Dear Ms Kearsley, Luke Brooks Inquest I write further to my letter of 9th August 2023, to confirm the changes that have now been made with respect to procedure and policy within the 111 service regarding self-conveyance to hospital and information passed to the Out of Hours provider in this case, which was Go To Doc. I will first address the former 111 policy relating to the exclusion of patients with chest pain from advice to make their own way to hospital. The revised policy now provides that all exclusions for self-conveyance, save for Category 1 incidents, will be removed, and patients will be asked if they can make their own way to hospital. These changes to the Standard Operating Procedure (SOP) were approved by the 111 SOP review group and then by the 111 Quality Business Group (QBG). The second point to address arose during the evidence of when she agreed that Mr Brooks did not directly refuse an ambulance and only advised he was unable to make his own way to hospital. Your concern in this regard was fed back to the 111 service with the suggestion that advisors must be clear that a patient is refusing an ambulance disposition with this being confirmed directly with the patient, wherever possible. This guidance was also approved by the 111 SOP review group and then by the 111 Quality Business Group (QBG). The SOP, reflecting both above changes, went live on 5th September 2023 and the changes were communicated to staff via the 111 SharePoint site (locally called OneSpace) in line with all SOP updates.

Staff are provided with reading time across their duties to ensure that they are up to date on all changes within 111. I trust this update is sufficient, however should you require any further clarification or information, please do not hesitate to contact me.

Dear Joanne, RESPONSE TO PREVENT FUTURE DEATHS REPORT: INQUEST INTO THE DEATH OF LUKE MATTHEW BROOKS Thank you for your letter and investigative report (dated 17 August 2023) into the sad death of Luke Matthew Brooks, which was made in accordance with Paragraph 7, Schedule 5, of the Coroners and Justice Act 2009 and Regulations 28 and 29 of the Coroners (Investigations) Regulations 2013. In providing this response to the Report, we offer our sincere condolences to Mr Brooks’ family. On behalf of the Department for Levelling Up, Housing and Communities (“DLUHC”) I now want to outline our response to the Regulation 28 Report to Prevent Future Deaths concerning the death of Mr Brooks (“the Report”), which identified matters of concern and recommended that action be taken to prevent future deaths. The Report followed the investigation and the inquest into the death of Mr Brooks which commenced on 16 February 2023 and concluded on 10 August 2023. The conclusion of the inquest was that Mr Brooks died as a result of acute respiratory distress syndrome due to Aspergillus Pneumonia. Whilst the inquest considered whether the Aspergillus (fungi/mould) was linked to the property, the evidence did not support this. The source of the Aspergillus could not be determined. It was, however, noted that Mr Brooks’ family had numerous concerns with the condition of the property over several years, which was cold and damp. The matters of concern identified in the Report are as follows:
1. There is no register of private landlords available in England. The court heard that this was out of step with other countries within the UK who had a national register. The lack of this meant that local authorities could be hampered in not knowing up-to-date address/contact details when they were made aware of concerns with a privately rented property. This is particularly important when the issue is one which is potentially life threatening, such as asbestos in a property, dangerous items such as inappropriate cord blinds in a property with children or excessive damp. A3

2. North West Ambulance Service (“NWAS”) had a local policy of advising people who described symptoms of chest pain (not immediate life threatening) to not attend A&E on their own. Whilst NWAS have now revised this policy to remove this, it is not known if this could be set out in the local policies of other ambulance services. This letter will respond to the first matter of concern. A separate response from the Department of Health and Social Care will respond to the second. First matter of concern: There is no register of private landlords available in England. We are taking action to address this. The Renters (Reform) Bill was introduced to parliament on 17 May 2023 and includes provision for a new private rented sector database that will support the new Privately Rented Property Portal digital service. Subject to parliamentary approval, all private residential landlords (letting property in England via an assured tenancy under the Housing Act 1988 or a regulated tenancy under the Rent Act 1977) will be legally required to register with the Property Portal, and to provide certain information relating to the properties they let. The service will help landlords understand their legal obligations and give tenants the information they need to make informed choices before entering into a tenancy agreement. The portal will also help landlords understand their legal responsibilities when letting property and provide renters with a new information source to see relevant information about a landlord and property. It will also allow local housing authorities to identify poor quality and non-compliant properties and who owns them, and take prompt action where appropriate. Other Government actions of relevance While you found that the condition of Mr Brooks’ property did not contribute to his death, I wanted to outline action that DLUHC is taking to tackle damp and mould and improve standards and property conditions in the private rented sector. This September I, alongside the Secretary of State for Health and Social Care, published our comprehensive guidance on understanding and addressing the health risks of damp and mould in the home, which is available to view at: https://www.gov.uk/government/publications/damp-and­ mould-understanding-and-addressing-the-health-risks-for-rented-housing-providers. This guidance was written in response to the tragic death of two-year-old Awaab Ishak in 2020, due to mould in his family home. It provides social and private sector landlords with a thorough understanding of their legal responsibilities, and of the serious health risks that damp and mould pose. The guidance makes it clear that tenants should not be blamed for damp and mould. It is the responsibility of landlords to identify and address the underlying cause of the problem, such as structural issues or inadequate ventilation. In November 2022, I also wrote to Local Authority Chief Executives and council leaders setting out my expectation that they will take action to resolve poor housing conditions in their area and directing them to provide information on current housing conditions to the department. A summary of A4

