Dear Sir Inquest into the death of Judith HUGHES I refer to your Regulation 28 Report addressed to the Chief Medical Officer. This has been forwarded on to me as the Chief Nursing Officer. Mrs Hughes died over five years ago on 7th October 2020. Policies and Forms are, of course, subjected to regular review. As was mentioned at the inquest the relevant Form had already been revised in 2022 (a copy of the Policy which contains this is enclosed) following a routine review of the Policy. The Enhanced Care Risk Assessment Form is used by nursing staff to calculate the risk of a patient falling in hospital. You will note that the amended Form is clearer in setting out the risk factors. ‘Previous falls in the last 12 months’ essentially refers to falls outside of the hospital setting whereas ‘Inpatient fall during this admission’ refers to a new fall during the present admission. These are separate risk factors and the Form reflects this. Our nursing staff receive training on the Policy and Forms. The relevant Policy and Form are due to be reviewed again in the next few months and we will ensure that your comments are taken into account in this process.