 

You also  raised  concerns  about  privileges  to  practice  in  private  hospitals.  In  response to 
Recommendation 3 of the Paterson Inquiry report (published in 2020), this Department is 
currently  completing  clear,  patient-focused  information  that  explains  the  differences 

 
 
 
 
 
 
 between care provided by the NHS and the independent sector. This will help patients make 
informed  choices  whether  they  choose  to  be  treated  privately  or  to  receive  NHS-funded 
treatment (directly or in the independent sector). 

The draft guidance informs patients about how consultants are engaged at private hospitals 
(including practising privileges and indemnity), emergency and intensive care arrangements 
and handover of care between the NHS and the independent sector. It also provides a list 
of  questions  patients  would  benefit  from  asking  their  independent  sector  provider  before 
opting  to  seek  treatment  with  them.  Such  information  should  equip  patients  to  better 
scrutinise the providers with which they come into contact.  

As  part  of  the  concerns  raised  around  this  point,  there  were  references  to  whether  the 
consultant leading the CUS was appropriately qualified. All checks and balances have been 
undertaken,  and  NHS  England  have  assured  me  that 
  is  appropriately  registered 
under the GMC to provide the CUS services. Goring Hall have processes in place to recruit 
staff members and ongoing checks to ensure competency and adequate registration. NHS 
Sussex have visited this provider and are also following up on your recommendation that 
they refer themselves to GMC.  

Regarding reviewing the causes of Mr Hankin’s death and the risk of a lack of transparency, 
Mr  Hankin’s  case  was  reviewed  by  the  provider  under  the  National  Serious  Incident  (SI) 
framework as it occurred in 2023. NHS Sussex have reviewed the SI as per ICB scrutiny 
process  and  the  SI  has  been  closed.  This  provider  review  is  the  same  process  that  any 
provider  would  undertake  following  the  SI  Framework.  The  ICB  would  consider  an 
independent  review  if  the  quality  of  the  provider  report  was  an  issue  or  did  not  elicit 
appropriate  learning.  The  provider  SI  identified  appropriate  learning  and  subsequent 
actions. 

The use of Goring Hall is via patient choice and through a different contract from the CUS. 
I am sure they will be responding separately, but my officials have let me know that the main 
learning points there are in recognition and management of sepsis. I was informed key areas 
were around pre and post assessment checks, administration of antimicrobial therapy and 
compliance with the sepsis 6 pathway. 

I hope this response is helpful. Thank you for bringing these concerns to my attention.   

Yours sincerely,  

MINISTER OF STATE FOR HEALTH

Dr Karen Henderson 
Assistant Coroner 
County Records Office 
HM Coroners Office 
Orchard Street 
Chichester 
West Sussex 
PO19 1DD 

13 November 2025 

Dear Dr Henderson, 

NHS Sussex 
Sackville House 
Brooks Close 
Lewes 
East Sussex 
BN7 2FZ 

I write in response to your Regulation 28 report dated 17 September 2025 setting out your 
concerns after hearing evidence at the Inquest touching on the death of Mr Keith Hankin.  

I wish to begin by extending my sincere condolences to Keith’s family and friends. The inquest 
proceedings must have been an extremely difficult time for them, and I hope that my response 
provides them and you with assurances that NHS Sussex Integrated Care Board (ICB) has 
taken action to address the issues set out in your Regulation 28 report.  

I address your concerns as follows, after consultation with senior commissioners and clinical 
teams: 

Lack of clinical governance of the Community Urology Service (CUS) by the Integrated 
Care Board (ICB) who commissioned the service and Sussex Medical Chambers (SMC) 
who were responsible for providing the service.  
NHS Sussex Integrated Care Board (ICB) is responsible for commissioning most healthcare 
services for the Sussex population, including primary, community, and hospital services. All 
commissioned  services  have  a  standard  NHS  contract  in  place,  which  includes  a  specific 
service  specification  detailing  expectations  such  as  patient  outcomes  and  monitoring 
requirements.  It is recommended for use nationally by NHS Commissioners.  The contract is 
considered to represent best practice, and it sets out the quality and assurance monitoring 
required  along  with  the  expectations  of  the  service.  Under  the  standard  NHS  contract,  all 
commissioned  services  are  required  to  have  robust  organisational  quality  assurance, 
oversight and clinical governance processes in place. All providers of NHS clinical services 
are required to be registered with the Care Quality Commission (CQC) and are required to 
comply with relevant regulations which includes Clinical Governance processes. 

NHS Sussex ICB commissions a number of independent sector providers of NHS health care 
services as well as NHS providers. Sussex Medical Chambers are commissioned to provide 
non-complex community urology NHS services following a GP referral.   

The role of NHS Sussex ICB through contractual management processes is to ensure that the 
organisational  quality  assurance,  oversight  and  clinical  governance  processes  are  in  place 
and to seek assurance where improvements are required. ICBs are required to monitor at an 
organisational level and do not review individual patient level information.   

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Following  the  conclusion  of  the  inquest  which  highlighted  HM  Coroner’s  concerns  about 
Sussex Medical Chamber (SMC) clinical governance NHS Sussex took the following action:   

•  Sussex Integrated Care Board (ICB) issued a Contract Performance Notice (CPN) to 
Sussex  Medical  Chambers  (SMC)  under  the  NHS  Standard  Contract.  In  response, 
SMC  provided  a  comprehensive  set  of  documents  and  evidence  demonstrating  the 
governance  framework  in  place. SMC  submitted  its  Clinical  Governance  Policy, 
supported by the Terms of Reference for its Clinical Governance Committee, which 
outlines the oversight structure and reporting mechanisms. 

•  For 2026/2027 NHS Contract negotiations, NHS Sussex has set out its expectations 
in relation to quality standards which includes Clinical Governance and Effectiveness, 
Patient Safety and Experience for all commissioned services. 

Lack of Integration of the Community Urology service with the NHS Hospital Urology 
Services.   
Through legislation, patients have a statutory right at the point of referral from general practice 
to  choose  any  available  consultant-led  provider  able  to  deliver  the  care  they  require  (NHS 
Commissioning Board and CCG (Responsibilities and Standing Rules) Regulations 2012). For 
non-complex Urology cases, this choice includes community providers, able to deliver more 
timely care for a range of minor conditions than local NHS providers. 

The  providers  of  community-based,  consultant-led  services  commissioned  under  an  any-
qualitied-provider (AQP) contract by NHS Sussex ICB are governed by the same professional 
and regulatory standards as NHS organisations/clinicians. Clinicians are expected to adhere 
to their regulatory professional standards of safely treating patients within the scope of their 
individual practice or the facilities available within the service.  

Where  the  needs  of  patients  are  such,  their  treatment  cannot  safely  be  undertaken  by the 
chosen the provider, they can appropriately be referred onto another provider (NHS or non-
NHS undertaking NHS work) to complete their treatment. A large proportion of non-complex 
urology  patients  can  be safely  managed  by community  providers, freeing  capacity  for  NHS 
Urology services to treat appropriate patients. 

When community providers determine they are unable to meet the needs of patients referred 
to them, they can refer the patient to NHS Urology services. 

Lack of appraisal and mandatory assessment of clinicians employed by CUS. 
NHS Sussex ICB does not directly employ the clinicians and is therefore not responsible for 
the appraisal or mandatory assessment of individual clinicians who are working either for the 
NHS or extra-contractually outside their NHS work. It is compulsory for a medical clinician to 
have valid GMC registration and to belong to a medical defence organisation. Appraisal and 
mandatory assessment are the responsibility of the employer which in this case was Sussex 
Medical Chambers and Goring Hall Hospital. 

Practicing Privileges within the private sector  
NHS Sussex ICB was provided with assurances from Goring Hall Hospital and by SMC that 
the CUS is a consultant led service. The named consultant is Mr Al Singary is on the GMC 
Specialist Register for urology with the entry stating that he is qualified to apply for all roles 
including at consultant level.   

 
 
 
 
 
 
 
 
 
 
 
 Goring  Hall  Hospital  is  responsible  for  decisions  regarding  Practising  Privileges  and  NHS 
Sussex ICB has no power over the system of who is granted admitting rights.   

Learning from Mr Hankin’s death. 
NHS  Sussex  ICB  is  not  responsible  for  conducting  serious  incident  (SI)  investigations 
regarding individual patient care this is the responsibility of the providers in line with National 
NHSE  Serious  Incident  Framework  which  was  in  place  in  2023.  Goring  Hall  Hospital 
completed the appropriate notifications to NHS Sussex.  

Following  the  Inquest  Goring  Hall  Hospital  have  submitted  the  final  version  of  the  Serious 
Incident which has followed the Serious Incident Framework. NHS Sussex have reviewed the 
incident and have identified that all learning and recommendations have been identified. NHS 
Sussex  through  enhanced  contract  quality  meetings  will  follow  up  to  ensure  that 
recommendations are complete. The next meeting is on 14th November 2025. 

Management of Mr Hankin at Goring Hall Hospital.  
NHS Sussex ICB have served a contract performance notice to Goring Hall Hospital (Circle 
Health  Group)  in  respect  of  services  delivered  at  Goring  Hall  Hospital,  following  concerns 
about  the  governance  and  response  to  a  serious  patient  safety  incident.  The  CPN  cited 
breaches of the NHS Standard Contract, including failure to meet clinical standards, failure to 
act meaningfully on serious incident learning, and lack of transparent quality assurance.  

In response, Goring Hall Hospital submitted a comprehensive reply, including a revised and 
updated Post-Inquest Action Plan, and the finalised Serious Incident Investigation Report. The 
provider acknowledged differences between its original investigation and subsequent findings 
at inquest and has updated its internal learning and processes accordingly.  

These steps, together with ongoing engagement with NHS Sussex ICB, aim to address the 
contractual  concerns  and  support  sustained  assurance  in  the  safety  and  quality  of  care 
provided at Goring Hall Hospital.  

Thank  you  for  bringing  your  concerns  to  my  attention.  I  trust  that  this  response  provides 
assurance that action is being taken to address the issues raised. 

I  hope  that  we  have  provided  you  and  Mr  Hankin’s  family  with  some  assurance  that  NHS 
Sussex ICB has taken steps to address the concerns outlined in your report and that we are 
continuing to take action to prioritise patient safety. 

Thank you again for raising this matter with me and please contact me if I can be of any further 
assistance. 

