Dear Mr Thomas Re: Stephen Mark Amer (Deceased) Thank you for your letter oJ the 2s July 20'14, issued under Regulation 2g (paragrapn 7(1 ) of schedule 5 of the coroner and Justice Act 2009, followr:ng the inqulst into the death of Mr Stephen Amer. I have had the opportunity to discuss the tragic death of this genfleman and the important observations and recommendations you have raised in your letter with the Director of the Health & Community Services dLpartment. During the inquest, referred to a new protocol which was being developed with our hearth partners. we entirery agree with your recommendation that consent arrangements should be included to aliow patient information to be shareo with social care services (your first bullet point on page 2 of your letter). Hertfordshire County Council recognises the value of this recommendation which will also support and promote.the appropriate exchange of information "a *" .ou" towards further integration of health and.social care servicEs and the n"* ,""ponribiliiies set out ,I th9 C{9 Act (2014). We wiil devetop and introduce a consent form by the 20 October 2014. we also understand that where there is a change of pran, in this case, refrecting tne clearly expressed view of Mrs Amer that sne wiineo to return to her home, that the change of pran is given to the relevant person, in jarticular the ""r"r. | ,"ibi io yo* :::gid bullet point on.page 2 of your tetter and In the light ot tnis tragic c;se, ine department has issued a practice instruction to sociar cire starto ciEale oiirpoate a separate carer's assessment. This must consider the impact of the decision on the carer and set out in oeta]] tr9 support they wirr require to continue canng-ri-init i. tn"i, wish' The assessment must arso. addresi continjency plans if for any reason they oecome unable to care for the vulnerable p"r.onl rh6 bounty counir riilrs*nare tnis new requirement with hearth.coileagues and request that they foilow tne same practce when they arrange hospital discharles ot vutneiaote patients or carers outside of social care referral arrangements. www. hertsdirect.org

The method of communication must indeed be considered carefully (your third recommendation). Whilst carers and relatives may choose not to take up the opportunity of a face to face meeting to discuss discharge arrangements, this remains the preferred and most effective method of communicating care arrangements. This arrangement provides a better opportunity to discuss and clarify every aspect of care and any associated concerns. lt is recognised that mounting pressure on NHS hospital beds can result in very limited notice of discharge. We will share your conclusions with local hospital trusts in an effort to ensure that they allow sufficient time to discuss discharges with relatives / carers face to face. I would like to thank you for your recommendations which we formally accept. We will introduce the revised arrangements outlined above and will share these with our health partners within Hertfordshire. We will also take the opportunity to share your observations and recommendations more widely with other local authorities through the network of practice development meetings organised by the Association of Directors of Adult Social Services. Yours sincerely John Wood Chief Executive & Director - Environment

CORONER'S OFFICE AREA OF HERTFORDSHIRE The Old Courthouse, St Albans Road East, Hatfield, Hertfordshire' AL10 oES DX: 100702 Hatfield Tel: Ol 707 292780 F a><: 01 707 897399 E-mail:coroner.service@hertfordshire.gov.uk MR EDWARD THOMAS Senior Coroner MR GRAHAM DANBURY Deputy Coroner Dr FRANCES CRANFIELD, ALISON GRIEF, EDWARD SOLOMONS ASSiStANt COTONETS 19 August 2014 Mr John Wood Chief Executive & Director - Environment CH 0238 County Hall Hertford SG13 8DE Your Ref: JWMGB/1651 HCS OurRef: 00229-2014 Dear Mr Wood, Re: Stephen Mark AMER, deceased Dear Mr Wood Thank you very much indeed for your letter of the 2/h July and for your prompt response to my Regulaiion 28 iefter. I have circuiated copies to the Interested Persons according to my list. Kind regards