Dear Ms Mutch

Re: Regulation 28 Report to Prevent Future Deaths – Alfred Jones 07/09/2020

Thank you for your Regulation 28 Report dated 30/04/2019 concerning the sad death of Alfred Jones on 07/09/2020. Firstly, I would like to express my deep condolences to Alfred Jones’s family.

The inquest concluded that Alfred’s death was a result of 1a) Bronchopneumonia in combination with Covid-19; II) Falls with vertebral fractures, Type 2 diabetes mellitus, pulmonary fibrosis, heart failure and epilepsy.

Following the inquest you raised concerns in your Regulation 28 Report to Greater Manchester Health and Social Care Partnership (GMHSCP) that there is a risk future deaths will occur unless action is taken.

This letter addresses the issues that fall within the remit of GMHSCP and how we can share the learning from this case.

The Greater Manchester system is cognisant of the capacity issue in terms of slots for MRI scanners both in the Trust and the wider NHS. There is also the compounding issue of the shortage of radiology staff. This is an issue that is prevalent across the country as fundamentally there are insufficient numbers of qualified radiologists and radiographers.

Tameside and Glossop Integrated Care NHS FT At the time of Mr Jones’ referral, Tameside and Glossop Integrated Care NHS Foundation Trust (T&GIC FT) was sourcing additional scanner capacity by provision of a mobile MRI scanner. This was implemented on 20th September 2020, offering additional outpatient scanning capacity for 12 hours per day, 7 days per week. The mobile MRI van is still used currently to provide additional capacity. It is also worth noting that the Trust did not reduce or delay suspected cancer patient scans due to the pandemic, and therefore, the MRI scanner was being fully utilised.

In 2019, the division of clinical support services was established at T&GIC FT and encompasses diagnostics including Radiology. This was intended to provide coordinated leadership, oversight and governance.

Since this time, investment has been made to increase the clinical workforce, increasing the number of substantive Radiologist from three to five with a further two undertaking their CESR qualification (Certificate of Eligibility for Specialist Registration), there are also 3 locum consultants bringing a total establishment to 8.5 whole time equivalent. This is an increase of 3.5 in the last 18 months. In addition to this there is also a Consultant Sonographer and 5 Advance Practice Reporting Radiographers.

Regional Collaboration and infrastructure to address the shortfall A Greater Manchester Imaging Network has been established, and there are several examples of interventions taking place across GM to address the imaging workforce challenges. However, it has been agreed that a regional approach should be taken which has resulted in the three NW Imaging Networks working collaboratively to develop a NW Imaging Workforce Strategy (out for consultation until 12/6/21).

Health Education England NW (HEE) has commissioned a programme of work to support and progress Diagnostic Radiographer (DRAD) workforce planning priorities across the region, through scoping activities and targeted actions/ interventions. This will ultimately provide a North West (NW) imaging workforce framework and strategy. Although the overall approach is regional, each ICS has its own workforce team that will be required to deliver on local workforce priorities.

The NW Imaging Workforce Strategy The strategy focusses on the professions involved in delivering imaging services:
• Radiologists
• Diagnostic Radiographers and Sonographers
• Assistant Practitioner Radiographers
• Radiology Support Workers

Following approval and subsequent adoption of the strategy, a workforce implementation plan for the North West will be developed. This will provide a framework for imaging networks to develop their own workforce plans by offering a range of initiatives/ solutions/ interventions that can be developed and implemented for the imaging workforce in Cheshire & Merseyside (C&M), Greater Manchester

(GM) and Lancashire & South Cumbria (L&SC), taking into account the neighbourhoods and the populations they serve. Greater Manchester Allied Health Professions Workforce Programme The GM Allied Health Professions workforce programme has several interventions that aim to increase the supply, bridge the gap between education and employment and enable the workforce to develop and grow. Therapeutic and diagnostic radiography are priority areas including the following interventions:

• Pre-registration education expansion
• Placement expansion
• Widening participation and workforce diversity
• Careers activity
• Return to Practice
• AHP support workforce
• Apprenticeships (level 2 – 6)
• Reducing Pre-registration Attrition and Improving Retention (RePAIR), including preceptorship
• Leadership
• Better understand and utilise GM AHP workforce data
• Support AHPs to actively engage in GM Cancer programme ❖ Advanced Clinical Practice and consultant roles

Clinical Placement Expansion Programme The University of Salford is currently delivering a HEE funded project (Expansion of PreRegistration Placements for Diagnostic Radiography) to increase student numbers to support the workforce shortages in radiographers. Student numbers are projected to increase by 30 places over the 2019 baseline of 62 over a 3-year period. In addition to under-graduate increases in student numbers UoS is working in collaboration with the clinical collaboration lead for the Radiology Imaging Network to support workforce needs in the future with post-graduate offerings.