Yours sincerely, 

Chief Nursing Officer  
On behalf of NHS Sussex

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8-99:106;(cid:0)<5-/-2;(cid:0)=4530+4(cid:0)675-:27(cid:0)*1;(cid:0)J:*/0.04B(cid:0)H5-30B45(cid:0)01(cid:0)KL’M(cid:0)*1B(cid:0)5414D4B(cid:0)
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(cid:4)(cid:3)(cid:5)(cid:0)(cid:19)(cid:17)(cid:19)(cid:7)(cid:14)(cid:16)(cid:19)(cid:0)(cid:7)(cid:8)(cid:0)(cid:19)(cid:18)(cid:9)(cid:9)(cid:8)(cid:10)(cid:7)(cid:0)(cid:12)(cid:8)(cid:8)(cid:5)(cid:0)(cid:16)(cid:4)(cid:3)(cid:4)(cid:12)(cid:14)(cid:16)(cid:14)(cid:3)(cid:7)(cid:0)(cid:24)(cid:14)(cid:10)(cid:14)(cid:0)(cid:20)(cid:21)(cid:14)(cid:4)(cid:10)(cid:21)(cid:17)(cid:0)(cid:19)(cid:14)(cid:7)(cid:0)(cid:8)(cid:18)(cid:7)(cid:0)(cid:4)(cid:3)(cid:5)(cid:0)(cid:18)(cid:3)(cid:5)(cid:14)(cid:10)(cid:19)(cid:7)(cid:8)(cid:8)(cid:5)(cid:23)(cid:0)
(cid:21)(cid:14)(cid:4)(cid:5)(cid:14)(cid:10)(cid:19)(cid:0)(cid:13)(cid:14)(cid:21)(cid:5)(cid:0)(cid:10)(cid:14)(cid:12)(cid:18)(cid:21)(cid:4)(cid:10)(cid:0)(cid:18)(cid:9)(cid:5)(cid:4)(cid:7)(cid:14)(cid:0)(cid:16)(cid:14)(cid:14)(cid:7)(cid:6)(cid:3)(cid:12)(cid:19)(cid:0)(cid:7)(cid:8)(cid:0)(cid:5)(cid:6)(cid:19)(cid:20)(cid:18)(cid:19)(cid:19)(cid:0)(cid:4)(cid:3)(cid:5)(cid:0)(cid:10)(cid:14)(cid:11)(cid:6)(cid:14)(cid:24)(cid:0)(cid:7)(cid:13)(cid:14)(cid:0)(cid:19)(cid:14)(cid:10)(cid:11)(cid:6)(cid:20)(cid:14)(cid:0)(cid:4)(cid:3)(cid:5)(cid:0)(cid:7)(cid:13)(cid:14)(cid:10)(cid:14)(cid:0)(cid:24)(cid:4)(cid:19)(cid:0)
(cid:14)(cid:15)(cid:15)(cid:14)(cid:20)(cid:7)(cid:6)(cid:11)(cid:14)(cid:0)(cid:19)(cid:7)(cid:4)(cid:15)(cid:15)(cid:0)(cid:16)(cid:14)(cid:14)(cid:7)(cid:6)(cid:3)(cid:12)(cid:0)(cid:19)(cid:7)(cid:10)(cid:18)(cid:20)(cid:7)(cid:18)(cid:10)(cid:14)(cid:0)(cid:4)(cid:3)(cid:5)(cid:0)(cid:19)(cid:17)(cid:19)(cid:7)(cid:14)(cid:16)(cid:19)(cid:0)(cid:15)(cid:8)(cid:10)(cid:0)(cid:20)(cid:4)(cid:19)(cid:20)(cid:4)(cid:5)(cid:6)(cid:3)(cid:12)(cid:0)(cid:6)(cid:3)(cid:15)(cid:8)(cid:10)(cid:16)(cid:4)(cid:7)(cid:6)(cid:8)(cid:3)(cid:0)(cid:24)(cid:6)(cid:7)(cid:13)(cid:6)(cid:3)(cid:0)(cid:7)(cid:13)(cid:14)(cid:0)
(cid:8)(cid:10)(cid:12)(cid:4)(cid:3)(cid:6)(cid:19)(cid:4)(cid:7)(cid:6)(cid:8)(cid:3)!(cid:0)(cid:0)
(cid:2)(cid:0)(cid:6)(cid:3)(cid:11)(cid:6)(cid:7)(cid:14)(cid:0)(cid:17)(cid:8)(cid:18)(cid:0)(cid:7)(cid:8)(cid:0)(cid:10)(cid:14)\(cid:20)(cid:8)(cid:3)(cid:19)(cid:6)(cid:5)(cid:14)(cid:10)(cid:0)(cid:7)(cid:13)(cid:14)(cid:0)(cid:14)(cid:11)(cid:6)(cid:5)(cid:14)(cid:3)(cid:20)(cid:14)(cid:0)(cid:2)(cid:0)(cid:13)(cid:4)(cid:11)(cid:14)(cid:0)(cid:9)(cid:10)(cid:8)(cid:11)(cid:6)(cid:5)(cid:14)(cid:5)(cid:23)(cid:0)(cid:4)(cid:3)(cid:5)(cid:0)(cid:7)(cid:13)(cid:14)(cid:0)(cid:5)(cid:8)(cid:20)(cid:18)(cid:16)(cid:14)(cid:3)(cid:7)(cid:19)(cid:0)(cid:19)(cid:18)(cid:27)(cid:16)(cid:6)(cid:7)(cid:7)(cid:14)(cid:5)(cid:23)(cid:0)
