Prevention of Future Deaths reports · 2026

Elsie Jones

Regulation 28 report to prevent future deaths, reference 2026-0269, written 7 May 2026. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report7 May 2026
Reference2026-0269
DeceasedElsie Jones
CoronerLouise Hunt
Coroner areaBirmingham and Solihull
Sourcejudiciary.uk record
Responses published2

The report

Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.

REPORT TO PREVENT FUTURE DEATHS 

REGULATION 28 OF THE CORONERS (INVESTIGATIONS) REGULATIONS 2013 

If during an investigation, a coroner becomes concerned about circumstances that create a risk 
of future deaths, Paragraph 7 of Schedule 5, Coroners and Justice Act 2009, provides coroners 
with the duty to make reports to a person, organisation, local authority or government department 
or agency where the coroner believes that action should be taken to prevent future deaths. That 
report is called a Prevention of Future Deaths Report (PFD report). 

The Chief Coroner provides this template to support coroners in the effective and consistent 
exercise of their statutory duties under the Coroners and Justice Act 2009 and Regulations 28 
and 29 of the Coroners (Investigations) Regulations 2013. 

The purpose of the template is to provide a clear and structured framework for setting out the 
matters of concern identified during an investigation which, in the coroner’s opinion, give rise to a 
risk of future deaths. It is designed to promote clarity, ensure that reports are formulated in a way 
that enables recipients to understand and address the concerns raised, and to support good 
practice across jurisdictions. 

The template does not fetter judicial independence: coroners remain responsible for determining 
the facts, identifying the matters of concern, and drafting reports that accurately reflect the 
circumstances of each individual case. The template may be adapted as necessary to ensure 
that the report properly and precisely records the coroner’s views. 

In accordance with the Chief Coroner’s PFD Publication Policy (2026) any applications for 
redactions to content or general publication of the report must be sent to the coroner. The 
coroner will provide the representations to the Chief Coroner for a decision.  

REPORT TO PREVENT FUTURE DEATHS 

REGULATION 28 OF THE CORONERS (INVESTIGATIONS) REGULATIONS 2013 

(Please do not include any living persons’ names in this document, in accordance with the Chief 
Coroner’s PFD Publication Policy (2026)) 

 CORONER 

1 

 I am Louise Hunt HM Senior Coroner for the coroner area of Birmingham and Solihull 

 DATE OF REPORT 

2 

 7th May 2026 

 CORONER’S LEGAL POWERS 

3 

  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. 

 THIS REPORT IS BEING SENT TO 

1. Department of health and social care

2. Birmingham and Solihull Integrated care board.

4 

 You are under a duty to respond to this report within 56 days of the date of this report, namely 
by 2 July 2026. I, the coroner, may extend the period if an appropriate application is made. 

 YOUR RESPONSE 

 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. 

 I have a duty to send a copy of your response to the Chief Coroner. 

 In accordance with the Chief Coroner’s Publication Policy, you should send me any 
representations regarding the publication of your response. These representations should be 
made at the same time as the response is provided. I will pass any representations received to 
the Chief Coroner for a decision. 

5 

 Please note any links to webpages included in the response will not be checked for sensitive 
information prior to publication, as the information is already online. 

 The names of those who do not respond to PFD reports are regularly published on the Chief 
Coroner’s webpages Non-responses to Prevention of Future Death (PFD) reports - Courts and 
Tribunals Judiciary. 

 SUMMARY OF THE CORONER'S CONCERN 

6 

The inquest heard evidence that patients who suffer from severe dementia who need specialist 
placements often spend many months in hospital whilst funding and suitable placements are 
being found. Given the resources available on acute hospital wards this puts these patients at 
risk as they cannot always be adequately supervised.  I am concerned that the lengthy delays in 
securing funding and finding suitable placements for these most vulnerable patients creates a 
risk of future deaths and I consider action should be taken. 

 ACTION SHOULD BE TAKEN 

7 

 In my opinion unless action is taken to address the above concerns then there is a significant 
risk of future deaths and I believe each of you have the power to take such action. 

