Dear Ms Lake write further to Ihe report dated 5 August 2014 that you issued following your inquest into the death of Mr John Wilsher in December 2013. We have reviewed your report carefully and can respond particularly to your concern number ie that Ihe discharge letter from this hospital contained inaccurate information. A review of incidents relating to discharge from hospital trusts was published by NHS England in August 2014. In fact; a stream of work concerning this was already underway within the Trust, led by one of our Associate Medical Directors and involving a number of stakeholder parties, including GPs, consultants, junior doctors etc_ The outcome of that work was presented to our Executive Board at the beginning of September and a series of steps are put in place to improve the accuracy of discharge information provided to GPs and community services_ The aim of these changes is to ensure speedier completion of electronic discharge letters, a more 'rounded' picture of the patient and improved continuity of care The steps taken may be summarised as follows: Revision of the template discharge letter, to make this easier to complete and give prominence to the most important information; Creation of an additional bespoke template letter for patients of our Older People's Medicine Department (such as Mr Wilsher) , with fields specific to the issues affecting this group of patients; Revision of the prompts guiding clinicians when completing these letters, to ensure all relevant information is included; Changes to the training programme associated with use of the templates We will continue to monitor the effect of the changes outlined above and whelher any further steps are necessary to promote the safe transfer of care between hospital and community. The Trust sees up to a million patients a year and we recognise the importance of good communication between healthcare providers; Your concerns have been raised with the junior doctor who wrote the discharge letter, to ensure that he is fully aware of the implications of inaccurate information provided. hope that this information provides you with the assurance you need but if it would be helpful to discuss please let us know.

Dear Madam Re: John Henry Wilsher deceased refer to your report dated 5 August 2014 and should be grateful if you would accept this letter as the response on behalf of Norfolk County Council Community Services. confirm that the importance of giving appropriate feedback to the person who raised: the safeguarding concern ("the referrer' has been acknowledged and it is agreed that this should be an integral part of the safeguarding process. The Multi-Agency Safeguarding Hub MASH") and the safeguarding manager within Norfolk Council have been working with colleagues to ensure this action is embedded in the safeguarding process_ This will ensure a more outcome focussed safeguarding process This will also enable the referrer t0 be clear when the council has assessed an issue not to fall within the safeguarding arena In practice this will mean that if similar situation were to arise in the future the feedback given to the referrer will enable the referrer to raise their concerns directly with the residential home_ Norfolk County Council Community Services continues to work closely with the Norfolk & Norwich Community Hospital to ensure safe discharges are made: There are social care practitioners linked to those Wards which care for older people who, if requested, are available to support any health staff who are directly in contact with residential home managers and staff.

2014 LIZSOR [ LQOI'L ~ulh '267;} Fax: 15G07) ; . Our

trust this deals with your concerns but if there is anything else can assist with then please do not hesitate to contact me_