(cid:24)(cid:13)(cid:6)(cid:20)(cid:13)(cid:0)(cid:5)(cid:14)(cid:16)(cid:8)(cid:3)(cid:19)(cid:7)(cid:10)(cid:4)(cid:7)(cid:14)(cid:0)(cid:7)(cid:13)(cid:4)(cid:7)(cid:0)(cid:20)(cid:8)(cid:16)(cid:9)(cid:10)(cid:14)(cid:13)(cid:14)(cid:3)(cid:19)(cid:6)(cid:11)(cid:14)(cid:0)(cid:12)(cid:8)(cid:11)(cid:14)(cid:10)(cid:3)(cid:4)(cid:3)(cid:20)(cid:14)(cid:0)(cid:9)(cid:10)(cid:8)(cid:20)(cid:14)(cid:19)(cid:19)(cid:0)(cid:24)(cid:14)(cid:10)(cid:14)(cid:23)(cid:0)(cid:4)(cid:3)(cid:5)(cid:0)(cid:10)(cid:14)(cid:16)(cid:4)(cid:6)(cid:3)(cid:23)(cid:0)(cid:6)(cid:3)(cid:0)
(cid:9)(cid:21)(cid:4)(cid:20)(cid:14)!(cid:0)
K((cid:0))*+,(cid:0)-.(cid:0)A16425*60-1(cid:0)-.(cid:0)674(cid:0)8-99:106;(cid:0)<5-/-2;(cid:0)E4530+4(cid:0)D067(cid:0)NO=(cid:0)O-EH06*/(cid:0)<5-/-2;(cid:0)
=4530+4E((cid:0)
I74(cid:0)8<=(cid:0)H5-30B4B(cid:0)+-99:106;Q@*E4B(cid:0):5-/-2;(cid:0)E4530+4E(cid:0)D067(cid:0)1-1Q+-1E:/6*16(cid:0)
25*B4(cid:0):5-/-20E6E(cid:0)D067-:6(cid:0)*1;(cid:0)-345E0276(cid:0)-5(cid:0)016425*60-1(cid:0)D067(cid:0)7-EH06*/Q@*E4B(cid:0)
+-1E:/6*16(cid:0)/4B(cid:0):5-/-2;(cid:0)E4530+4E((cid:0)(cid:0)]70/E6(cid:0)67454(cid:0)D*E(cid:0)*1(cid:0)-HH-56:106;(cid:0).-5(cid:0)8<=(cid:0)6-(cid:0)
(cid:0)
(cid:0)
(cid:2)(cid:3)(cid:4)(cid:3)(cid:2)(cid:0)(cid:5)(cid:6)(cid:2)(cid:3)(cid:0)(cid:7)(cid:6)(cid:5)(cid:8)(cid:9)(cid:3)(cid:10)(cid:0)(cid:8)(cid:11)(cid:12)(cid:13)(cid:3)(cid:14)(cid:12)(cid:15)(cid:0)(cid:12)(cid:6)(cid:0)(cid:16)(cid:17)(cid:18)(cid:0)(cid:17)(cid:6)(cid:15)(cid:8)(cid:13)(cid:12)(cid:11)(cid:9)(cid:0)(cid:19)(cid:2)(cid:20)(cid:15)(cid:12)(cid:15)(cid:0)(cid:12)(cid:21)(cid:3)(cid:0)(cid:22)(cid:15)(cid:13)(cid:9)(cid:6)(cid:22)(cid:0)(cid:3)(cid:4)(cid:4)(cid:3)(cid:7)(cid:12)(cid:0)(cid:6)(cid:4)(cid:0)(cid:12)(cid:21)(cid:3)(cid:15)(cid:3)(cid:0)(cid:23)(cid:0)
(cid:15)(cid:3)(cid:2)(cid:24)(cid:13)(cid:7)(cid:3)(cid:15)(cid:0)(cid:25)(cid:11)(cid:15)(cid:0)(cid:15)(cid:20)(cid:7)(cid:21)(cid:0)(cid:12)(cid:21)(cid:11)(cid:12)(cid:0)(cid:12)(cid:21)(cid:3)(cid:26)(cid:0)(cid:3)(cid:4)(cid:4)(cid:3)(cid:7)(cid:12)(cid:13)(cid:24)(cid:3)(cid:9)(cid:26)(cid:0)(cid:25)(cid:6)(cid:2)(cid:27)(cid:3)(cid:28)(cid:0)(cid:13)(cid:14)(cid:28)(cid:3)(cid:8)(cid:3)(cid:14)(cid:28)(cid:3)(cid:14)(cid:12)(cid:9)(cid:26)(cid:0)(cid:6)(cid:4)(cid:0)(cid:3)(cid:11)(cid:7)(cid:21)(cid:0)(cid:6)(cid:12)(cid:21)(cid:3)(cid:2)(cid:29)(cid:0)(cid:0)(cid:19)(cid:21)(cid:3)(cid:0)
(cid:11)(cid:30)(cid:15)(cid:3)(cid:14)(cid:7)(cid:3)(cid:0)(cid:6)(cid:4)(cid:0)(cid:11)(cid:0)(cid:2)(cid:6)(cid:30)(cid:20)(cid:15)(cid:12)(cid:0)(cid:5)(cid:20)(cid:9)(cid:12)(cid:13)(cid:31)(cid:28)(cid:13)(cid:15)(cid:7)(cid:13)(cid:8)(cid:9)(cid:13)(cid:14)(cid:11)(cid:2)(cid:26)(cid:0)(cid:12)(cid:3)(cid:11)(cid:5)(cid:0)(cid:11)(cid:15)(cid:15)(cid:3)(cid:15)(cid:15)(cid:5)(cid:3)(cid:14)(cid:12)(cid:0)(cid:25)(cid:13)(cid:12)(cid:21)(cid:13)(cid:14)(cid:0)(cid:12)(cid:21)(cid:3)(cid:0) !(cid:18)(cid:0)(cid:11)(cid:14)(cid:28)(cid:0)(cid:12)(cid:21)(cid:3)(cid:0)
(cid:9)(cid:11)(cid:7)(cid:27)(cid:0)(cid:6)(cid:4)(cid:0)(cid:15)(cid:3)(cid:14)(cid:13)(cid:6)(cid:2)(cid:0)(cid:7)(cid:9)(cid:13)(cid:14)(cid:13)(cid:7)(cid:11)(cid:9)(cid:0)(cid:6)(cid:24)(cid:3)(cid:2)(cid:15)(cid:13)"(cid:21)(cid:12)(cid:0)(cid:6)(cid:4)(cid:0)(cid:7)(cid:6)(cid:5)(cid:5)(cid:20)(cid:14)(cid:13)(cid:12)(cid:26)(cid:0)(cid:20)(cid:2)(cid:6)(cid:9)(cid:6)"(cid:26)(cid:0)(cid:8)(cid:11)(cid:12)(cid:13)(cid:3)(cid:14)(cid:12)(cid:15)(cid:0)(cid:30)(cid:26)(cid:0)(cid:16)(cid:17)(cid:18)(cid:0)
