Dear Ms Schofield

RE: Inquest touching upon the death of Mr Nicolas Pennicott

In April 2023, the Trust provided information to the Coroner about developments in neurology services since Mr Pennicott’s death (letter dated 12 April 2023). At the end of the inquest, you asked for an update at the end of July 2023 on measures the Trust intended to introduce but were not in place or fully in place in April 2023. I am writing to provide you with that update on the development of neurology services at Worthing and St Richards Hospitals.

The service introduced the new e-RS system for managing referrals on 2nd May 2023.

Advice and Guidance service for GPs

• The Trust now has 3 consultant sessions per week for neurology consultants to provide advice and guidance for GPs. This is a new facility which was introduced in May 2023, for GPs to access advice prior to or instead of referring for an outpatient clinic
• GPs can select the advice and guidance dropdown option when they are using ERS to refer patients. We are now receiving up to 10 requests per week so are confident that GPs are aware of this service and able to access it
• A wider communication with primary care updating on developments has been written to increase awareness amongst GPs of this facility and we expect this to be shared in the primary care newsletter published by the ICB in August
• This will include an update to the Directory of Services for neurology clearly identifying the advice and guidance facility along with other specialist clinics provided

Triage for outpatient clinic referrals

• Patients referred for outpatient clinic are triaged by a consultant neurologist and categorised by clinical urgency based on the information provided by the GP
• The triage criteria were updated as planned in May 2023. We have introduced a pre-screen to assist the consultant triaging and ensure any patient already known to the service is made known. The consultant is triaging by urgent, 2 week wait cancer, first seizure or routine. For urgent referrals, the consultant is indicating the maximum number of weeks they would expect the patient to be seen within
• We have introduced regular monitoring of the waiting list, with reviews of urgent patients waiting to be seen to allow appropriate prioritisation within available clinic capacity
• Implementation of the e-RS system has reduced the previous delay to uploading referrals for consultant triage

Waiting times for patients referred to outpatient clinics

• We have now employed a locum consultant neurologist to support the service and provide additional outpatient clinics and consultant triage. This arrangement is ongoing
• We have engaged Elective Services to provide additional outpatient capacity to address waiting times for new patients and anticipate that these measures will reduce waiting times for all patients. Elective Services are providing in excess of 600 outpatient appointments over a 12-week period
• We have advertised for substantive consultant neurologists. The advert closes on 26th July and we look forward to shortlisting any applicants
• We are implementing changes to manage the demand for new outpatient appointments across the 3 sites within the Trust to reduce the maximum waiting time for patients across Sussex., offering patients appointments at alternative sites to reduce waiting time

Neurology workforce review

• There remain significant pressures on the neurology medical workforce with national and local consultant shortages
• We continue to develop our model of advanced clinical practice in neurology with a team of clinical nurse specialists working in general neurology as well as in specialist areas, including headache, epilepsy and Parkinson’s disease. We have developed a proposal to increase the capacity of the services that ACPs are providing and expect to deliver this in the second half of this financial year

Advice and guidance for hospital consultants

• A Standard Operating Plan (SOP) is in place for the Emergency Department / Emergency Floor consultants to access advice from a consultant neurologist on weekdays. At weekends, advice can be sought from the on-call neurology teams at Southampton General Hospital or Royal Sussex County Hospital

• The department uses an electronic referral form that initiates a review by a consultant neurologist. During the week, this should be provided on a same day basis. If there are staffing constraints on a specific site then cross site solutions such as telephone advice are available. There is a consultant neurologist on call daily across the Trust. There is a regular ward review service for patients on the wards at St Richards Hospital and Worthing Hospital, by a consultant neurologists

Dear Ms Schofield,

Re: Regulation 28 Report to Prevent Future Deaths – Mr Nicholas John Pennicott who died on 19 August 2021.

Thank you for your Report to Prevent Future Deaths (hereafter “Report”) dated 11 May concerning the death of Nicholas John Pennicott on 19 August 2021. In advance of responding to the specific concerns raised in your Report, I would like to express my deep condolences to Nicholas’ family and loved ones. NHS England are keen to assure the family and the coroner that the concerns raised about Nicholas’ care have been listened to and reflected upon.

I am grateful for the further time granted to respond to your Report, and I apologise for any anguish this delay may have caused to Nicholas’ family or friends. I realise that responses to Coroner Reports can form part of the important process of family and friends coming to terms with what has happened to their loved ones and appreciate this will have been an incredibly difficult time for them.

In your Report, you raise a concern regarding the hospital waiting times for a Neurology outpatient appointment at the University Hospitals Sussex NHS Foundation Trust (UHSUSSEX) due to capacity issues. I have been sighted on their response to your Report and note that since July 2022, they are operating under a new clinical operating model which has improved neurology capacity at UHSUSSEX.

This includes consultant-led triaging of referred patients, providing advice and guidance to GPs and other hospital consultants, and reduction in administrative time taken to register referrals. I note that the Trust aims to see urgent referrals within 4 weeks and has committed to making further improvements across its neurology service.

Regarding staffing challenges within the neurology workforce at UHSUSSEX, I note from their response to you that they are in the process of recruiting to additional consultant posts. I am advised that there are currently two consultant vacancies, but that one locum is in place and that UHSUSSEX has also engaged Elective Services to provide additional outpatient capacity in the interim period while recruitment is ongoing.

National Medical Director NHS England Wellington House 133-155 Waterloo Road London SE1 8UG

26 July 2023

Your Report also raises a concern that there is a shortage of neurologists at a national level. This is a well-recognised issue within the NHS and there is currently significant variation in neurologist numbers across England. The Getting It Right First Time (GIRFT) programme for neurology (GIRFT is national NHS England programme designed to improve the treatment and care of patients through clinically led reviews) recommends that all acute hospitals have acute neurology liaison services in place, and, ideally, acute neurology outpatient clinics to urgently see rapidly deteriorating patients. However, this is dependent on workforce constraints.

Last month, NHS England published the NHS Long Term Workforce Plan, setting out our plans to grow, retain and reform our workforce across the next fifteen years. This plan looks to reduce the national shortages we see across the NHS, helping to provide safe and timely access to urgent care that will reduce the delays currently being faced by patients such as Nicholas.

I would also like to provide further assurances on national NHSE work taking place around the Reports to Prevent Future Deaths. All reports received are discussed by the Regulation 28 Working Group, comprising Regional Medical Directors, and other clinical and quality colleagues from across the regions. This ensures that key learnings and insights around preventable deaths are shared across the NHS at both a national and regional level and helps us pay close attention to any emerging trends that may require further review and action.

Thank you for bringing these important patient safety issues to my attention and please do not hesitate to contact me should you need any further information.