 INVESTIGATION and INQUEST 

8 

 On 27 November 2025, I commenced an investigation into the death of Elsie Margaret Jones, 

 aged 86 Years  

The medical cause of death was 

 1a   Advanced vascular dementia 

 1b    

 1c    

 1d   

 II    Frailty of old age, Fall with left hip fracture( operated) 

 How, when and where - see below 

 Conclusion  

 The investigation concluded at the end of the inquest . The conclusion of the inquest was Died 
from natural causes contributed to by injuries sustained in a fall 

 CIRCUMSTANCES OF DEATH 

 [Please explain the relevant circumstances of the individual’s death, ideally this should be in no 
more than 500 words] 

9 

  Mrs Jones suffered from advanced dementia and was at high risk of falling. On 20/06/25 she 
was admitted to Birmingham Heartlands Hospital after being found outside her home in an 
agitated state. She presented with challenging behaviour due to a deterioration in her dementia 
and was initially admitted to the older persons assessment and decisions unit and later moved 
to ward 30 on 23/06/25. She was managed with regular observations, blood tests, close 
supervision, and multidisciplinary input with medical optimisation being achieved by 07 August 
2025. She was awaiting discharge to a specialist service. She continued to display challenging 
behaviour and had a tendency to wander and had several falls in hospital including at times 
when she had 1:1 supervision. On 01/11/25 at 16.03 she fell whilst mobilising around the ward 
sustaining a hip fractured which was surgically fixed on 03/11/25. Post operatively the decision 
was made for her to receive palliative care and she was transferred to Connaught house on 
08/11/25 where she died on 16/11/25. 

 CORONER'S CONCERNS 

 During the course of the inquest I heard evidence giving rise to concern. In my opinion there is 
a risk that future deaths could occur unless action is taken. In the circumstances it is my 
statutory duty to report to you.  

The MATTERS OF CONCERN are as follows: 

10 

 [250-word statement addressing what circumstances of the death have led to the coroner’s 
concern, and why the coroner thinks the person to whom the report is directed is responsible for 
taking action to prevent future deaths. This statement must not propose what action should be 
taken, as coroners cannot make recommendations]. 

The inquest heard evidence that patients who suffer from severe dementia who need specialist 
placements often spend many months in hospital whilst funding and suitable placements are 

 being found. Given the resources available on acute hospital wards this puts these patients at 
risk as they cannot always be adequately supervised.  I am concerned that the lengthy delays in 
securing funding and finding suitable placements for these most vulnerable patients creates a 
risk of future deaths and I consider action should be taken. 
 COPIES AND PUBLICATION OF THIS REPORT 

 I have a duty to send a copy of my report to every interested person who in my opinion should 
receive it. 

 I also may send a copy of the report to any other person who I believe may find it useful or of 
interest. 

 I can confirm I have sent the report to: (please do not use individual's names, but instead 
roles/titles) 

11 

1. Mrs Jones's family

2. University Hospital Birmingham NHS Foundation Trust

 I also have a duty to send a copy of the report to the Chief Coroner. 

 You may make representations to me, the coroner, about the publication of the contents of this 
report in line with Chief Coroner’s PFD Publication Policy (2026). Any representations will be 
sent to the Chief Coroner alongside the report. Please refer to box 4 above for additional 
information relating to the publication of   reports and responses. 

 SIGNATURE 

 Louise Hunt 

 Senior Coroner for Birmingham and Solihull

Responses

2 responses 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 Birmingham and Solihull Integrated Care Board
RESPONSE TO A REPORT TO PREVENT FUTURE DEATHS 

REGULATION 28 OF THE CORONERS (INVESTIGATIONS) REGULATIONS 2013 

When a coroner sends a prevention of future deaths (PFD) report to a person or organisation, 
they must respond within 56 days. Recipients of a PFD report can apply to the coroner for an 
extension.  A response to a PFD report must detail the action taken or to be taken, whether in 
response to the report or otherwise, or it must explain why no action is proposed. 

