Dear Mr Horsley

Re: Inquest Touching on the Death of Anthony Charles Walker

Thank you for your report dated 14th May 2019 and for giving SCAS the opportunity to work with Portsmouth Hospital NHS Trust (PHT) regarding your concern.

To confirm, your concerns relate to callers to our 111 service who are in a mental health crisis. You were concerned that the 111 reports were not currently made available to the Emergency Department at Queen Alexandra Hospital (QAH), Portsmouth. SCAS met with Senior Emergency Departement Consultants and Jacqueline Haines, Head of Legal Services, for PHT earlier this month to discuss the matter.

SCAS already has the technology available to send a copy of the 111 report to the Emergency Department at Queen Alexandra Hospital. The report could be sent to the Emergency Department’s Reception Team via the nhs.net secure email service at the end of the 111 call. Our meeting therefore discussed how feasible it would be for these reports to be read and stored by the Emergency Department Team; particularly when a patient record will not be created on their system until the patient arrives with them.

Since Mr Walker’s death in November 2017, there have been changes within our Emergency Operations Centre in Otterbourne. We now host Mental Health Nurses from Southern Health Foundation Trust within our call centre 24 hours a day, 7 days a week. This is on a long-term trial basis until December 2019 and is funded by our local Commissioners, Hampshire County Council and the Police and Crime Commissioner. It is sensible for callers to be assessed by this service first so they can assess whether attendance at the Emergency Department is necessary. PHT will now liaise with

from Southern Health to discuss how information regarding their assessment of patients identified as being at high risk of suicide or self-harm will be identified and Northern House, 7 - 8 Talisman Business Centre, Talisman Road, Bicester, Oxfordshire, OX26 6HR Tel: 01869 365 000

Registered Headquarters: 7 and 8 Talisman Business Centre, Talisman Road, Bicester 0X26 6HR referred to Queen Alexandra Hospital to close the information loop. Should this service cease in December 2019, SCAS will work with PHT again to address the concerns you have raised.

I hope this response has addressed your concern but please do come back to me if I can assist you further

Dear Mr Horsley Regulation 28: Report to Prevent Future Deaths, concerns arising out of evidence heard at the Inquest into the death of Anthony Walker Following the inquest into the death of Anthony Walker, which was concluded on 29t April, you issued regulation 28 report addressed to several public bodies, including Portsmouth Hospitals NHS Trust (PHT); asking them to respond to a list of 3 concerns_ Of those concerns, the following required action from PHT: "3. was told in evidence that the contents of 111 emergency calls to South Central Ambulance Service involving callers mental health issues are not made available to the Accident and Emergency Department at Queen Alexandra Hospital, Portsmouth: believe making this information available to the Accident and Emergency Department may help reduce the risk of suicidel self-harm to patients attending the department in consequence of such calls: In response to the regulation 28 report;, can report that senior representatives from the Emergency Department at PHT have met with senior representatives from SCAS to discuss the feasibility of introducing a process to enable 111 calls to be made available for clinical staff in the Emergency Department (ED) to access in "real time"_ It was agreed that such a process would not currently be feasible for technical and resource reasons; however this is something that the organisations will continue to discuss_ Since Mr Walker's death there have been changes within the SCAS Emergency Operations Centre in Otterbourne. understand that a Mental Health Team (MHT) from Southern Health Foundation Trust is now hosted within the Ops Centre on 24 hours days week basis. As understand it; patients who are identified by 111 callers as being at high risk of suicide or self _ harm are referred onward to the MHT in the Ops Centre_ It is possible that the SCAS hosted MHT may occasionally consider it appropriate to advise those patients to attend ED, because they also have physical health need, and PHT are putting in place a process with SCAS to ensure that the MHT team have direct telephone access to a Consultant in ED to give them advanced notice of the attendance_ Chair: Melloney Poole OBE Chief Executive: Mark Cubbon Portsmouth Hospitals NHS Trust, Trust HQ, Queen Alexandra Hospital, Southwick Hill Road, Cosham, PO6 3LY Registered charity number: 1047986 day,

do this response addresses your concern, but please do not hesitate to contact me if you require further information, or if there is any other way in which can assist.

