Dear Mr Ellery RE:

Report to Prevent Future Deaths Thank you for your letter dated 21st Decembeä 2018, reporting a matter to us, in accoådance with Regulations 28 and 29 of the Coroner's (Investigations) Regulations 2013. · May I take this opportunity to reassure you that following death, we undertook a thorough investigation into the care delivered by the Trust. Following discussions within the teams involved, I ani now in a position to respond to your specific concerns, where by you. stated you heard at the inquest during the course of the evidence:
1. Delay in IAPT Counselling After turned 18 she moved to Adult Mental Health Services. She had parallel contact with her GP surgery in

Shortly before 18th birthday according to the MPFT Clinical Review I (page 9 of 33), was referred to Improving Access to Psychological Therapies (IAPT) . by'the Access Team for assessment for psychological therapy or counselling. On 14th November 2017 (page 12 of 33) it was agreed with to add her to her GP surgery waiting list for counselling in line with her treatment'preference.

remained on the IAPT waiting list for counselling at the time of her death ..

•• fi'1:b1. Midlands Partnership NHS foundation Trust A Keele Universi ty Teaching Trust The evidence at the inquest was that a 3 month time interval would be optimal but in case, in relation to this GP surgery, 10 months would be the norm. Such a delay is sub-optimal and could have an adverse effect on a patient waiting for counselling to commence. Historically, counselling provision i has been provided from a practice•based model and commissioned from a number of providers, including /APT. Since January 2019 the commissioning arrangements for GP counselling i haveebeen changed, so that /APT will inefuture provide allecounselling provision across the county. The existing provision is person centred ineorientation where the patient will be given information and then decide where they would prefer to be seen. Theerevised model eligibility criteria will give the /APT service increased capacity, enabling greater flexibility with regard to where and when people can be seen. A 3­ month transitionaleperiod is currently underway during which a redesign ofthe /APT service is tak(ng place, whereby counselling provision will be more consistently provided across theecounty from a locality based mode./J which is mo_re efficient and therefore it will be more· possible to be flexible.in responding to changes in supply of staff to meet changes in demand thus reducing waiting times to within the statutory 18 week target. It is anticipated thateonce this work is completed, planned within a six month timescale, it will then beepossible to keep waiting times within theseerecommended limits.
2. The electronic records were hard for a lay person to follow or understand particularly when said to have been updated or validated with the potential for original entries to have bee,n overwritten (as opposed to amended or deleted). If the user of the system understands it then that does not make it unfit for purpose but it was not clear how a user would readily see what had originally been written. The Trust uses the Rio system for electronic patient records. It is impossible for clinicale staff to overwrite fields Jn Rio forms to change or delete an entry once it has been madee without the system recording this. Records of all changes can be viewed by the cliniciane through clicking on the "history" tab ..When a Subject Access Request is made, oure Health Records department print out the most up to date record. The "how to guides fore the forms in Rio are currently being updated to instruct staff how to find the history ofe an entry. Where the previous versions are requested, these are printed out as secondarye notes which include the dates the changes were made unfortunately, at present the onlye way to identify what the exact change was, 'is to compare the 2 sets of notes. We aree currently looking at further developing the system to address this issue.e In regard to the validation of notes, legally it is only students who must have theire records validated by a qualified member of staff. All other staff are required to validatee their own entries. The action of validating the entry represents the electronic signaturee of the accuracy and confirmation of that entry. The Trust has explored with our healthe information colleagues whether the default could be an automatic validation which ise then "unticked" but this is not achievable given that some staff must have their entriese
•••MPFT