The purpose of the response template below is to promote clarity, ensure that responses 
address the coroner’s concerns directly and transparently, and support consistency and good 
practice across organisations and sectors. It does not restrict how a person or organisation 
formulates their response; recipients remain responsible for determining what action is 
appropriate and for ensuring that their response accurately reflects the steps taken or planned. 

In accordance with the Chief Coroner’s PFD Publication Policy (2026) representations regarding 
publication of a response should be sent to the coroner. These representations should be made 
at the same time as the response is provided. The coroner will pass any representations 
received to the Chief Coroner for a decision 

RESPONSE TO A REPORT TO PREVENT FUTURE DEATHS 

REGULATION 28 OF THE CORONERS (INVESTIGATIONS) REGULATIONS 2013 

(Please do not include any living persons’ names in this document, in accordance with the 
Chief Coroner’s PFD Publication Policy (2026)) 

 THIS RESPONSE IS BEING SENT TO: 

 HM SENIOR/AREA/ASSISTANT Coroner Louise Hunt for Birmingham and Solihull in 
response to a ‘REPORT TO PREVENT FUTURE DEATH REGULATION 28’ following an 
inquest into the death of Elsie Margaret Jones that concluded on 7th May 2026.  

 RESPONDENT 

 In line with our duty under Regulation 28 of the Coroners (Investigations) Regulations 2013, 
Birmingham and Solihull ICB provides this response within 56 days (plus any extension 
granted) of the date of the Report to Prevent Future Deaths 

 DATE OF RESPONSE 

 2nd July 2026 

1 

2 

 
  
  
 
  
 
 
  
  
 
  
  CONFIRMATION OF CORONER'S MATTERS OF CONCERN 

 The MATTERS OF CONCERN were identified in the report as follows: 

3 

The coroner highlighted that patients with severe dementia who require specialist placements are 
experiencing  prolonged  delays  in  hospital  while  funding  approvals  and  suitable  placements  are 
secured. During these extended stays, the acute ward environment is not always able to provide the 
level of supervision required, increasing the risk to these patients. The coroner expressed concern 
that these systemic delays in both funding and placement availability create an ongoing risk of harm 
and potential future deaths, and that action is required to address this. 

 DETAILS OF ACTION TAKEN, how has the concern been addressed. 
(If no action is proposed please explain why here) 

 Please note that any links to webpages included in the response will not be checked for 
sensitive information prior to publication, as the information is already online. 

•  A  system-wide  integrated  escalation  framework  has  been  established  across  health  and 
social care to ensure timely identification and resolution of delays. This includes the routine 
escalation of patients experiencing extended lengths of stay, specifically those exceeding 7, 
14  and  21  days,  through  structured  long  length  of  stay  reviews  within  both  acute  and 
community  bedded  settings.  These  reviews  bring  together  multidisciplinary  and  multi-
agency teams to identify barriers to discharge, agree clear actions, and expedite decision-
making  relating  to  funding,  placement,  or  care  provision.  This  coordinated  approach 
strengthens  joint  accountability,  ensures  that  complex  cases  receive  appropriate  senior 
oversight,  and  reduces  the  risk  of  unnecessary  prolonged  hospital  admission,  thereby 
improving patient flow and supporting safer, more timely discharge. 

4 

•  Strengthened  community-based  alternatives  through  the  enhanced  utilisation  of  Urgent 
Community Response (UCR) services, the development of Pathway 1 (P1) step-up provision, 
and the implementation of a Single Point of Access (SPA – established November 2025). UCR 
services now operate to a two-hour response standard, providing rapid clinical intervention 
in patients’ usual place of residence to prevent unnecessary hospital admission and support 
timely discharge. In addition, P1 step-up pathways have been expanded, enabling patients 
to  be  safely  managed  at  home  with  health  and  social  care  support  as  an  alternative  to 
admission  or  prolonged  hospital  stay.  Access  to  these  services  has  been  streamlined 
through a Single Point of Access, ensuring timely triage, coordination, and mobilisation of 
appropriate  community  services.  Collectively,  these  improvements  reduce  reliance  on 
inpatient  beds,  support  Home  First  principles,  and  contribute  to  minimising  delays  in 
discharge by ensuring that patients can be safely supported in the community at the earliest 
opportunity. 

