Dear Mr Osborne am writing to set out the Trusts formal response to the Regulation 28: Report to Prevent Future Deaths, dated 15 December 2016. would like to begin by extending our condolences to the family of Mrs McHale_ hope this response provides them and you with assurance that the Trust are taking matter seriously and have an action plan to address the issues_ Although the Trust welcomes your remarks in court which indicate that you have no concerns about the care of Mrs McHale, we also acknowledge the concerns raised with regards to the number of Tissue Viability Nurses (TVN) available within our community health services_ In response to these, a service review has been undertaken. On reviewing the TVN service within the Trust, we can confirm that clear pathways are in place to ensure timely and effective referral to the service and we have increased provision of TVNs available over the past two years. Further to this, the community nurses although are not TVNs, do have ongoing training and monitoring to ensure are skilled in the prevention and early detection of pressure ulcers_ All category 3 and 4 pressure ulcers acquired in our care are thoroughly investigated through root cause analysis and 'Skin Matters panels to review care given and identify if any learning can be taken forward The Trust remains committed to continue to take action to reduce the number of pressure ulcers in the community and we have worked with the CCG, local authority and acute hospitals to support pathways, training and raising awareness CareQuallty Rona Commission "40e Ssttrall Good South Essex Partnership University NHS] NHS Foundatian Trust INVESTORS Gold IN PEOPLE Stonewall WWW SEPTnhs.uk FEB 2017 Sally the the they they bour Mive 1 015484t9

We have informed Bedfordshire CCG, who commissions our TVN service, of the outcome of the inquest: As a result, we are meeting with them shortly to further discuss reviewing the commissioned levels of TVN service in the community. Finally, would like to reiterate my condolences to Mrs McHale's family. hope that this response goes some way to providing assurance that the Trust regards their loss very seriously and has taken significant steps to review the TVN service and care and prevention of pressure ulcers in the community.