ETNon 2013/0080195ETPO FOR Edward Timpson MP Parliamentary Under Secretary of State for Children and Families Sanctuary Buildings 20 Great Smith Street Westminster London SWIP 3BT tel: 0370 000 2288 WWW. education gov uklhelplcontactus John S Pollard Senior Coroner The Coroner's Court Mount Tabor; Mottram Street Stockport SK1 3PA Your ref: JSPIKA/02333-2012 14 January 2014 Jak, Thank you for your letter of 11 December; addressed to the Secretary of State, enclosing a Regulation 28 Report to Prevent Future Deaths, in relation to the inquest examining the death of Millie Thompson: am replying as the minister responsible for this policy area. Millie Thompson's death, while in the care of Ramillies Nursery in Cheadle Hulme, was a tragedy: note that amongst your concerns about this case that you take the view that all staff working in nurseries should be subject to mandatory paediatric first aid training: The safety of children whilst being cared for by others is of paramount importance and staff with paediatric first aid training should always be available Paediatric first aid training is, and will remain, a statutory requirement for all eariy years providers regulated under the Childcare Act 2006. The requirements for early years providers, including nurseries, are set out in the Statutory Framework for the Early Years Foundation Stage (EYFS): At least one person who a current paediatric first aid certificate must be on the premises at all times when children are present; and must accompany children on outings. In July 2013 we published plans to further improve the quality and availability of childcare. In tandem with this publication, the Government launched a public consultation, The Regulation of Childcare" , which ran 16 July to 30 September 2013. The consultation sought views on proposals to amend the current childcare regulatory system and set out the measures needed to ensure children's safety. As part of that; we proposed to reinforce the need that a first-aid trained member of staff must be available at all times. 8 Ation 'ARTMENT EDUCE has from

We also proposed to say more in the EYFS about the specific content of suitable courses: We expect to be able to publish the results of the consultation shortly during February 2014 and make any changes needed later this year Yw sinu-} QLd _ Edward Timpson MP Parliamentary Under Secretary of State for Children and Families

Dear Mr Pollard MILLIE THOMPSON (DECEASED) We write further to your letter of 11 December 2013,enclosing a Regulation 28 Report to Prevent Future Deaths in relation to the inquest examining the death of Millie Thompson: Please accept this as our response in accordance with Regulation 29(4). We note that you raise concerns regarding the: selection and training of Emergency Medical Dispatchers (EMDs); and paediatric life saving equipment carried by emergency ambulances. EMDs North West Ambulance Service (NWAS) is acutely aware of the importance of EMDs in relation to the care of patients_ We have robust, competitive recruitment process for EMDs, attracting approximately 300 applications for each vacant post_ We continually review this recruitment and assessment process with the aim of ensuring only the most suitable and able candidates are appointed for this demanding and important role All EMDs undergo a six week training course, covering policies and procedures, the call taking processes, first aid, including paediatric resuscitation, and use of the Advanced Medical Priority Dispatch System (AMPDSI, which includes the ineffective breathing diagnostic tool: Successful completion of the course results in an internationally recognised qualification. In order to maintain their certification, EMDs must provide proof of continuing education and evidence of audit review, which provides safeguard to ensuring their continuing competence in the role: are also required to undergo CPR recertification every two years. 'adquarters: Ladybridge Hall, 399 Chorley New Road, Bolton. BL1 SDD Iairman: Mrs M Whyham MBE AAVLSTS ief Executive: Mr B Williams INT'FOPIE LlampIOn W Delivering the right care, at the right time, in the right place They JovI _

From the Rt Hon Jeremy Hunt MP Secretary of State for Health Department of Health Richmond House 79 WVhitehall POCI_829927 London SWIA 2NS Mr John Pollard Tel: 020 7210 3000 Senior Coroner Mb-sofs@dhgsi-gov.uk Coroner'$ Court Mount Tabor Mottram Street h FK; 2016 Stockport SKI 3PA Je A.e.Ile4, Thank you for your letter following the inguest into the death of Millie Thompson: In your report you state that Millie died choking: Millie was fed Shepherds Pie for lunch at the Ramillies nursery and started to choke; She inhaled some of the food which eventually lodged in her left main bronchus_ This led to a tension pneumothorax leading to cardiac arrest which was the underlying cause ofher death; When the call was made to the ambulance service it was wrongly assessed by the call taker meaning that a rapid response vehicle was not despatched, The call taker for the ambulance trust misinterpreted the information relating to effectivelineffective breathing and the case was wrongly allocated. When the ambulance arrived, the oxygen mask that was carried on the vehicle did not properly fit a very young child and so a second ambulance crew had to be called. You raise the following matters of concern and ask that we consider: Only = few of the nursery staff had undergone Paediatric first aid training: You feel it should be mandatory for all nursery staff to take paediatric first aid training; There should be better selection and training of call taking staff at the ambulance trust; All emergency ambulances should be equipped with suitable paediatric life- kit; from being ` saving

Inote that you have sent a copy of this_ Regulation 28 report to the Department for Education (DfE) and the North West Ambulance Service Trust (NWAS) The training ofnursery staff is the responsibility ofDfE whilst the selection and training of call taking staffat the NWAS is a matter for the NWAS Trust: I believe that these two issues should properly be addressed by the DfE and the NWAS. With regard to equipping emergency ambulances with suitable paediatric life- saving kit; this is the responsibility of the individual Ambulance Trust: Officials have however; discussed this issue with colleagues at NWAS and can report that locally, all their emergency response vehicles, both ambulances and response vehicles, are equipped with a range of paediatric emergency equipment as follows: Paediatric oropharyngeal airways Paediatirc Nasopharyngeal airways Layngeal masks Paediatric sized oxygen delivery masks Neonatal and paediatric bag-valve-mask devices for artificial ventilation Paediatric defibrillation Paediatric sized endotracheal tubes Paediatric laryngoscopes Cook IO needles for intra-osseous access (drug/fluid administration) All of the above equipment may be used in the resuscitation of paediatric patients. In addition; we will share this Regulation 28 report, our response and the NWAS response with the Association of Ambulance Chief Executives s0 can consider whether any further action 01 guidance is needed with regard to the equipping of emergency vehicles nationally. I that this response is helpful and am grateful to you for bringing the circumstances of Millie'$ death to my attention. L #1l JEREMY HUNT rapid pads they hope