(cid:7)(cid:6)(cid:14)(cid:15)(cid:20)(cid:9)(cid:12)(cid:11)(cid:14)(cid:12)(cid:0)(cid:7)(cid:9)(cid:13)(cid:14)(cid:13)(cid:7)(cid:13)(cid:11)(cid:14)(cid:15)(cid:0)(cid:9)(cid:3)(cid:11)(cid:28)(cid:15)(cid:0)(cid:12)(cid:6)(cid:0)(cid:11)(cid:0)(cid:7)(cid:6)(cid:14)(cid:7)(cid:3)(cid:2)(cid:14)(cid:0)(cid:12)(cid:21)(cid:11)(cid:12)(cid:0)(cid:12)(cid:21)(cid:3)(cid:0)(cid:20)(cid:2)(cid:6)(cid:9)(cid:6)"(cid:26)(cid:0)(cid:15)(cid:3)(cid:2)(cid:24)(cid:13)(cid:7)(cid:3)(cid:0)(cid:13)(cid:15)(cid:0)(cid:4)(cid:2)(cid:11)"(cid:5)(cid:3)(cid:14)(cid:12)(cid:3)(cid:28)(cid:0)
(cid:11)(cid:14)(cid:28)(cid:0)(cid:28)(cid:6)(cid:3)(cid:15)(cid:0)(cid:14)(cid:6)(cid:12)(cid:0)(cid:3)(cid:4)(cid:4)(cid:3)(cid:7)(cid:12)(cid:13)(cid:24)(cid:3)(cid:9)(cid:26)(cid:0)(cid:15)(cid:20)(cid:8)(cid:8)(cid:6)(cid:2)(cid:12)(cid:0)(cid:20)(cid:2)(cid:6)(cid:9)(cid:6)"(cid:26)(cid:0)(cid:8)(cid:11)(cid:12)(cid:13)(cid:3)(cid:14)(cid:12)(cid:15)(cid:0)(cid:25)(cid:13)(cid:12)(cid:21)(cid:13)(cid:14)(cid:0)(cid:12)(cid:21)(cid:3)(cid:0)(cid:2)(cid:3)"(cid:13)(cid:6)(cid:14)(cid:0)(cid:12)(cid:6)(cid:0)(cid:7)(cid:6)(cid:14)(cid:4)(cid:13)(cid:2)(cid:5)(cid:0)
(cid:30)(cid:3)(cid:15)(cid:12)(cid:0)(cid:8)(cid:2)(cid:11)(cid:7)(cid:12)(cid:13)(cid:7)(cid:3)(cid:0)(cid:11)(cid:14)(cid:28)(cid:0)(cid:6)(cid:8)(cid:12)(cid:13)(cid:5)(cid:11)(cid:9)(cid:0)(cid:12)(cid:2)(cid:3)(cid:11)(cid:12)(cid:5)(cid:3)(cid:14)(cid:12)(cid:29)(cid:0)
#(cid:0)$%&’()*+%&(cid:0)*,+*(cid:0)-.$((cid:0)/.%/’(%(cid:0)+(0)’)(cid:0)1(.2(cid:0) (cid:0) (cid:0)&’/0)0.%(cid:0)*.(cid:0)(’1’((cid:0)3((cid:0):+%;0%(cid:0)
*.(cid:0)<.(0%8(cid:0):+55(cid:0):.)=0*+5(cid:0)>+(cid:0)=(0?+*’(cid:0)=(.?0&’(@(cid:0)+%&(cid:0)%.*(cid:0)*.(cid:0)A.(*,0%8(cid:0):.)=0*+5(cid:0)>+%(cid:0)B:7(cid:0)
,.)=0*+5@(cid:0)80?’%(cid:0),0)(cid:0)/.62.(C0&0*0’)D(cid:0)(cid:0)73E(cid:0)1$55-(cid:0)+//’=*)(cid:0)*,0)(cid:0)/.%/’(%(cid:0)+%&F(cid:0)+)(cid:0)+(cid:0)(’)$5*(cid:0).1(cid:0)
*,0)F(cid:0)0)(cid:0)*(0+550%8(cid:0)*,’(cid:0)(’1’((+5(cid:0)(0);(cid:0)+))’))2’%*(cid:0)/,’/;50)*(cid:0)G,0/,(cid:0)G+)(cid:0))’%*(cid:0)*.(cid:0)-.$(cid:0).%(cid:0)H(cid:0)4$8$)*(cid:0)
IJIKD(cid:0)(cid:0)L,0)(cid:0)(’M$0(’)(cid:0)+55(cid:0)/50%0/0+%)(cid:0)G.(;0%8(cid:0)G0*,0%(cid:0)*,’(cid:0)EN7(cid:0)*.(cid:0)/.2=5’*’(cid:0)+(cid:0)/,’/;50)*(cid:0)1.((cid:0)+55(cid:0)
)$(80/+5(cid:0)(’1’((+5)D(cid:0)(cid:0)#*(cid:0)0)(cid:0)&’)08%’&(cid:0)*.(cid:0)’%)$(’(cid:0)*,+*(cid:0)+55(cid:0)=+*0’%*)(cid:0)+(’(cid:0)(’1’((’&(cid:0)+==(.=(0+*’5-(cid:0)
+%&(cid:0)(’/’0?’(cid:0).=*02+5(cid:0)*(’+*2’%*D(cid:0)
L$(%0%8(cid:0)*.(cid:0)-.$((cid:0)/.%/’(%(cid:0)(’8+(&0%8(cid:0)0%*’8(+*0.%(cid:0)G0*,(cid:0),.)=0*+56C+)’&(cid:0)/.%)$5*+%*(cid:0)5’&(cid:0)
$(.5.8-(cid:0))’(?0/’)F(cid:0)*,’(cid:0)2.&’5(cid:0)+*(cid:0)EN7(cid:0)0)(cid:0)%.(cid:0)&011’(’%*(cid:0)*.(cid:0).*,’((cid:0))0205+((cid:0)2.&’5)D(cid:0)(cid:0)L,’(cid:0)=$(=.)’(cid:0)
