_ heard evidence at inquest from and also had sight of a statement fromt of Hampshire police that he attended RHCH at 05.55 after pital staff contacted police to report the sudden death of Mr The officer queried with the sister in charge_ why there had been such a delay (over 4 hours since death) in notifying police about the death: The officer was told that there had been some confusion about the correct procedure t0 contact police. It was known that Mr Berry was a heroin user and it had been suspected that he had consumed heroin prior t his death It was noted that there were two small puncture wounds on Mr Berry's right forearm only one of which was caused by ambulance staff during treatment: confirmed that hospital staff did not have the details of Ihe address where Mr Berry was found so this necessitated having t0 make further enquiries to try and locate the ambulance staff_ Imanaged to locate an ambulance technician_ who was part of the second ambulance crew to arrive at but the first attender had by then gone off duty: was also told that when SCAS control room was contacted for the exact details, police were told that a private ambulance attended_ PC Headen attended at 06*45 but it again took some time to discover the exact address as the building is multi-occupancy: It was therefore some 6 hours+ after death was confirmed that the officers were able to locate and speak t0 the occupants of the flat who found Mr On the evidence heard, it seemed clear that the occupants were themselves under the influence of drugs. My concerns are: Hospital staff did not contact police in what appeared to be a suspicious and unnatural death for several hours Further, was told there appeared to be confusion about the correct procedure with regards to notifying police: This suggests a possible need to revisit who, when and how hospital staff contact the police both before and after death in appropriate cases_
2. Although was not shown the handover paperwork from the ambulance technicians to hospital staff;, the lack of basic detail such as the address where Mr Berry was found may mean that handover procedures should be revisited especially if there is private ambulance service involved.
3. Finally, the lack of an address may require further consideration of how basic but potentially important data is conveyed to SCAS control room from a private ambulance service especially before staff go off duty and thereby avoiding delay: