Dear Sir I refer to your letter dated 24 November 2014 regarding William Walton Jackson understand that your concerns relate to the 'Itcording/ 02/ cOaltoniCacioon bebecensede the Cardiothoracic Specialist Registrar at Freeman Hospital and staff at Cumberland Infirary. understand that the Cumberland Infirmary Accident & Emergency Department records do Fot indicate the exact time that the request for advice Wes made to the Specialist Registrar at Freeman Hospital. The Registrar on the night shift Idoes not recollect the patient but advises it is his usual practice to review diagnostic scanslimages if are available before offering an opinion. It is documented that Mr Jackson arrived at the Accident & Emergency Department at 13.30 hours. The arrival time and the of the CT scan undertaken at Cumberland Infirmary does serve to suggest it is most likely that an opinion was sought the shift, this period the Specialist Registrar was & locum; and it has not been possible to make contact with him. It has therefore not been possible to confirm if he gave the advice O indeed whether or not he viewed the scans himself before he provided that advice. It is however usual practice throughout Cardiothoracic Surgery to review the scans themselves, if available; before providing advice in such cases Scans sent from other hospitals are received via the Radiology Picture Archiving and Communication System (a computerised digital infrastructure), but only remain on the system for & finite period unless & request is made to be permanently archived, A record of receipt of the scans is created automatically on the system; however this original record is over written by the system if a subsequent request is made, as occurred in this case; It is therefore not possible to confirm whether or not the scans had been received at the Freeman Hospital at the time the opinion was provided In response to the Regulation 28 letter and as part of ongoing quality improvements the Regional Cardiothoracic Centre at the Freeman Hospital has addressed the following actions: Kingsley W: Smith OBE, Chairman Sir Leonard Fenwick CBE, Chief Executive the they timing during day During

Actions already taken: An electronic system is now in place within Cardiothoracic to record details of advice given when medical opinion is sought by healthcare professional in another hospital The Cardiothoracic Surgical Team is fully aware of the need to ensure consistency when this system on receiving requests for & medical opinion from outside of the Trust and where there is no opportunity to make a documented statement in the medical record (ii) Further planned actions: The importance of the electronic system to record the details of opinions sought, information available 0 the system been be included in the induction programme of newly recruited staff including trainees who are 0n rotation other parts of the NHS. The current system is further developed throughout the Newcastle Hospitals to prompt recording of items including information regarding radiological images viewed at the time of providing an opinion. I do this commitment and set of actions taken shall provide the assurances sought Please do not hesitate to contact me if you require any clarification.