.1(cid:0)EN7(cid:0)0)(cid:0)*.(cid:0)=(.?0&’(cid:0)/.%)$5*+*0.%)F(cid:0)*(’+*2’%*)(cid:0)+%&(cid:0)20%.((cid:0))$(80/+5(cid:0)=(./’&$(’)(cid:0)G0*,0%(cid:0)
*,’(cid:0)/.22$%0*-D(cid:0)4%-(cid:0)=(./’&$(’)(cid:0)G,0/,(cid:0)(’M$0(’(cid:0)+(cid:0)&+-(cid:0)/+)’(cid:0).((cid:0)8’%’(+5(cid:0)+%+’)*,’*0/(cid:0)+(’(cid:0)
(’1’((’&(cid:0)*.(cid:0)+(cid:0))’/.%&+(-(cid:0)/+(’(cid:0))’**0%8(cid:0).1(cid:0)*,’(cid:0)=+*0’%*9)(cid:0)/,.0/’D(cid:0)(cid:0)L,’(cid:0))’(?0/’(cid:0)’%)$(’)(cid:0)*,+*(cid:0)
=+*0’%*)(cid:0)(’/’0?’(cid:0)=(.2=*(cid:0)+%&(cid:0)+==(.=(0+*’(cid:0)*(’+*2’%*(cid:0)G0*,0%(cid:0)*,’(cid:0)/.22$%0*-(cid:0)+)(cid:0).==.)’&(cid:0)
*.(cid:0),+?0%8(cid:0)*.(cid:0)G+0*(cid:0)*.(cid:0)C’(cid:0))’’%(cid:0)+*(cid:0),.)=0*+5D(cid:0)(cid:0)L,’(cid:0))’(?0/’(cid:0)(’50’?’)(cid:0)=(’))$(’)(cid:0).%(cid:0)*,’(cid:0)B:7(cid:0)
+%&(cid:0)0)(cid:0)+(cid:0)=.=$5+((cid:0)).5$*0.%(cid:0)1.((cid:0)=+*0’%*)(cid:0)+%&(cid:0)<O)D(cid:0)(cid:0)L,’(’(cid:0)0)(cid:0)%.(cid:0)2$5*06&0)/0=50%+(-(cid:0)*’+2(cid:0)
+))’))2’%*(cid:0).1(cid:0)=+*0’%*)(cid:0)G,.(cid:0),+?’(cid:0)C’’%(cid:0)(’1’((’&(cid:0).%(cid:0)+(cid:0)(.$*0%’(cid:0)C+)0)(cid:0)G0*,0%(cid:0)*,’(cid:0)EN7(cid:0)
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(cid:14)(cid:5)(cid:13)(cid:25)(cid:5)(cid:2)(cid:11)(cid:7)(cid:15)(cid:0)(cid:2)(cid:7)(cid:5)(cid:8)(cid:13)(cid:8)(cid:13)(cid:31)(cid:0)(cid:3)(cid:5)(cid:9)(cid:0)#(cid:4)(cid:4)(cid:13)(cid:0)(cid:12)(cid:11)(cid:14)(cid:6)(cid:10)(cid:4)(cid:2)(cid:4)(cid:25)’(cid:0)(cid:12)(cid:11)(cid:13)(cid:9)(cid:8)(cid:25)(cid:4)(cid:7)(cid:8)(cid:13)(cid:31)(cid:0)(cid:16)(cid:4)(cid:4)(cid:25)#(cid:5)(cid:12)(cid:30)(cid:0)(cid:5)(cid:13)(cid:25)(cid:0)(cid:10)(cid:11)(cid:11)(cid:30)(cid:8)(cid:13)(cid:31)(cid:0)(cid:8)(cid:13)(cid:2)(cid:11)(cid:0)(cid:9)(cid:4)(cid:7)(cid:8)(cid:11)(cid:20)(cid:9)(cid:0)
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(cid:2)(cid:3)(cid:4)(cid:0)(cid:6)(cid:7)(cid:8)(cid:14)(cid:5)(cid:7)(cid:15)(cid:0)(cid:5)(cid:6)(cid:6)(cid:7)(cid:5)(cid:8)(cid:9)(cid:4)(cid:7)(cid:0)(cid:2)(cid:11)(cid:0)(cid:5)(cid:9)(cid:30)(cid:0)(cid:2)(cid:3)(cid:4)(cid:0)(cid:26)(cid:27)(cid:28)(cid:0)(cid:2)(cid:11)(cid:0)(cid:8)(cid:13)(cid:6)(cid:20)(cid:2)(cid:0)(cid:8)(cid:13)(cid:2)(cid:11)(cid:0)(cid:2)(cid:3)(cid:4)(cid:9)(cid:4)(cid:0)(cid:5)(cid:6)(cid:6)(cid:7)(cid:5)(cid:8)(cid:9)(cid:5)(cid:10)(cid:9)’(cid:0)(cid:29)(cid:3)(cid:8)(cid:12)(cid:3)(cid:0)(cid:29)(cid:4)(cid:0)(cid:5)(cid:10)(cid:29)(cid:5)(cid:15)(cid:9)(cid:0)
(cid:25)(cid:11)(cid:0)(cid:11)(cid:13)(cid:0)(cid:7)(cid:4)&(cid:20)(cid:4)(cid:9)(cid:2)(cid:23)(cid:0)(cid:0)*(cid:4)(cid:0)(cid:5)(cid:7)(cid:4)(cid:0)(cid:6)(cid:7)(cid:11)$(cid:8)(cid:25)(cid:4)(cid:25)(cid:0)(cid:29)(cid:8)(cid:2)(cid:3)(cid:0)(cid:2)(cid:3)(cid:4)(cid:0)(cid:6)(cid:7)(cid:8)(cid:14)(cid:5)(cid:7)(cid:15)(cid:0)(cid:5)(cid:6)(cid:6)(cid:7)(cid:5)(cid:8)(cid:9)(cid:5)(cid:10)(cid:0)(cid:6)(cid:5)(cid:6)(cid:4)(cid:7)(cid:29)(cid:11)(cid:7)(cid:30)(cid:0)(cid:16)(cid:11)(cid:7)(cid:0)(cid:5)(cid:10)(cid:10)(cid:0)(cid:11)(cid:20)(cid:7)(cid:0)