•  Development  of  a  sustainable  winter  resilience  plan  (2025/2026)  which  included  the 
provision  of  additional  surge  capacity  across  pre-hospital  and  community  services.  This 
includes  increased  capacity  within  community-based  teams  to  support  admission 
avoidance, facilitate earlier discharge, and  respond to periods of heightened demand. By 
strengthening provision upstream of hospital admission and within community pathways, 

 
 
 
 the system is better able to maintain patient flow, reduce pressure on acute services, and 
minimise delays in discharge. Delivery of this plan is supported through ongoing monitoring 
and  system  oversight  to  ensure  that  additional  capacity  is  deployed  effectively  and 
continues to meet patient need during peak periods. Winter Resilinec plan for 26/27 is in 
development. 

•  The ICB both embodies and facilitates an open and transparent reporting of patient safety 
events, both within our organisation and across our system. The transparency required for a 
thorough, candid, and systematic approach to learning and improvement is supported by 
our quality governance and oversight mechanisms which are embedded across the system. 
Organisations and across the system has strengthened its approach to learning through the 
Patient Safety Incident Response Framework (PSIRF) by ensuring that findings from Patient 
Safety Incident Investigation (PSII) and After Action Reviews (AARs) are consistently shared 
across  all  partner  organisations,  including  acute,  community,  mental  health  and  Local 
Authority  services.  The  ICB-facilitated  system  patient  safety  group  ensures  that  patient 
safety and the PSIRF framework (Patient Safety Incident Response Framework) is robustly 
linked  to  continuous  improvement  in  teams.  This  approach  ensures  that  where  delays  in 
discharge have contributed to patient harm or risk, the contributory factors such as delays 
in care package provision, funding decisions, or multi-agency coordination are identified and 
disseminated beyond the originating organisation. Learning is translated into system-wide 
actions, 
(P1/P2/P3),  escalation 
processes,  and  multidisciplinary  working,  with  actions  formally  tracked  through  system 
governance structures. This collective and transparent approach enables recurring themes 
to be addressed at scale, strengthens joint accountability, and ensures that learning directly 
informs service improvement, with the aim of reducing delays, improving patient flow, and 
minimising the risk of similar incidents occurring in future. 

improvements  to  pathway  management 

including 

•  The system has expanded the Same Day Discharge Service to include all community bedded 
settings. Previously, patients requiring a Pathway 1 discharge experienced delays of up to 2–
5  days  due  to  the  need  for  care  packages  to  be  brokered  prior  to  discharge.  The  revised 
model removes this dependency by enabling immediate discharge with care arrangements 
put in place on the same day, aligned to Home First principles. This change ensures that all 
patients  entering  Pathway  1  can  now  be  discharged  within  the  24-hour    expectation, 
reducing unnecessary length of stay, minimising the risk of deconditioning associated with 
prolonged hospital admission, and improving patient flow. The impact of this service change 
is subject to ongoing monitoring through system oversight arrangements to ensure it delivers 
sustained improvement in timeliness and safety of discharge. 

The system has strengthened community-based alternatives through the enhanced 
utilisation of Urgent Community Response (UCR) services, the development of Pathway 1 
(P1) step-up provision, and the implementation of a Single Point of Access (SPA). UCR 
services now operate to a two-hour response standard, providing rapid clinical intervention 
in patients’ usual place of residence to prevent unnecessary hospital admission and 
support timely discharge. In addition, P1 step-up pathways have been expanded, enabling 
patients to be safely managed at home with health and social care support as an 
alternative to admission or prolonged hospital stay. Access to these services has been 
streamlined through a Single Point of Access, ensuring timely triage, coordination, and 
mobilisation of appropriate community services. Collectively, these improvements reduce 
reliance on inpatient beds, support Home First principles, and contribute to minimising 
delays in discharge by ensuring that patients can be safely supported in the community at 
the earliest opportunity.  

