Gloucestershire

Noted (AI summary) The Trust acknowledges bed availability challenges and mentions ongoing work to improve bed management and reduce out-of-area placements. They plan to prioritise inpatient strategy development with the Integrated Care Board and ensure adequate access to inpatient care is acknowledged through the Contract Management Board. The DHSC acknowledges the concerns, notes actions ICBs are required to take, refers to funding and initiatives to support mental health crisis care, and describes broader government commitments to suicide prevention.

Noted (AI summary) NICE is working collaboratively with the MHRA on the issues raised and will provide a further response once that work has concluded; the outcome will inform any action NICE may need to take in respect of its recommendations. The MHRA outlined existing warnings and guidelines related to SSRIs and suicidal behavior, referencing NICE guidance, and added the adverse reaction report to the Yellow Card database. The Royal College of GPs provides general comments on GP curriculum, shared decision making, NICE guidance and its Mental Health toolkit, but notes no specific changes it will make.

Noted (AI summary) The British Diving Safety Group (BDSG) highlights its existing efforts to promote awareness of Immersion Pulmonary Oedema (IPO) through training materials, safety documentation, and collaboration with various organizations. They do not believe a 'fitness to dive' medical certificate is required. The UKDMC continues research into IPO and publish findings, educate medical referees via Google-group and conferences, provide information directly to diving organisations and articles are published on the UKDMC website and in magazines for divers, provide lectures at conferences for amateur divers, work with the British Diving Safety Group, spoken to the Royal College of Pathologists and provide guidance on fitness to dive. The new operators of the Diving Centre, Deep Training Services Limited (DTSL), are implementing a requirement for safety boat capability to be available during all diving activities to assist with diver removal from the water.

Noted (AI summary) Network Rail states that instructions *are* provided to signallers, and closing the crossing would require agreement from the authorised user, for which compensation has been offered. They have also contacted the public rights of way officer at Gloucestershire County Council to consider the feasibility of extinguishing or diverting the bridleway.

Noted (AI summary) The Trust acknowledges receipt of the coroner's letter and confirms that the Trust now works under different systems than in 2008 with processes to arrange follow-up appointments; they have no further submissions to assist the coroner.

Noted (AI summary) The CQC is gathering evidence into this matter with a view to deciding whether there has been a failure by BUPA and/or the Registered Manager to comply with the Health and Social Care Act 2008 and will contact BUPA to request a copy of their response to the prevention future death report.