(cid:12)(cid:10)(cid:8)(cid:13)(cid:8)(cid:12)(cid:8)(cid:5)(cid:13)(cid:9)(cid:0)(cid:4)$(cid:4)(cid:7)(cid:15)(cid:0)(cid:15)(cid:4)(cid:5)(cid:7)(cid:0)(cid:5)(cid:13)(cid:25)(cid:0)(cid:29)(cid:4)(cid:0)(cid:7)(cid:4)$(cid:8)(cid:4)(cid:29)(cid:0)(cid:2)(cid:3)(cid:8)(cid:9)(cid:0)(cid:5)(cid:9)(cid:0)(cid:6)(cid:5)(cid:7)(cid:2)(cid:0)(cid:11)(cid:16)(cid:0)(cid:11)(cid:20)(cid:7)(cid:0)(cid:8)(cid:13)(cid:2)(cid:4)(cid:7)(cid:13)(cid:5)(cid:10)(cid:0)(cid:7)(cid:4)$(cid:8)(cid:4)(cid:29)(cid:0)(cid:6)(cid:7)(cid:11)(cid:12)(cid:4)(cid:9)(cid:9)(cid:23)(cid:0)(cid:0)(cid:24)(cid:13)(cid:0)
(cid:5)(cid:25)(cid:25)(cid:8)(cid:2)(cid:8)(cid:11)(cid:13)(cid:0)(cid:2)(cid:11)(cid:0)(cid:7)(cid:4)(cid:12)(cid:4)(cid:8)$(cid:8)(cid:13)(cid:31)(cid:0)(cid:2)(cid:3)(cid:8)(cid:9)(cid:0)(cid:8)(cid:13)(cid:16)(cid:11)(cid:7)(cid:14)(cid:5)(cid:2)(cid:8)(cid:11)(cid:13)(cid:0)(cid:5)(cid:13)(cid:13)(cid:20)(cid:5)(cid:10)(cid:10)(cid:15)(cid:0)(cid:16)(cid:7)(cid:11)(cid:14)(cid:0)(cid:2)(cid:3)(cid:4)(cid:0)(cid:6)(cid:7)(cid:8)(cid:14)(cid:5)(cid:7)(cid:15)(cid:0)(cid:4)(cid:14)(cid:6)(cid:10)(cid:11)(cid:15)(cid:4)(cid:7)(cid:0)(cid:11)(cid:16)(cid:0)(cid:4)(cid:5)(cid:12)(cid:3)(cid:0)(cid:11)(cid:16)(cid:0)(cid:11)(cid:20)(cid:7)(cid:0)
(cid:12)(cid:10)(cid:8)(cid:13)(cid:8)(cid:12)(cid:8)(cid:5)(cid:13)(cid:9)’(cid:0)(cid:28)+(cid:26)(cid:0)(cid:12)(cid:11)(cid:13)(cid:25)(cid:20)(cid:12)(cid:2)(cid:9)(cid:0)(cid:5)(cid:13)(cid:0)(cid:5)(cid:13)(cid:13)(cid:20)(cid:5)(cid:10)(cid:0)(cid:7)(cid:4)$(cid:8)(cid:4)(cid:29)(cid:0)(cid:29)(cid:8)(cid:2)(cid:3)(cid:0)(cid:4)$(cid:4)(cid:7)(cid:15)(cid:0)(cid:12)(cid:10)(cid:8)(cid:13)(cid:8)(cid:12)(cid:8)(cid:5)(cid:13)(cid:23)(cid:0)(cid:0) (cid:3)(cid:8)(cid:9)(cid:0)$(cid:5)(cid:7)(cid:8)(cid:4)(cid:9)(cid:0)(cid:5)(cid:12)(cid:12)(cid:11)(cid:7)(cid:25)(cid:8)(cid:13)(cid:31)(cid:0)
(cid:2)(cid:11)(cid:0)(cid:7)(cid:11)(cid:10)(cid:4)(cid:0)(cid:5)(cid:13)(cid:25)(cid:0)(cid:9)(cid:4)(cid:13)(cid:8)(cid:11)(cid:7)(cid:8)(cid:2)(cid:15)’(cid:0)#(cid:20)(cid:2)(cid:0)(cid:12)(cid:11)(cid:14)(cid:6)(cid:7)(cid:8)(cid:9)(cid:4)(cid:9)(cid:0)(cid:11)(cid:16)(cid:0)(cid:12)(cid:11)(cid:14)(cid:6)(cid:10)(cid:8)(cid:5)(cid:13)(cid:12)(cid:4)(cid:0)(cid:12)(cid:3)(cid:4)(cid:12)(cid:30)(cid:9)’(cid:0)(cid:14)(cid:5)(cid:30)(cid:8)(cid:13)(cid:31)(cid:0)(cid:9)(cid:20)(cid:7)(cid:4)(cid:0)(cid:14)(cid:5)(cid:13)(cid:25)(cid:5)(cid:2)(cid:11)(cid:7)(cid:15)(cid:0)
(cid:2)(cid:7)(cid:5)(cid:8)(cid:13)(cid:8)(cid:13)(cid:31)(cid:0)(cid:8)(cid:9)(cid:0)(cid:20)(cid:6)(cid:0)(cid:2)(cid:11)(cid:0)(cid:25)(cid:5)(cid:2)(cid:4)’(cid:0)(cid:4)(cid:13)(cid:9)(cid:20)(cid:7)(cid:8)(cid:13)(cid:31)(cid:0)(cid:2)(cid:3)(cid:5)(cid:2)(cid:0)(cid:26)()(cid:0)(cid:3)(cid:5)(cid:9)(cid:0)#(cid:4)(cid:4)(cid:13)(cid:0)(cid:12)(cid:11)(cid:14)(cid:6)(cid:10)(cid:4)(cid:2)(cid:4)(cid:25)’(cid:0)(cid:5)(cid:13)(cid:25)(cid:0)(cid:7)(cid:4)$(cid:8)(cid:4)(cid:29)(cid:8)(cid:13)(cid:31)(cid:0)(cid:5)(cid:13)(cid:25)(cid:0)
