Dear Mr Haigh, RE: Maureen Margaret (known as Mandy) Jarvis Thank You for your letter dated 11lh September 2019, reporting a matter to US, in accordance with Regulations 28 and 29 of the Coroner's (Investigations) Regulations 2013 May | take this opportunity to reassure you that following Mrs Jarvis' death, we undertook a thorough investigation into the care delivered by the Trust_ Following discussions both within the mental health Services in the Staffordshire and Stoke Care Group and across wider Trust, am now in a position to respond to your specific concerns, raised by you during the course of the evidence you heard at the inquest Area of concern; during her final admission to the George Bryan Centre Mrs Jarvis did not have & proper medical examination by a doctor: The reasons given for this were that she would not consent and that her condition never warranted this done on a non- consensual basis_Among other witnesses heard helpful evidence from the Consultant Psychiatrist who indicated that this was a difficult area and also (Ehe Iead author of the Serious Incident Review) who believed there was a policy about physical health examination of admitted psychiatric patients and this should be disseminated to all staff involved: In response we can confirm that a policy and Standard Operating Process (SOP) existed at the time of Mrs Jarvis's death. These outline the responsibilities and expectations of inpatient staff to undertake physical health investigations on admission and also the expectation in the circumstance of refusal to consent to continue to attempt during the MPFT the being from

MHS Midlands Partnership NHS Foundation Trust A Keele University Teaching Trust admission. These documents are currently due for review as part of the continuous improvement and ratification cycle. Following changes in recording of investigations in our electronic health record system further guidance was developed to sit alongside these SOP's. can confirm that these documents have been circulated to all the staff on our mental health inpatient wards and are referenced in new inpatient staff local inductions_ In addition several actions have been completed to further enhance the physical health care of our patients admitted to our mental health units. These include: The ward staff on Milford Unit (previously the George Bryan Centre West Wing) have undertaken bespoke training in order to further develop their knowledge and understanding of common physical health difficulties. An electronic dashboard has been developed to provide an "at a glance" view of whether key physical health assessments and investigations have been completed and recorded on the electronic health record in the appropriate form: This is utilised in clinical discussions on the ward as a live audit tool: The ward has secured regular input from an Advanced Nurse Practitioner to specifically to support the physical health needs and monitoring of patients on the ward. Ward staff reminded to record consent andlor lack of capacity to consent to a physical health assessment within RiO and if either lacking preventing assessment to regularly revisit and record attempts_ Dissemination of the Physical Health Policy and SOP as part of the junior doctors induction Please find enclosed a copy of the full action plan developed as a result of the investigation: hope this response helps to address your concerns: However; if you require any further information please do not hesitate to contact me