Dear Miss Hamilton-Deeley The late Mrs Janet Willcock Following receipt of your Regulation 28 report of 9 April 2021, your concerns have been discussed at the Trust's Mortality Review meeting and by Trust Directors and Executives. Sadly, Mrs Willcock died of a stroke in November 2020, which was a recognised complication of necessary surgery - itself a consequence of her emergency admission in October 2020. Our thoughts are with Mrs Willcock's family. We acknowledge that there is no evidence in Mrs Willcock's clinical records of her heart being auscultated when she attended the hospital during August 2020. However, we agree with you that this did not change the outcome for Mrs Willcock, who died of a documented complication that could not have been influenced by any earlier intervention. We do not believe that there are issues with the Trust's systems or processes in relation to cardiac examination - and specifically auscultation. Clinical training and experience determine the examinations and investigations that are undertaken in all our patients; whether or not the heart is examined in a particular patient is always an individual clinical judgement, determined in real time by the specific clinical presentation. For example, we would not expect an Anaesthetic clinician working in a Day Surgery department to examine the cardiovascular system when carrying out a procedure under local anaesthetic. However, having personally reviewed Mrs Willcock's clinical records and in discussion with our Emergency Department Governance Lead, I have recommended that Mrs Willcock's

case is presented at the next Governance Meeting, to ensure learning and to highlight the importance of auscultation in all patients presenting, like Mrs Willcock with unexplained syncope. Furthermore, if a clinical decision is taken not to auscultate, the rationale should be documented in the records. There will be an audit of the Emergency Department documentation to ensure standards are to the level expected. Once again, our thoughts are with Mrs Willcock's family and we would be happy to meet with them should they wish.