John Stiff
PFD Report
Partially Responded
Ref: 2023-0120
Coroner's Concerns (AI summary)
Insufficient ortho-geriatric provision for elderly patients with hip and pelvic fractures, despite repeated requests, risks future deaths due to inadequate recognition and treatment of co-morbidities.
View full coroner's concerns
The Inquest heard evidence from an orthopaedic surgeon that patients such as Mr Stiff, who suffer hip and pelvic fractures and who have a number of additional age-related co-morbidities, would be best cared for by ortho-geriatricians. The inquest heard that this matter has been raised by the orthopaedic team on multiple occasions, but the orthogeriatric provision has not been increased.
The Inquest also heard that the lack of orthogeriatric provision is a national issue of concern within the NHS.
Orthopaedic trauma in elderly patients often exacerbates underlying medical conditions. Orthogeriatric trained staff would be better trained to recognise and treat medical co-morbidities. It is therefore considered that improved access to orthogeriatric care for this patient cohort could prevent future untimely deaths.
The Inquest also heard that the lack of orthogeriatric provision is a national issue of concern within the NHS.
Orthopaedic trauma in elderly patients often exacerbates underlying medical conditions. Orthogeriatric trained staff would be better trained to recognise and treat medical co-morbidities. It is therefore considered that improved access to orthogeriatric care for this patient cohort could prevent future untimely deaths.
Responses
Action Planned
The Department of Health and Social Care acknowledges the concerns regarding orthogeriatric provision and highlights the NHS Long Term Workforce Plan, which aims to double the number of medical school places in England by 2031/32 and increase generalist skills. (AI summary)
The Department of Health and Social Care acknowledges the concerns regarding orthogeriatric provision and highlights the NHS Long Term Workforce Plan, which aims to double the number of medical school places in England by 2031/32 and increase generalist skills. (AI summary)
View full response
Dear Miss Persaud,
Thank you for your Regulation 28 report to prevent future deaths dated 18 April 2023 about the death of John Edward Stiff. I am replying as Minister with responsibility for heath and secondary care.
Firstly, I would like to say how saddened I was to read of the circumstances of John Edward Stiff. I offer my sincere condolences to their family and loved ones. The circumstances your report describes are concerning and I am grateful to you for bringing these matters to my attention. Please accept my sincere apologies for the significant delay in responding to this matter.
The report raises concerns over orthogeriatric provision both at the Barking, Havering and Redbridge University Hospitals NHS Trust and nationally.
Orthogeriatric care is a medical-surgical model which brings together multidisciplinary health professionals from trauma, orthopaedics and geriatric medicine to treat the fracture and frailty issues affecting people with hip fractures. I understand that Orthogeriaric provision varies across the NHS. Each individual Trust will create their own care pathways, having regard to both their patients and the skills of their workforce.
The NHS Long Term Workforce Plan (LTWP) published by NHS England on 30 June last year sets out the case for reforming medical education and training and states that “To care for ever increasing numbers of older people with multiple and complex conditions, health and care professionals will need to continue to enhance their specialist knowledge while also
maintaining and developing their generalist and core skills. This will support health and care professionals to work in multidisciplinary, integrated teams that respond to population health needs and effectively deliver care in communities. The way we train staff also needs to address predicted future workforce shortfalls, match differing generational expectations and meet the needs of those joining the workforce in future.”
The LTWP also sets out an aim to double the number of medical school places in England to 15,000 places a year by 2031/32, and to work towards this expansion by increasing places by a third, to 10,000 a year, by 2028/29. We have brought forward the trajectory of this planned expansion for the last 2 years, having allocated 205 and 350 additional places for the 2024 and 2025 academic years respectively.
This expansion builds on a recent increase in Government funded medical school places. This previous increase was completed in September 2020 and delivered five new medical schools in England, and an additional 1,500 medical school places per year for domestic students in England. This represented a 25% increase and took the total number of medical school places in England to 7,500 each year.
These expansions and reforms will increase the pool from which future Geriatricians, Orthopaedic surgeons and other specialists can be drawn, and increase the skills in the medical workforce that are required to treat complex patients. Together this will facilitate more staff becoming involved in Orthogeriatric Care.
I hope this response is helpful. Thank you for bringing these concerns to my attention.
Thank you for your Regulation 28 report to prevent future deaths dated 18 April 2023 about the death of John Edward Stiff. I am replying as Minister with responsibility for heath and secondary care.
Firstly, I would like to say how saddened I was to read of the circumstances of John Edward Stiff. I offer my sincere condolences to their family and loved ones. The circumstances your report describes are concerning and I am grateful to you for bringing these matters to my attention. Please accept my sincere apologies for the significant delay in responding to this matter.
The report raises concerns over orthogeriatric provision both at the Barking, Havering and Redbridge University Hospitals NHS Trust and nationally.
Orthogeriatric care is a medical-surgical model which brings together multidisciplinary health professionals from trauma, orthopaedics and geriatric medicine to treat the fracture and frailty issues affecting people with hip fractures. I understand that Orthogeriaric provision varies across the NHS. Each individual Trust will create their own care pathways, having regard to both their patients and the skills of their workforce.
The NHS Long Term Workforce Plan (LTWP) published by NHS England on 30 June last year sets out the case for reforming medical education and training and states that “To care for ever increasing numbers of older people with multiple and complex conditions, health and care professionals will need to continue to enhance their specialist knowledge while also
maintaining and developing their generalist and core skills. This will support health and care professionals to work in multidisciplinary, integrated teams that respond to population health needs and effectively deliver care in communities. The way we train staff also needs to address predicted future workforce shortfalls, match differing generational expectations and meet the needs of those joining the workforce in future.”
The LTWP also sets out an aim to double the number of medical school places in England to 15,000 places a year by 2031/32, and to work towards this expansion by increasing places by a third, to 10,000 a year, by 2028/29. We have brought forward the trajectory of this planned expansion for the last 2 years, having allocated 205 and 350 additional places for the 2024 and 2025 academic years respectively.
This expansion builds on a recent increase in Government funded medical school places. This previous increase was completed in September 2020 and delivered five new medical schools in England, and an additional 1,500 medical school places per year for domestic students in England. This represented a 25% increase and took the total number of medical school places in England to 7,500 each year.
These expansions and reforms will increase the pool from which future Geriatricians, Orthopaedic surgeons and other specialists can be drawn, and increase the skills in the medical workforce that are required to treat complex patients. Together this will facilitate more staff becoming involved in Orthogeriatric Care.
I hope this response is helpful. Thank you for bringing these concerns to my attention.
Sent To
- Department of Health and Social Care
- Barking, Havering and Redbridge University Hospitals NHS Trust
Response Status
Linked responses
1 of 2
56-Day Deadline
13 Jun 2023
About PFD responses
Organisations named in PFD reports must respond within 56 days explaining what actions they are taking.
Source: Courts and Tribunals Judiciary
Report Sections
Investigation and Inquest
On 1 December 2022 I commenced an investigation into the death of John Edward Stiff. The investigation concluded at the end of the inquest on the 5 April 2023. The conclusion of the inquest was that Mr Stiff died as a result of an accident (following a fall).
Circumstances of the Death
On the 10 November 2022, Mr. Stiff was admitted to Queen's Hospital having suffered a believed unwitnessed fall. In Queen's Hospital, he was diagnosed as suffering from an undisplaced fracture of the pelvis. A decision was taken to treat Mr. Stiff conservatively. Even though there was no surgical intervention, he was admitted under the care of the orthopaedic team. The orthopaedic team are not specialists in controlling medical problems associated with fractures. During the course of the admission, Mr. Stiff's appetite was much reduced. He was not offered any nutritional supplements. On the 15 November 2022 he had reduced oxygen saturations and the medical team became involved in his care. He was diagnosed as suffering from a chest infection. He was treated with supplemental oxygen; intravenous fluids and intravenous antibiotics. Sadly, Mr. Stiff did not recover and he passed away at Queen's Hospital on the 16 November 2022. It is likely that the fall and fractured pelvis on the 10 November 2022 caused a decline in health and mobility which would have contributed to the development of the fatal pneumonia.
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Data sourced from Courts and Tribunals Judiciary under the Open Government Licence.