responses has been published at: https://www.gov.uk/government/publications/damp-and-mould­ in-the-private-rented-sector. My department will continue this work with Local Authorities, and I will be making £10m available to pilot measures to improve enforcement of damp and mould. This project is being run in conjunction with the Department of Health and Social Care, and the Department for Work and Pensions, and through it we hope to learn what approaches are most effective and the wider impacts of increased enforcement. I am committed to going further to improve property standards in the private rented sector by introducing the Decent Homes Standard to the sector for the first time and intend to do so at the earliest available legislative opportunity. Work is currently underway to review the Decent Homes Standard to ensure it is up to date and fit for purpose. A core element of decency is assessed by the Housing Health and Safety Rating System (HHSRS), the tool used to assess hazards in rented homes. Following review of the HHSRS, our summary report on the outcomes and next steps is available to view at:

review-outcomes-and-next-steps. An updated HHSRS that is accessible to landlords and tenants and efficient for local councils to use forms a vital part of our reforms to both the social and private rented sectors. New regulations to bring the findings of the review into force will be introduced after the conclusion of our review of the Decent Homes Standard. The Government is committed to taking action to improve standards within the private rented sector. Thank you, once again, for providing your report. I am copying my response to the Secretary of State for Health and Social Care. Yours ever, RT HON MICHAEL GOVE MP Secretary of State for Levelling up, Housing and Communities Minister for Intergovernmental Relations A5

Dear Ms Kearsley, Thank your letter of 17 August 2023 to the Secretary of State for Health and Social Care, Steve Barclay, about the death of Luke Matthew Brooks. I am replying as Minister with responsibility for urgent and emergency services. Please accept my sincere apologies for the delay in responding to this matter. I would like to assure you that the Department is mindful of the statutory responsibilities in relation to prevention of future deaths reports and we are prioritising responses as a matter of urgency. Firstly, I would like to say how saddened I was to read of the circumstances of Mr Brooks’ death, and I offer my sincere condolences to his family. It is vital that we learn from incidents, where they are identified, to improve NHS care. I am grateful to you for bringing these matters to my attention. The report raises concerns about the advice North West Ambulance Service NHS Trust (NWAS) gave to Mr Brooks which was to advise people who describe the symptoms of chest pain not to make their own way to A&E. Your report raised a concern that although NWAS had revised this policy other ambulance services may have similar policies. In preparing this response, my officials have made enquiries with NHS England (NHSE). NHSE has confirmed, after engaging with ambulance trusts in England, that no such blanket policies are in place. NHS111 calls are dealt with on a case–by-case basis. There may be instances where patients may be advised not to go to A&E on their own, including:
• Where patients with chest pain have no alternative but to drive themselves to A&E, then it may be recommended that patients wait for an ambulance in order to protect themselves and other road users; A6

• Where an ambulance service clinician recommends that moving a patient (e.g. if extremely unwell or at risk of collapsing) may do more harm by going to A&E than waiting for the ambulance to arrive on scene. In addition, all patients calling 111 where it has been decided they need an ambulance, will be given interim advice which includes what to do should their condition worsen. Thank you for bringing these concerns to my attention. Yours, HELEN WHATELY A7