The evidence of both Consultant in Emergency Medicine, and _ Consultant Physician; was that there is currently no venothromboembolism risk assessment model in place in the Emergency Department to assess the risk of VTE in patients discharged with lower limb immobilisation. The reason for this appeared to be that the evidence base regarding risk factors and success of prophylaxis is varied. accepted that Sharon Louise Henshall should have been assessed. His evidence was that he and colleagues were working on developing a tool that would try to extrapolate data from the inpatient assessment tools to create an outpatient tool, but that it was difficult to know what benefit would be derived from giving prophylactic treatment Dr McDowell's evidence was that creating a risk assessment tool would be a very easy thing to do, but that it would require a "major change in pathways, which would need to involve primary care to monitor complications (1) To have no assessment in place at all and to offer nothing in an area of known risks on the basis that the evidence base is varied, as opposed to having a tool in place, even one that recognises only the highest and obviously knownlunderstood risk factors, seems unlikely to be adequate, and gives rise to a concern that future deaths will occur; (2) To have no interim tool in place pending the outcome of 'major change in pathways' seems unlikely to be adequate; (3) Dr McDowell's evidence was that other European countries routinely give LMWH to patients with lower limb immobilisation , this is not something that is done at LTHTR; Or uniformly across Trusts in land and Wales; (4) According to the NICE guidance in this area, which was updated in June 2015, states that clnicians should have a discussion about risks and benefits with each individual, which necessarily requires having some form of tool or model in place to facilitate that discussion, yet there is no such tool in place within LTHTR; (5) The evidence of bott was that whether patients will be offered prophylaxis varies according to which hospital patients attend, since some Trusts offer it ad some Trusts do not,and different Trusts have differing risk assessment tools taking different risk factors into account: It is of concern that due to the absence of national guidance there appears to be something of a 'postcode lottery' with regards to prophylaxis offered or not