 
 
 
 
 •  Weekly escalation meetings with Local Authority leads provides a structured, system-wide 
forum  for  identifying,  escalating,  and  resolving  delayed  discharge  issues  requiring  Local 
Authority  intervention,  ensuring  timely  patient  flow  in  line  with  Home  First  and  D2A 
principles. The objectives of these meetings is to unblock complex discharge delays, enable 
rapid senior decision making and improve system floe and reduce length of stay, strengthen 
accountability and ownership, identify and address recurring system barriers and support 
safe, risk managed discharge decisions. 

•  The  system  has  commenced  comprehensive  demand  and  capacity  modelling  across  all 
Intermediate Care services, with completion scheduled for July 2026. This work will provide 
a robust, data-driven assessment of current and future demand against available capacity 
across  Pathways  1,  2  and  3,  enabling  the  identification  of  gaps  contributing  to  discharge 
delays.  The  outputs  will  directly  inform  system  planning  and  commissioning  through  the 
Neighbourhood Health Boards, ensuring that community provision is aligned to population 
need at a local level. This approach will support targeted investment, optimise the use of 
intermediate  care  resources,  and  strengthen  community  capacity,  thereby  reducing 
reliance on inpatient beds and minimising delays in discharge. 

•  The  system  monitors  delivery  of  Better  Care  Fund  (BCF)  metrics  through  formal  BCF 
governance meetings, providing a joint forum for health and social care partners to review 
performance  and  drive  improvement.  These  meetings  oversee  key  metrics  including 
reduction  in  delayed  discharges,  time  from  Discharge  Ready  Date  to  discharge,  length  of 
stay,  non-elective  admissions  (65+),  and  reablement  outcomes,  in  line  with  national  BCF 
requirements.  
BCF  meetings  are  attended  by  Integrated  Care  Board  (ICB)  representatives  (System 
Discharge Director, Finance, Commissioning and Informatics), Local Authority leads. acute, 
community  and  mental  health  providers,  and  wider  system  partners,  with  input  from 
finance, commissioning, and operational leads where required. This ensures that discharge 
performance is reviewed through a multi-agency lens, with shared accountability for delivery 
across  the  system.  Through  this  forum,  partners  agree  and  monitor  locally  defined 
trajectories  for  improvement,  challenge  areas  of  underperformance,  and  implement 
corrective actions. This structured approach strengthens oversight, transparency and joint 
ownership, ensuring that discharge delays are actively managed, and that patients awaiting 
discharge continue to receive safe, coordinated, and high-quality care while system-wide 
improvements are delivered.  

 
 
 
  
  DETAILS OF FURTHER ACTION PROPOSED 

 Please note that any links to webpages included in the response will not be checked for sensitive 
information prior to publication, as the information is already online. 

•  A  model  of  developing  ‘Anchor  Contracts’    model  is  being  established,  with  University 
Hospitals  Birmingham  (UHB)  accountable  to  the  ICB.  This  provides  devolves  more  of  the 
budget for the urgent care pathway to one organisation allowing a more co-ordinated repose. 
As part of that contract the intention is to standardise the approach to areas such as Single 
Points  of  Access  to  provide  a  consistent  offer  for  both  patients  and  professionals  in 
organisations  such  as  West  Midlands  Ambulance  Service.    To  support  this  delivery,  a 
Neighbourhood Health Board is being implemented to provide clear oversight, assurance, 
and  escalation  across  system  partners.  In  its  first  year,  the  Board  will  focus  on  driving 
integration  and  service  transformation  at  both  system  and  locality  level,  working  with 
existing commissioned providers to strengthen key interfaces that impact patient flow. This 
work  will  be  delivered  by  the  Neighbourhood  Health  Group,  reporting 
into  the 
Neighbourhood  Health  Board  and  includes  urgent  and  emergency  care  pathways, 
intermediate  care  services  (including  step-up,  step-down  and  discharge  pathways), 
neighbourhood  health  provision  (such  as  Single  Point  of  Access,  Urgent  Community 
Response  and  discharge  coordination),  and  long-term  condition  management.  This 
structured governance approach will improve alignment across organisations, enable timely 
escalation  of  risks,  and  support  the  development  of  more  responsive,  community-based 
services, thereby reducing delays in discharge and improving patient outcomes. 

