Dear Mr Cox Terrance Douglas Thornton deceased Thank you for your letter of 3rd April 2019, addressed to the Chief Executive. Please accept our sincere apologies for delay in responding: In your letter; you raised concerns that work pressures may have contributed to the error that occurred: In relation to the issue raised regarding the Consultant Neuroradiologist we can confirm that he reported and checked a total of 39 scans that afternoon (which was a busy day): There are 5 Consultant Neuroradiologists and on the in question Saturday 16 September 2017, we can confirm that the neuroradiology rota was covered as planned by a consultant and a registrar. Subsequent to the incident; the Consultant Neuroradiologist submitted the case for review at the departmental audit meeting: It was also discussed at the departmental discrepancy meeting on 2 November and it was noted that whilst the findings on the CT head were subtle, the use of multi-planar reformatting (looking at it from different angles) and selected windows (reviewing image on different settings) would have improved chances of identifying the subtle subdural haematoma The lessons from the investigation have been shared with the Radiology team: You also raised concerns about the shortages of radiology clinicians where you recognised that there are difficulties nationally but you are concerned that the problems at Derriford and the very day the the

appear to be worsening with the consequent risk that similar fatalities may occur in the future. You were informed at the inquest at that time University Hospitals Plymouth NHS Trust had 6 consultant vacancies (out of an establishment of 44 consultants): Although one of those vacancies was for a Neuroradiologist; it was not a contributory factor to the incident We can clarify that the 6 vacancies referred to were new posts and the department is planning to increase its establishment by a further 4 posts this year: When we benchmark ourselves against other similar Trusts we compare favourably with the number of radiologists in post and we are planning to further increase our establishment; As part of the organisations business planning process we review the estimated demand against our capacity to ensure that we have the correct number of radiologists_ The level of radiology vacancies at University Hospitals Plymouth NHS Trust UHP is fewer than many other Trusts in England. Nationally 6 in 10 Consultant Radiologist vacancies remain unfilled for 12 months or more: (Source: Royal College of Radiologists UK workforce census 2018) hope the above serves to provide assurance around the actions we are taking in respect of the problems that you have raised. Please feel free to in touch, if further information is required. With best wishes_