Dear Ms Henderson Re: Mrs Freda Mary Lennox Regulation 28 Report to Prevent Future Deaths Please find below my responses to your concerns raised in your email received on 11 May 2022 following the inquest into the death of Mrs Freda Mary Lennox. The Regulation 28 report sets out the matters giving rise to concern numbered 1-5 below.
1. An echocardiogram was requested September 2020 but was not carried out prior to her surgery.
2. No recent review by consultant prior to admission on 2 November 2020 despite medical co-morbidities giving rise to concern over suitability for elective total hip replacement.
3. The consultant anaesthetist was not informed about Mrs Lennox and her medical co- morbidities prior to her admission. Nonetheless the consultant anaesthetist undertook a thorough pre-operative assessment on the day of surgery and Mrs Lennox consented for surgery.
4. Lack of funding for a dedicated high-risk consultant led anaesthetic pre-operative assessment clinic with the necessary equipment to be able to suitably risk assess patients prior to any potential surgery.
5. There was no designated (permanent) room space to set up such a clinic and no secretarial input to type reports for high-risk patients which led to a significant delay in providing a timely service. The Trust has appointed an anaesthetic lead for high-risk anaesthetic patient pathways, and in response to your concerns we have finalised our plans to expand the services for high-risk patients. We now have four dedicated fully functioning high risk anaesthetic pre-assessment clinics per week. The clinics are led by consultant anaesthetists with a specialist interest in pre- assessment and high-risk patients, one of which is an orthopaedic anaesthetist whose clinics focus on high-risk orthopaedic patients. Additionally, clinics are protected in consultant job plans, and the estate resources such as appointment rooms with appropriate medical equipment are also protected.

,.,,:kj Ashford and St. Peter's Hospitals NHS Foundation Trust During these clinics there is the opportunity to follow up on any outstanding tests in good time prior to any planned surgery, discuss the detail of any anaesthetic risk with the patient and answer any questions they may have. The Trust introduced an electronic patient record system in 2022, called Surrey Safe Care (SCC). We have created a specific SSC pathway for referral into the high-risk clinic that sits separately to the standard pre-operative assessment referral pathway. This requires a referral by a consultant surgeon. The SSC system also allows for a range of formalised patient risk assessments and recognised scoring systems individualised to the patient as appropriate. These risk assessments are visible to all relevant staff with the aim of adequately informing anaesthetists and others, pre-operatively about their patient's risk status. The Trust expects the current funding for consultant led dedicated high risk anaesthetic clinics to continue and these will likely expand in the future. I do hope the details of the changes the Trust has made to our practices are sufficient to allay the concerns you have raised in your report. Please do not hesitate to contact me should you require further details or documentation.