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(cid:5)(cid:7)(cid:4)(cid:0)(cid:13)(cid:11)(cid:0)(cid:5)(cid:6)(cid:6)(cid:7)(cid:5)(cid:8)(cid:9)(cid:5)(cid:10)(cid:9)(cid:0)(cid:11)(cid:7)(cid:0)(cid:14)(cid:5)(cid:13)(cid:25)(cid:5)(cid:2)(cid:11)(cid:7)(cid:15)(cid:0)(cid:5)(cid:9)(cid:9)(cid:4)(cid:9)(cid:9)(cid:14)(cid:4)(cid:13)(cid:2)(cid:9)(cid:0)(cid:29)(cid:8)(cid:2)(cid:3)(cid:8)(cid:13)(cid:0)(cid:2)(cid:3)(cid:4)(cid:0)(cid:26)(cid:27)(cid:28)(cid:23)(cid:0)(cid:0)*(cid:4)(cid:0)(cid:5)(cid:10)(cid:9)(cid:11)(cid:0)(cid:25)(cid:11)(cid:0)(cid:13)(cid:11)(cid:2)(cid:0)
(cid:20)(cid:13)(cid:25)(cid:4)(cid:7)(cid:9)(cid:2)(cid:5)(cid:13)(cid:25)(cid:0)(cid:29)(cid:3)(cid:15)(cid:0)(cid:15)(cid:11)(cid:20)(cid:0)(cid:9)(cid:2)(cid:5)(cid:2)(cid:4)(cid:0)(cid:2)(cid:3)(cid:5)(cid:2)(cid:0)(cid:13)(cid:11)(cid:0)(cid:4)$(cid:8)(cid:25)(cid:4)(cid:13)(cid:12)(cid:4)(cid:0)(cid:29)(cid:5)(cid:9)(cid:0)(cid:6)(cid:7)(cid:11)$(cid:8)(cid:25)(cid:4)(cid:25)(cid:0)(cid:5)(cid:9)(cid:0)(cid:2)(cid:11)(cid:0)(cid:2)(cid:3)(cid:4)(cid:0)(cid:4),(cid:6)(cid:4)(cid:7)(cid:8)(cid:4)(cid:13)(cid:12)(cid:4)(cid:0)(cid:5)(cid:13)(cid:25)(cid:0)
(cid:12)(cid:11)(cid:14)(cid:6)(cid:4)(cid:2)(cid:4)(cid:13)(cid:12)(cid:15)(cid:0)(cid:11)(cid:16)(cid:0)(cid:2)(cid:3)(cid:4)(cid:0)(cid:12)(cid:10)(cid:8)(cid:13)(cid:8)(cid:12)(cid:8)(cid:5)(cid:13)(cid:9)(cid:0)(cid:29)(cid:11)(cid:7)(cid:30)(cid:8)(cid:13)(cid:31)(cid:0)(cid:29)(cid:8)(cid:2)(cid:3)(cid:8)(cid:13)(cid:0)(cid:2)(cid:3)(cid:4)(cid:0)(cid:26)(cid:27)(cid:28)(cid:23)(cid:0)(cid:0)-(cid:11)(cid:20)(cid:0)(cid:5)(cid:9)(cid:30)(cid:4)(cid:25)(cid:0)(cid:16)(cid:11)(cid:7)(cid:0)(cid:2)(cid:3)(cid:4)(cid:0)&(cid:20)(cid:5)(cid:10)(cid:8)(cid:16)(cid:8)(cid:12)(cid:5)(cid:2)(cid:8)(cid:11)(cid:13)(cid:9)(cid:0)
(cid:5)(cid:13)(cid:25)(cid:0)!"(cid:28)(cid:0)(cid:6)(cid:11)(cid:9)(cid:8)(cid:2)(cid:8)(cid:11)(cid:13)(cid:9)(cid:0)(cid:11)(cid:16)(cid:0)(cid:5)(cid:10)(cid:10)(cid:0)(cid:9)(cid:2)(cid:5)(cid:16)(cid:16)’(cid:0)(cid:5)(cid:13)(cid:25)(cid:0)(cid:2)(cid:3)(cid:8)(cid:9)(cid:0)(cid:29)(cid:5)(cid:9)(cid:0)(cid:6)(cid:7)(cid:11)$(cid:8)(cid:25)(cid:4)(cid:25)(cid:0)(cid:2)(cid:11)(cid:0)(cid:15)(cid:11)(cid:20)(cid:0)(cid:11)(cid:13)(cid:0).(cid:0)/(cid:20)(cid:31)(cid:20)(cid:9)(cid:2)(cid:0)(cid:17)(cid:21)(cid:17)(cid:22)(cid:23)(cid:0)(cid:0)(cid:24)(cid:13)(cid:0)(cid:2)(cid:3)(cid:4)(cid:0)
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(cid:29)(cid:5)(cid:9)(cid:0)(cid:13)(cid:11)(cid:2)(cid:0)(cid:8)(cid:13)(cid:0)(cid:5)(cid:0)(cid:6)(cid:11)(cid:9)(cid:8)(cid:2)(cid:8)(cid:11)(cid:13)(cid:0)(cid:2)(cid:11)(cid:0)(cid:5)(cid:25)(cid:25)(cid:7)(cid:4)(cid:9)(cid:9)(cid:0)(cid:15)(cid:11)(cid:20)(cid:7)(cid:0)(cid:12)(cid:11)(cid:13)(cid:12)(cid:4)(cid:7)(cid:13)(cid:9)(cid:0)(cid:5)(cid:13)(cid:25)(cid:0)(cid:8)(cid:9)(cid:0)(cid:20)(cid:13)(cid:5)#(cid:10)(cid:4)(cid:0)(cid:2)(cid:11)(cid:0)(cid:25)(cid:11)(cid:0)(cid:9)(cid:11)(cid:0)(cid:8)(cid:13)(cid:0)(cid:2)(cid:3)(cid:8)(cid:9)(cid:0)(cid:7)(cid:4)(cid:9)(cid:6)(cid:11)(cid:13)(cid:9)(cid:4)(cid:0)
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