Dear Steven

Re: Anthony Charles Walker, Regulation 28 recommendations

Following the Coroner’s Inquest into the death of the above named at The Grange Approved Premises, Purbrook, Hants the Regulation 28 recommendations below were made. The National Probation Service response, provided by , Head of SWSC Approved Premises, is also below.

1. I heard evidence that there was no liaison between Mr Walker’s Keyworker at The Grange and local Mental Health Services which were not therefore involved in Mr Walker’s care. I believe such liaison and advice to Probation hostel staff could help prevent future deaths.

NPS response – During the time Mr Walker was resident at The Grange Approved Premises he was not actively engaged with or receiving treatment from the Local Community Mental Health Service. He did, however, seek support from his GP and the Crisis Support Team at the local hospital, both assisted and facilitated by staff at the Approved Premises.

There is no formal arrangement in place between Approved Premises and local Community Mental Health Services, and staff have no mechanism for undertaking enhanced referrals to such services. In addition, due to medical confidentiality, such services will not provide information to Probation staff without the explicit consent of the individual resident.

All residents arriving at Approved Premises are asked to sign a medical consent form to facilitate liaison between the National Probation Service and other agencies, and are expected to liaise as required when aware that any resident is engaged with such services. In the case of Mr Walker this did not happen.

In terms of future action, I will be issuing the following instructions to all Approved Premises across the SWSC Division.

 All new residents will be asked and encouraged to sign the necessary consent forms  All Approved Premises will seek to identify a Single Point of Contact (SPOC) at the local Community Mental Health Team to enhance liaison opportunities  Staff will be reminded of the importance of liaison with other agencies involved in the care of residents  Staff will be reminded to support and facilitate referral to appropriate agencies who can assist in the care and management of residents  Please also see the National Self-Inflicted Harm/Deaths actions outlined below

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2. I also heard evidence that there was no signposting for staff at The Grange to local Mental Health Services and other agencies that could have assisted with Mr Walker’s Care. I believe staff should have such information readily available to them at all times.

NPS response – Although staff were instrumental in facilitating Mr Walker attending appointments with both his GP and the Crisis Team at the local hospital it is accepted that no pro-active signposting occurred. The highlighted actions required by the National Reducing Self-Inflicted Harm/Deaths Action Plan implemented in late 2018 address this recommendation.

The NPS has now produced a National Reducing Self-Inflicted Harm/Deaths Action Plan requiring that all Approved Premises must:

 Ensure staff attend Ligature Training and that ligature knives are available  Ensure staff attend Self Inflicted Harm/Deaths training  Ensure staff attend a one day First-Aid training and refresh every 3 years  Ensure all Approved Premises are linked in with their Local Authority Suicide Prevention Action Plans  Ensure that Approved Premises staff are communicating with Offender Managers effectively with regards to risk to self information  Ensure that there are processes and procedures in place to ensure that risk to self concerns are communicated to all Approved Premises staff  Approved Premises have in place a national process for identifying, assessing, monitoring and managing residents who may pose a risk to self  Ensure residents are supported to register with the local Approved Premises GP (on a full time or temporary basis) within a week of arrival and that all residents are encouraged to sign a consent for staff to contact GP if necessary and a record made of this.  Ensure that resident notice boards contain relevant information on suicide prevention, CMHT contact details, Samaritans and to provide Samaritans support cards in the induction pack provided to residents, during crisis and on leaving the Approved Premise.  Ensure Nominated Approved Premises Manager/Area Manager attends and contributes to Divisional Suicide Prevention Forum  Implement and develop the role of local Suicide Prevention Champions within Approved Premises to include a Divisional Champions Network.  Ensure suicide prevention is a standing agenda item at Approved Premises team meetings, cluster Approved Premises meetings, Approved Premises manager and Area Manager meetings, and that emotional wellbeing is covered in Approved Premises residents’ meetings  Every Approved Premise has a distraction box which residents can access at times of crisis or difficulty  Each Approved Premise has a collated file of local support available for staff to access and provide to residents

This plan is currently being implemented across all SWSC Approved Premises and should address not only the Regulation 28 recommendations but also the many of the wider issues associated with risks related to self-inflicted harm and deaths.

I trust this provides a satisfactory response to the recommendations, and the reassurance sought by the Coroner, however, if any further detail or information is required please no not hesitate to contact me.