5 

•  A programme of work has commenced to transform the Transfer of Care Hubs (ToCH) and 
Bed management teams in line with NHS England national guidance and action cards. This 
programme,  being  delivered  in  partnership  with  the  Neighbourhood  Health  Group,  is 
focused  on  developing  a  fully  integrated,  system-wide  coordination  function,  bringing 
together  health,  social  care,  and  community  partners  into  a  single,  aligned  model.  The 
transformation aims to strengthen multidisciplinary working, improve real-time oversight of 
patients  awaiting  discharge,  and  ensure  timely  escalation  and  decision-making  across 
pathways.  This  integrated  approach  will  enhance  coordination  across  services,  reduce 
fragmentation at key interfaces, and support more timely and effective discharge planning, 
thereby minimising delays and improving patient flow across the system. 

•  The  system  has  undertaken  comprehensive  demand  and  capacity  modelling  across  all 
intermediate care pathways, with completion expected in July 2026. Once complete, this will 
provide a robust, system-wide understanding of current capacity, demand pressures, and 
variation  across Pathways 1, 2 and  3. The outputs will be used to identify commissioning 
gaps and inform targeted service redesign, enabling the system to prioritise investment and 
transformation  activity  where  it  will  have  the  greatest  impact.  This  will  support  the 
development and implementation of co-ordinated transformation plans across all discharge 
pathways, strengthening community capacity, improving pathway flow, and reducing delays 
in discharge through a more sustainable and responsive model of care. 

•  Work has commenced through the Neighbourhood Health Group to develop shared system-
wide  data  dashboards  to  provide  real-time  visibility  of  discharge  performance.  These 
dashboards  will  incorporate  key  metrics,  including  NCTR  measures,  discharge  pathway 
data,  and  reasons  for  delay,  enabling  consistent  tracking  of  patients  awaiting  discharge 
across all partners. The dashboards will be embedded within the system’s governance and 
quality  oversight  framework,  with  routine  reporting  into  programme  boards,  quality  and 

 
 
 
 
 safety committees, and escalation forums, ensuring that risks relating to delayed discharge 
are identified early and acted upon. This approach strengthens system-wide transparency, 
accountability,  and  data-driven  decision-making,  enabling  more  timely  escalation  and 
intervention,  and  supporting  continuous  improvement  in  patient  flow  and  discharge 
outcomes. 

•  The system is exploring the viability and effectiveness of implementing a risk stratification 
tool  for  patients  awaiting  discharge  to  support  earlier  identification  of  those  at  risk  of 
prolonged length of stay. This approach would utilise standardised criteria to assess factors 
such  as  patient  complexity,  discharge  pathway  (P1/P2/P3),  delays  related  to  funding  or 
placement, and risks associated with extended hospital admission. By proactively stratifying 
patients,  the  system  aims  to  prioritise  high-risk  individuals  for  early  escalation,  targeted 
intervention,  and  senior  oversight,  ensuring  that  barriers  to  discharge  are  addressed  in  a 
timely  and  coordinated  manner.  Subject  to  feasibility  and  evaluation,  the  tool  would  be 
embedded  within  existing  operational  and  governance  processes,  including  escalation 
forums  and  performance  dashboards,  enabling  a  more  consistent,  data-driven,  and 
proactive approach to reducing delays and improving patient flow. 

•  The system will monitor discharge performance against national expectations and locally 
agreed trajectories through the Neighbourhood Health Board. This will include oversight of 
key indicators such as time from being medically optimised to discharge, pathway utilisation 
(P1/P2/P3), and length of stay. Performance will be routinely reviewed to identify variation, 
emerging risks, and areas requiring intervention, with clear escalation routes where delivery 
is  not  on  track.  This  approach  provides  system-wide  visibility,  accountability,  and 
assurance,  enabling  timely  corrective  action  and  supporting  continuous  improvement  in 
reducing delays and improving patient flow. 

• 

In  response  to  the  concerns  raised  regarding  delayed  discharge,  the  system  will  monitor 
performance  against  national  discharge  expectations  and  locally  agreed  trajectories 
through established governance arrangements, including Better Care Fund (BCF) meetings. 
Nationally, this includes expectations that patients are discharged promptly once medically 
optimised, with a 24-hour expectation for Pathway 0/1 discharges, timely transfer through 
Pathway 2/3, and adherence to the Discharge to Assess model and Home First principles.  
Performance  will  be  monitored  against  key  indicators  including  time  from  ready  for 
discharge to actual discharge, length of stay (including >14 and >21 day patients), pathway 
utilisation, and reduction in delayed discharges, in line with Better Care Fund metrics, which 
require  systems  to  demonstrate  improvement  in  discharge  timeliness  and  patient 
outcomes.  
Oversight is provided through BCF governance meetings, attended by the Integrated Care 
Board, Local Authority representatives (including adult social care), acute and community 
providers, and wider system partners, where progress against locally agreed trajectories is 
reviewed, variation is challenged, and corrective actions are agreed. 
In  addition,  the  ICB  works  collaboratively  with  partners  to  ensure  that  patients  awaiting 
discharge  continue  to  receive  safe,  high-quality  care,  including  regular  clinical  review, 
multidisciplinary oversight, risk stratification (under development), and proactive escalation 
where delays present a risk of deterioration. 
Where performance is not in line with expected trajectories, this is escalated through system 
governance  structures,  with  further  actions  implemented  to  increase  capacity,  address 
process delays, and strengthen community provision, ensuring continuous improvement in 
patient flow and minimisation of discharge delays. 

 
 
 
 
 
 •  The  system  is  undertaking  a  review  of  current  arrangements  for  individuals  with  complex 
dementia  to  determine  the  most  appropriate  commissioning  and  operational  oversight, 
specifically whether these pathways should sit within Urgent and Emergency Care (UEC) or 
Long-Term Conditions (LTC) frameworks. This review is aimed at ensuring that patients with 
complex  dementia  are  managed  within  the  most  appropriate  pathway,  with  clear 
accountability,  timely  access  to  specialist  provision,  and  streamlined  decision-making 
processes. By clarifying pathway ownership and strengthening alignment across health and 
social  care,  the  system  seeks  to  reduce  delays  associated  with  funding,  placement  and 
coordination,  improve  patient  flow,  and  ensure  that  individuals  with  complex  dementia 
receive care in the most suitable setting at the earliest opportunity. 

•  The  system  has  established  a  robust,  integrated  approach  to  audit,  learning,  and  quality 
oversight.  Actions  arising  from  incidents  and  delays  are  formally  tracked  and  subject  to 
ongoing audit within provider organisations, with progress and outcomes routinely reviewed 
through  Quality  and  Safety  Committees  and  Contract  Quality  Review  Meetings  (CQRMs). 
Learning from these reviews is embedded into practice and aligned with system-wide Quality 
Surveillance processes, ensuring that themes relating to discharge delays are consistently 
identified,  scrutinised,  and  escalated  where  required.  This  coordinated  governance 
approach  strengthens  accountability,  transparency,  and  continuous  improvement  across 
organisational  boundaries,  ensuring  that  actions  are  implemented,  impact  is  monitored, 
and  the  risk  of  recurrence  is  reduced  through  sustained  oversight  at  both  provider  and 
system level. 

 SIGNATURE 

6 

Chief Executive Officer    
NHS Birmingham & Solihull and Black Country ICBs     

 2 July 2026
Response from Department of Health and Social Care
Minister of State for Care  

39 Victoria Street  
London  
SW1H 0EU 

HM Coroner: Louise Hunt, HM Senior Coroner for Birmingham and Solihull   

26 June 2026 

Dear Louise, 

Thank you for the Regulation 28 report sent to the Department of Health and Social Care (DHSC) 
about the death of Ms Elsie Margaret Jones. I am replying as the Minister with responsibility for adult 
social care. 

