From Ben Gummer MP Parliamentary Under Secretary of Stale for Care Quality Department Richmond House of Health 79 Whitehall London POCS 946053 SWIA 2NS Tel: 020 7210 4850 Mr A_ Walker Senior Coroner North London Coroner' s Court 29 Wood Street Barnet ENS 4BE H Ulu Thank you for your letter of 30mh July 2015 following the inquest into the death of Anthony Dwyer: Iwas very sOrry to hear of Mr Dwyer's death and wish to extend my sincere condolences to his family. Iunderstand Mr Dwyer was a term tracheostomy patient who had complex multiple medical needs. He removed his tracheostomy tube which subsequently led to collapse and cardiac arrest: You are concerned that there is inadequate guidance for Trusts about the general management of term tracheostomy patients with complex medical needs. Guidance in this area is the responsibility of the patient safety team at NHS England: The advice I have received is that adequate guidance is already available for staff caring for patients with a tracheostomy: Firstly, the UK National Tracheostomy Safety Project (NTSP) has developed a range of resources to improve care for patients with a tracheostomy which can be found at: http:/ Lwww tracheostomy Org ukl The NTSP Manual (2013) was developed in collaboration with stakeholders, including the Intensive Care Society, the Royal College of Anaesthetists, the College of Emergency Medicine; the Resuscitation Council UK and the Royal College of Nursing: It covers all aspects of tracheostomy management including guidance on observing patients with a tracheostomy: It states: long long ` key

as a general rule the patient should be nursed in an open observation area, rather than a side room (unless continuous 1:1 staffing is provided). Discussion with infection control teams should take place aS close observation for airway compromise is likely to take priority over use of a side room for infection control purposes_ The Manual is supplemented with e-learning modules and videos. Further resources include the report, Tracheostomy Care: On the Right Trach? published by The National Confidential Enquiry into Patient Outcome and Death (NCEPOD), which is available at: httpILwww ncepod org uk/20L4tc This report was published with a self-assessment checklist for trusts, allowing the monitoring of progress in adopting NCEPODs recommendations. The Intensive Care Society (ICS) has issued updated standards and guidelines on tracheostomy care: http:ILwww ics ac uklics-homepagelguidelines-and-standardsl Finally, the Global Tracheostomy Collaborative; an initiative launched in the UK, aims to improve tracheostomy care through international collaboration including benchmarking the quality of care. Further details can be found at: http:ILwwwglobaltrach org NHS England will continue to work with stakeholders to identify and act on tracheostomy issuesy They will also work with Dr Brendan McGrath; the National Tracheostomy Lead/Clinician, who was recently nominated for the role of National Clinical Advisor tqNHS England. S BEN GUMMER htm