Dear Ms Voisin am writing in response to the Prevention of Future Death report you issued to this Trust following the inquest into death of Oliver Ford deceased. The response has been prepared by the Quality Director for North Somerset Services_ Following the review, the telephone triage process now includes the access trigger tool which is a trust wide tool that requires every clinician to ask in depth questions about risk; In essence it is a risk assessment which will indicate an immediacy of response The access trigger tool will assess: Referrer concerned about Family memberslcarer concerned about: Referrer requesting: Lack of corroborative information Two or more previous contacts (by any means) to AWP services from other sources about this person Patient previously known to AWP services Previous history of significant suicide attempts or risks Previous history of significant suicide attempts or risks Adverse life-event or unresolved factors reported to be associated with suicidal ideation or risk to others
e.g. pending court appearance Recent serious self-harm, especially if life-threatening or planned Co-morbid alcohol andlor drug use judged to have adverse impact on mental state and level of risk Previous history of self-harm Substance and alcohol use Risk summary Continued. Acting Chair Trust Headquarters Chief Executive Jenner House, Langley Park; Chippenham, SN1S 1GG 'Hayley Richards "We are & teaching, learning and research trust; we aim to inform you about relevant opportunities, unless you tell us otherwise. the

Pending or recent discharge from inpatient mental health care or other transition Admission history Further detail relating to known risk information
1.1.1 Clinical information regarding current presentation:
1.1.2 High risk clinical syndrome depression, adjustment disorder, psychosis emotionally unstable personality disorder
1.1,3 Any Safeguarding issues
1.1.4 Impulsivity
1.1.5 Currently, or very recently, in a high risk situation
e.g: threatening to jump from height; located in a high risk setting such as a railway line 1,1.6 Referrer reports any kind of difficulty in engaging with patient
1.1.7 If known to mental health services, care coordinator expresses concerns regarding risk and requests temporary allocation to a more intensive treatment pathway
1.1.8 There now 2 clinicians on duty at PCLS until 8.OOpm Monday to Friday, the service transfers at 8pm, to the Intensive Support Team that operates 24 hours per day: Following the Access Trigger Tool assessment the clinicians required to document on RIO a full rationale for decision making based on the collateral information gathered from the Access Trigger Tool_ This is being used in all Access referrals This process is audited by the PCLS Team Manager on a monthly basis. For all urgent and emergency referrals the PCLS service will be covered by the Intensive Support Team (outside of its normal operating hours which are Monday to Friday 08.00-20.00) The Intensive Support Team operates 24 hours per day 365 days per year. Any action that requires follow up outside PCLS working hours (including bank holidays and weekends) will be handed over to Intensive Support Team for action. If you require further information, please do not hesitate to let me know