Dear Mr Gittins Re: Regulation 28 Response re Mr: Daniel Watson write in response to the Regulation 28 issued on 18th December 2017 as a result of the Inquest into the death of Mr. Daniel Watson. In relation to your first matter of concern in that the Concerns Root Cause Analysis Investigation undertaken by BCUHB revealed multitude of care and delivery problems which cumulatively represented missed opportunities to improve the Deceased s mental health. As you are aware an action plan has been produced to improve on the service delivery and this has been provided to you: In relation to evidence given at the Inquest by the Community Psychiatric Nurse (CPN), I can confirm that the CPN was provided with an initial debriefing session to reflect on the delivery of evidence provided at the Inquest: Further debriefing and ongoing supervision will provide the opportunity for the CPN to optimise learning and provide focus on their understanding and empathy for their continued professional development; which will be incorporated into their appraisal _ An initial focused session for the wider team's learning will be held around awareness of empathy towards families and transparency to the Coroner at Inquest In relation to your second area of concern relating to a significant improvement in the training of staff within the CMHT in relation to their understanding of risk assessment and potential escalation of concerns to a formal Psychiatric Assessment: The Wales Applied Risk Research Network (WARRN) Asking Difficult Questions and Formulating Risk (WARRN ADQ) is National Programme of training; endorsed by Welsh Government; in the assessment; formulation and management of risk to self or others. One of the main aims of WARRN is to drive forward a standardised and consistent approach to risk assessment and formulation nationally, across services_ The MHLD Division will continue to make available the WARRN Accredited Programme for Care Coordinators and new training dates have been confirmed for 2018 to be delivered through our group of specialised trainers_ A copy of the training dates is attached. can also confirm the CPN has previously received WARRN training in 2012. Cyfeiriad Gohebiaeth ar y Cadeirydd a'r Prif Weithredwr Correspondence address for Chairman and Chief Executive: Swyddfa'r Gweithredwyr Executives' Office Ysbyty Gwynedd, Penrhosgarnedd Bangor; Gwynedd LLS7 2PW Gwefan: WWW pbc cymru.nhs.uk Web: wwWbcu.wales nhs.uk gyfer

GIG Bwrdd lechyd Prifysgol CYMRU Betsi Cadwaladr NHS University Health Board W AL ES can also confirm that the MHLD Division will have updated the MHLD Supervision Guidance for Nurses and Support Workers Policy by the end of February 2018 to ensure staff can discuss and reflect on cases in a structured and facilitated process. A copy of the draft MHLD Supervision Guidance for Nurses and Support Workers Policy is attached_ Assurance regarding compliance with appraisals and training is provided to the Senior Management Team on monthly basis through the network teams performance report: Additionally, the MHLD Division has committed to undertaking a bi annual audit of Care and Treatment Plans using the Welsh Government recommended audit tool (see attached) which will be reviewed biannually within the divisions Quality and Safety Group and reported within our annual report on the local delivery of 'Together for Mental Health'.

Dear Mr Gittins Re: Report for theprevention of future deaths Inquest of Daniel Scott Watson Thank you for your letter of 15th December 2017 regarding the Regulation 28 Report: The response of Wrexham Adult Social Care is as follows - Wrexham Adult Social Care accepts the recommendations highlighted in the Regulation 28 Report: The Department has discussed this matter with its partner agency, Betsi Cadwaladr University Health Board, with which it jointly provides the Community Mental Health Team Service With respect to the evidence given at the inquest by the Social Worker involved showing lack of understanding of issues and a lack of empathy, the member of staff concerned is to be given feedback and management supervision: The Mental Health and Learning Disability Supervision Guidance for Nurses and Support Workers Policy is being implemented by the BCU to improve discussion and reflection on cases in a structured and facilitated process and will apply also to social workers employed by Adult Social Care in the integrated team: A copy of this policy will be submitted by the BCU in its response_ With respect to the issue of significant improvement in training of staff in Community Mental Health regarding risk assessment and escalation of concerns towards a formal psychiatric assessment; the Mental Health Learning Disability Division uses the Wales Applied Risk Research Network (WARRN) Asking Difficult Questions and Forumlating Risk training programme. This is intended to provide a consistent and standard approach to risk assessment, New training has been confirmed for 2018 and the staff that provided care to Mr Watson have been booked onto the training: In addition the MHLD Division will supplement the WARRN training with specific training on assessment of suicide. Adult Social Care Social Workers within the integrated CMHT service will be included within these training programmes: continuedl . Rydym yn croesawu gohebiaeth yn Gymraeg- Byddwn yn ymateb unrhyw ohebiaeth yn Gymraeg ac ni fydd hyn yn arwain at unrhyw oedi. We welcome correspondence in Welsh: We will respond t0 any correspondence in Welsh and this will not lead t0 any delay:

L..continued 2 trust that you will find this response satsifactory. Please contact me if you have any fruther queries