Dear Karin

Please see the response from the Trust, County Durham and Darlington Foundation Trust, detailing the actions that have been taken following the concerns that you raised after the inquest held for the late Mrs Margaret Anne Kelly.

In your correspondence you raised two main issues of concern:-

1. Evidence was given at the Inquest that there was no policy in place between City Hospitals Sunderland NHS Foundation Trust and County Durham and Darlington NHS Foundation Trust clarifying the areas of responsibility and channels of communication between the two when patients are referred.

2. Evidence was given that there were poor levels of communication both direct and indirect between medical and professionals at each trust and poor understanding of each other’s differing practices and procedures.

We have recognised that there were significant gaps in the provision of services to Margaret therefore, Anne Ferry, City Hospitals Sunderland, and the Trust have worked closely with our colleagues at City Hospital Sunderland to address the issues raised. In collaboration we have developed a new standing operational procedure to provide a comprehensive approach to inter organisational referrals for plastic surgery opinions. The standard operating procedure provides a process to ensure that the referral is clearly documented; that a suitable response is provided within clearly defined timescales, and that it is clear to all parties that patients on wards at Sunderland Royal remain under the care of the admitting consultant at all times, and not the plastics team. I have included this for your information.

Chief Executive. Darlington Memorial Hospital, Hollyhurst Road, Darlington, County Durham DL3 6HX Please don’t hesitate to contact me if you require any further on this issue