Dear Mr Haig, Re: Peter Jonathan WRIGHT (Deceased) Thank you for letter dated March 2015, reporting concerns to US, in accordance with Regulations 28 and 29 of the Coroner's (Investigations) Regulations 2013. Following discussions within the Mental Health Division , (Medical Director) and (Director of Nursing & Chief Operating Officer) , am now in a position to respond to your specific concerns as outlined below: At the time of the death the ward was understaffed. Of the quota staff of three, one care assistant had called to assist in another ward (and had in fact just retured) and one care assistant was with another patient who required continuous observation: This left just the qualified nurse to deal with 16 patients. She did not record all necessary observations and was doing a drugs round by herself (contrary to policy) . This was recognised in the SIR carried out by] but no recommendation was made about it on the basis that the Trust was undergoing a major staffing review in any event: It may therefore be that the situation has already been addressed but this was not clear t0 me at the Inquest and the impression received from the nurse was that there is now some extra support at times but it is still not satisfactory. The Trust undertakes nurse staffing establishment reviews for each of our in-patient ward areas on at least a six-monthly basis. In undertaking these reviews, the Trust uses: quality metrics (such as clinical incidents , patient experience information, complaints and workforce data such as sickness, vacancy rates and turnover) and data taken from an evidence based workload calculator tool, in combination with professional judgement arising from their clinical experience regarding staffing levels Once the review has been undertaken, the team's recommendations are published and reviewed by the Trust Board regarding the most effective level of nurse staffing establishment required to meet the needs of our patients. During the last review which was presented at Trust Board in December 2014, there were additional investments made to the nursing establishments on a number of our wards. For 2015/16 Brocton Ward staffing establishment is 4/4/3 (with two registered nurses on duty at all times) . This is the minimum level which can be expected on the ward

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South Staffordshire and Shropshire Healthcare NHS] NHS Foundation Trust A Keele University Teaching Trust with additional staff being deployed to meet any increased acuity. There are also non- nursing clinical staff who will be present on the ward undertaking other duties examples will include medical and allied health professionals providing therapeutic interventions 2_ At the time of this incident there was still a 24 hour Emergency Department at the nearby Stafford Hospital and at St George 's Hospital there was no doctor on site. Now the Emergency Department at County (formerly Stafford) Hospital is not open the night and the nearest ED is at Stoke was told that the situation can be managed by calling paramedics. While appreciate that nearly all the doctors at St George 's are psychiatrists not medics wonder if any consideration has been given to out of hours cover by a doctor The Trust does not have resident doctors on call but operates a non-resident out of hour's rota to comply with European Working Time Directive The psychiatrists on call out of hours at St George's Hospital are all qualified doctors. The most immediate tier of the rota involves doctors in training (Core Trainees in Psychiatry) who operate a non-resident rota but Who in reality are often on site and are supported by middle grade and consultant staff. Our medical and nursing staff are all trained in basic life support as part of mandatory training and some have intermediate and advanced skills_ Every clinical and non-clinical area has first aid in place and wards are stocked with equipment for managing common emergencies We do however recognise that more sophisticated medical equipment and support may be required at and in the case of a medical emergency we expect staff to call 999 without delay, as this is what people in the community would do in similar circumstances On occasions when a medical emergency occurs we call 999 without delay, and staff are instructed to provide basic life support until paramedics arrive. The closure of A&E at County Hospital will inevitably mean that patients from this area will travel further than before in order to reach A&E but the stabilising treatment on site and prior to transfer is important; and paramedics are best placed to provide this. Our experience is that response times have been satisfactory. this response helps to address your concerns. However if you require any further information please do not hesitate to contact me