Firstly, I would like to say how deeply saddened I was to read of the circumstances of Ms Jones’ 
death, and I offer my sincere condolences to her family and loved ones. The circumstances outlined 
in your report are very concerning, and I am grateful to you for bringing these matters to my attention.  

The matters of concern are as follows: 

1.  The  inquest  heard  evidence  that  patients  who  suffer  from  severe  dementia  who  need 
specialist  placements  often  spend  many  months  in  hospital  whilst  funding  and  suitable 
placements are being found.  

2.  Given the resources available on acute hospital wards, this puts these patients at risk as they 

cannot always be adequately supervised.  

3.  Lengthy delays in securing funding and finding suitable placements for these most vulnerable 

patients creates a risk of future deaths. 

I understand that there is concern that delays in discharge could mean that people spend lengthy 
stays in hospital. 

Clinicians determine when a person is medically ready for discharge using clinical judgement and 
established criteria, and consideration is given to the most appropriate environment and support to 
enable  them  to  leave  hospital  safely.  Where  a  person  needs  further  care  following  discharge, 
multidisciplinary care transfer hubs bring together NHS, local authority, adult social care, housing 
and  other  relevant  professionals  to  support  safe  and  timely  transfers  of  care,  and  to  ensure  that 
appropriate care and support arrangements are in place.   

I recognise the importance of effective discharge arrangements for people living with dementia or 
delirium. The High Impact Change Model supports local systems to improve the timely and effective 
discharge  of  individuals  into  the  community,  by  setting  out  practical  actions  and  good  practice to 
strengthen discharge processes and support better outcomes.  

I also recognise the concern that pressures within hospital settings may affect the level of supervision 
available to patients with high levels of need.  

Providers  are  required  under  Regulation  18  of  the  Health  and  Social  Care  Act  2008  (Regulated 
Activities)  Regulations  2014  to  ensure  sufficient  numbers  of  suitably  qualified,  competent  and 

  
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 experienced staff are available at all times to meet people’s needs, including appropriate supervision 
and risk management. CQC does not mandate staffing levels or 1:1 supervision, but providers are 
expected to comply with Regulation 18 and carry out adequate risk management to provide safe and 
person-centred care to people using their services. 

Additionally, under the Safe domain in CQC’s assessment framework, they can assess provider’s 
abilities  to  understand  and  manage  risk  under  the  Involving  people  to  manage  risks  Quality 
Statement. CQC would expect that where people using services are at risks of falls that providers 
take  adequate  steps  to  risk  assess  and  manage  this.  NICE  has  a  published  guidance  Falls: 
assessment and prevention in older people and in people 50 and over at higher risk that registered 
providers may want to refer to when risk assessing falls. 

Furthermore, the Department of Health and Social Care (DHSC) will also deliver the first ever Modern 
Service framework for Frailty and Dementia (MSF), which will set clearer expectations for the care 
of people living with dementia, reducing unwarranted variation and delivering rapid and significant 
improvements  in  quality  of  care  and  productivity.  This  will  be  informed  by  phase  one  of  the 
independent commission into adult social care, which is expected this year.   

We will continue to work closely with NHS England, CQC and local partners to address the risks 
identified in your report, including improving the timeliness of discharge and ensuring that people 
with severe dementia receive safe, appropriate care and supervision. 

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

Yours sincerely, 

MINISTER OF STATE FOR CARE

Related reports

Other reports by Louise Hunt

See all →

Track Louise Hunt

See every Prevention of Future Deaths report matching Louise Hunt, and how often a new one appears.

What would an alert for this have sent me? Search the full text

Free to try — the preview shows the real matches and how many arrived in the last 12 months. Your first email alert is free.

These reports are published by the Chief Coroner's office at judiciary.uk and are © Crown copyright. The text here is reproduced from the published PDF so it can be searched. If something on this page is wrong, or you are a person named in it and want it reviewed, email drcjar@gmail.com and we will act promptly.