Dear Ms Saunders Re: Re; Aneurin Bevan University Health Board response to Regulation 28 Report received following the inquest touching on the death of Catriona Martin Thank you for your letter of 4th December 2023 and accompanying report, which the Health Board received on 5 December 2023 I am writing to provide you with the Health Board’s response to the Regulation 28 Report to Prevent Future Deaths, following the inquest into the death of Catriona Martin As requested, the information presented below is intended to describe the actions which have been taken/are being taken by Aneurin Bevan University Health Board to mitigate the risk of future deaths. You require the Health Board to provide you with the following information: All guidelines and policies regarding the delegation of nursing responsibilities to family members when these are tasks that the family do not normally provide and for which they have had no training. Note, this is separate to the care provided in hospital by regular community carers or family members who undertake these tasks at home and are cognisant of the patient’s normal needs and requirements. Firstly, the Health Board wishes to make clear that no family member should be requested to undertake tasks or provide care to patients if this is not something they normally provide, wish to continue providing or the patient has not consented to. Care planning and the delivery of care must be personalised and assessed on an individual basis and any delegation of care must be considered as appropriate, safe and mutually agreed with patients, families and nursing staff. In August 2021, the Health Board developed and then launched a Person-Centred Enhanced Observational Framework. The purpose of the framework is to provide personalised, appropriate, consistent and high-quality enhanced observation/care for those patients deemed appropriate to receive such care requirements. The person-centred enhanced observation framework incorporates an individual management plan and tool kit which assesses a patient’s needs and supports the delivery of care to provide safe and dignified patient centred care. Bwrdd Iechyd Prifysgol Aneurin Bevan Aneurin Bevan University Health Board Pencadlys, Ysbyty Sant Cadog Headquarters, St Cadoc’s Hospital Ffordd Y Lodj, Caerllion, Casnewydd NP18 3XQ Lodge Road, Caerleon, Newport NP18 3XQ 01633 436 700 BwrddIechydPrifysgol BIPAneurinBevan 01633 436 700 AneurinBevanHealthBoard AneurinBevanUHB Rydym yn croesawu gohebiaeth yn Gymraeg a byddwn yn ymateb yn Gymraeg heb oedi. We welcome correspondence in Welsh and we will respond in Welsh without delay. Bwrdd Iechyd Prifysgol Aneurin Bevan yw enw gweithredol Bwrdd Iechyd Lleol Prifysgol Aneurin Bevan. Aneurin Bevan University Health Board is the operational name of Aneurin Bevan University Local Health Board.

Supported by the patient centred care team the framework has been rolled out across all acute and community wards to ensure patients requiring a level of enhanced observation and supervision, either through an increase in observation, cared for in a cohorted environment or requiring 1:1 nursing care, are identified and appropriate care and observation initiated. The framework includes:  A description of the different levels of enhanced care, and the enhanced support and observation required to deliver each level of observation.  A detailed personalised management plan which includes: − individual care planning around environment, agitation, pain, infection, nutrition, constipation, hydration, medication, sleep and risk of falls.  Enhanced observation review documentation to determine whether enhanced care requirements have changed, whether there is a need to escalate/de-escalate.  Behaviour charts which also determine trigger points which may require escalation.  Person centred meaningful activity chart  Enhanced care staff rotation record  Patient centred enhanced observation information leaflet. Following the raising of the matters of concern, it is recognised that additional training and education is required to ensure staff are clear in their responsibilities in regards appropriate delegation of care to family members. This can include patient care that is not only prescribed through cognitive impairment but is associated with acuity and complexity associated with intervention such as, post operative procedures. Education and training will be delivered via Patient Safety and Quality focused study sessions, supported by a bespoke programme of work with the Person-Centred Care Team. Throughout this work increased emphasis will be placed on appropriate and safe delegation, family involvement and utilising the framework not only for those patients with cognitive impairment but for those patients with complex medical acuity. The Health Board is currently in the process of revising the Person-Centred Enhanced Observational Framework. The revised version will include the following requirements to be documented:  A conversation with family members on expected levels of care delivery and involvement.  Levels of delegation and the responsibility of the registrant to deliver care and assessment to the patient meeting their individual needs in collaboration with family.  Documented evidence which demonstrates that the care plan has been developed in collaboration with patients (if able to do so) and family.  Learning implemented to date and future plans:  HealthRoster SafeCare is a digital platform that has been introduced and currently being rolled out across the Health Board. SafeCare gives nurses the visibility of staffing levels across wards and departments, allowing them to maintain safe and compliant patient care based on patient numbers, acuity and dependency. It supports day-to-day operational changes to the roster in real time, facilitating the redeployment of staff to support enhanced care requirements. The system enables a review of daily staffing levels and whether they are deemed safe to meet clinical demand. SafeCare provides the functionality to enter acuity and/or dependency data to inform evidence-based decision making on staffing requirements and workforce. This provides a visual platform of establishments, skill mix, patient demand/acuity in real-time to ensure informed decisions are made and supports acuity-driven staffing level requirements. 2

 An ‘Educational and Recommendations After Significant Events (ERASE) Poster’ to raise awareness and share learning, specific to this case, has been developed and disseminated.  This case has been discussed and outcomes shared widely. Delegation of care, documented conversations with family members and the importance of clear concise communication with families and friends has been reinforced ensuring clarity is gained in regards family involvement in patient care. I trust that this information provides assurances in regards the matters raised. However, if any further information or assurance is required, please do not hesitate to contact me.