As part of the evidence when there is a fall in hospital (and understand that SWICC is now part of Great Western Hospital hence am writing to you): always look at the risk assessments. For ease of reference have enclosed with this letter marked A, copy of the earliest assessment that can on file dated 14 December 2016 in Great Western Hospital format which as you will see in response to the question as to whether or not the patient was admitted due to the fall or has fallen since admission and is at the risk of again the response is "Yes although the ultimate decision was not to engage bed safety rails_ As already stated Francis was transferred to SWICC on 30 January 2017 and have been supplied with a screen dump image marked B showing the two assessments carried out on 30 January and 12 February 2017_ The style is very different to the Great Western Hospital approach and in conjunction with this have regard to a statement from who was the Forest Ward Manager at the relevant time marked C You will see at the bottom of his statement that the reason safety bedrails were not engaged is the fact that Francis did not have a history of falls from bed. have to say that am somewhat concerned and found the questions raised by the SWICC assessment and responses to be contradictory: By way of example will refer you to the assessment that was carried out on 12 February a few days before the fall from bed on 17 February 2017. In response to the question as to whether or not Francis was at risk from falls from bed the answer was Yes and No" In relation to whether or not the patient could injure themselves against the rails due to spasms or uncontrolled movements, the answer was Yes" yet in response to Does the patient have any behaviour that may interfere with the correct use of the safety rails the answer was "No"_ The latter two responses to me contradict each other Francis was noted that he would have been compliant with the use of safety rails have dealt with many cases whereby patients have fallen from their bed or chairs or simply collapsed whilst on the ward resulting in that patient sustaining a head injury from which have died. To me given Francis' immobility and the fact that he was in a condition with lower limb paralysis that was essentially alien to him and which involved involuntary movements am concerned that when assessing the risk as to why safety rails were not engaged in the absence of any mental disorder know this is a concern shared by his widow: To me the risk of knocking a lower limb against one of the rails is outweighed by protecting a patient against the risk a bed and sustaining in particular a serious head injury In reading the SWICC approach it is almost as if the fact that Francis had not had a fall from bed already predetermines that he is not at risk which to me seems a odd way of risk assessment would be grateful if you could please look at the inconsistency that appears to exist between the approach to the use of bedrails on the Forest Ward as compared to the rest of Great Western Hospital as have said the SWICC assessment concerns me that it is overly complicated and as have demonstrated has given rise to conflicting answers as part of the assessment process_ would also be grateful for the Trust's consideration in relation to the policy deployed generally when patients suffer whole or partial paralysis as to whether or not automatically those patients should be subject to bedrails_ appreciate it is not entirely black and white but do find it surprising and am concerned that bedrails were not engaged as at the 17 February 2017 although as already stated and wish to emphasise did not find that the fall contributed to his death