Activity to promote Radiography as a career choice Throughout the year several activities take place where Allied Health Professions career are showcased and promoted to our communities in GM. We are committed to prioritising Diagnostic Radiography during career events in 21/22.

Next steps The NW Imaging Workforce Strategy has been informed by engagement with the workforce groups from the three NW ICS, the NW DRAD WAG, HEE, various groups undertaking specific workforce projects and colleagues in other regions.

To support delivery of the strategy, a NW implementation plan for the next 5 years will be developed, which will inform the local implementation plans for the three ICS.

The implementation plan will describe the clear steps we will take to embed and progress the priority areas articulated here. It will importantly contain an approach to

communication and support for ICS to enable each system to build and deliver on the areas of focus critical for their systems.

Actions taken or being taken to prevent reoccurrence across Greater Manchester.

1. Learning to be presented/shared with the Greater Manchester Quality Board. This meeting is attended by commissioners, including commissioners of specialist services, regulators, Healthwatch and NICE.

2. Learning to be shared with the Greater Manchester commissioners of services to consider the findings of the investigation within the context of the services they commission

The Greater Manchester Health and Social Care Partnership (GMHSCP) is committed to improving outcomes for the population of Greater Manchester. In conclusion key learning points and recommendations will be monitored to ensure they are embedded within practice.

I hope this response provides the relevant assurances you require. 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.

Dear Ms Mutch,

Re: Regulation 28 Report to Prevent Future Deaths – Alfred David Jones

Thank you for your Regulation 28 Report (hereafter “report”) dated 30 April 2021 concerning the death of Alfred David Jones on 7 September 2020. Firstly, I would like to express my deep condolences to Mr Jones’s family.

The report concludes Mr Jones’s death was a result of bronchopneumonia in combination with Covid-19 contributed to by falls with vertebral fractures, Type 2 diabetes mellitus, pulmonary fibrosis, heart failure and epilepsy.

Following the inquest you raised concerns in your report that there is a shortage of MRI scanners both in the Trust and the wider NHS. This was compounded by a shortage of radiology staff which the inquest was told is part of a wider issue of a national shortage of qualified radiologists and radiographers. This led to a prolonged admission in hospital whilst awaiting tests and led to him having a fall whilst on the ward and contracting Covid-19 whilst an inpatient.

I am not aware of the precise details of the events prior to Mr Jones’s death, although I can comment that generally, if access to MRI services is experiencing challenges, alternate imaging such as CT scanning can often have an important role in diagnosis and timely condition management. This is particularly applicable for vertebral fractures and may have adequately answered the diagnostic question more rapidly. This alternate imaging option is often required for patients who for example suffer from claustrophobia or have cardiac pacemakers.

From a National perspective, in supporting the ambitions of the NHS Long Term Plan, NHS England & Improvement (NHSE&I) commissioned an independent review of diagnostic services. The recently published report (October 2020), Diagnostics: Recovery and Renewal conducted by also took into account the impact of the Covid-19 pandemic. The recommendations have been accepted by NHSE&I and work has already begun to address the NHS England and NHS Improvement recommendations made, which include an increase in both imaging equipment and imaging workforce in England.

Funding within the 2021/22 spending review has been targeted to support diagnostics via the development of community diagnostic hubs which will in turn augment access for inpatient activity in acute hospital services through the movement of elective activity to community settings. It is anticipated that MRI, CT scanning, Ultrasound and X-ray services will be the core imaging offer for these new centres and will represent new additional imaging capacity.

There is also a recommendation regarding a major expansion of the imaging workforce which is now being developed in tandem with Health Education England (HEE) to augment training numbers for radiographers and radiologists, deliver new Imaging Training Academies and pump prime innovative technologies to deliver more productive and safer imaging services.

The National Imaging Strategy published in November 2019 also sets out the case for the development of Imaging Networks across England and work is now well underway to establish these new operating models to support increased service resilience, quality of care and improved patient access.

Through these measures NHSE&I are supporting the transformation of imaging services for the longer term and in recognition of the vital role diagnostics has in supporting clinical services for patients.

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