Manchester North

Noted (AI summary) NHS England is working with the Resuscitation Council UK (RSUK) to design an updated Neonatal Life Support (NLS) course including homebirth scenarios, and funding is provided for practitioners to have this training. They will work with the UK Midwifery Study System (UKMIDSS) to improve national data collection. NICE will review existing guidance to consider the feasibility of defining 'high' and 'low' risk pregnancies, and clarify differentiation between risks of pregnancy and labour. They reference existing NICE guidelines covering intrapartum care and midwifery staffing. The RCOG expresses condolences and defers to other organisations (RCM/NMC and NHSE/DHSC) to address the specific concerns raised regarding national guidance, training, data collection and staffing models for home births, while referencing existing NICE guidance. The RCM states it will advocate for national guidance on when transfer to hospital is necessary, promote existing guidance and resources, and will continue to advocate for sustained investment in maternity staffing to support safe services. The Nursing and Midwifery Council (NMC) will strengthen midwifery standards, specifically mapping proficiencies against previous maternity reviews. They propose to feed into a task force addressing bespoke training needs analysis for midwives in home birth teams. The Department of Health and Social Care acknowledges the need for urgent action to improve homebirth services and will work with NHS England to address the coroner's concerns. This includes funding a new neonatal resuscitation training programme with homebirth scenarios. The JRCALC guidelines have been amended to clarify that if bleeding persists despite a firm uterus after birth, other causes such as trauma should be reconsidered. The guidance also specifies continuous observations form part of ongoing management.

Noted (AI summary) The RCRP Strategic Partnership Board acknowledges the concerns and explains that Right Care: Right Person (RC:RP) is an internal process for directing calls to the most appropriate service. They state that they will discuss call transfer and external communications with partner agencies. The Deputy Mayor will further consider with relevant agencies the options that will best meet the needs of the public, recognising that NWAS would not have powers of entry and would have to call GMFRS in the described scenario. They wish to take the time to consider the various options that will best meet the needs of the public. The College of Policing explains that Right Care Right Person (RCRP) focuses on internal triage processes between agencies, not on directing the public to specific services when calling for emergency assistance. They state they will continue to monitor emerging themes and risks with partner agencies.

Noted (AI summary) NWAS acknowledges ineffective communication between GMP and NWAS but states GMP is taking action in relation to this and will be writing separately. Pennine Care NHS Foundation Trust has commissioned a review of the governance and decision-making around which type of learning review was commissioned and undertaken following Mr Hamid’s death, expected by the end of November 2025, after which decisions around changes to the assessment process may be implemented. Response was empty and couldn't be classified. Oldham Council acknowledges the coroner's concerns regarding the transportation of Mr. Hamid, but states that their AMHP service acted lawfully and with appropriate consideration. They state that safeguarding adults’ partners are working with Oldham Safeguarding Adults Board to consider whether a Safeguarding Adults Review (SAR) is required.

Noted (AI summary) NHS England has requested that all ICBs put in place integrated crisis text services, with delivery expected across all areas by Spring 2026. Greater Manchester ICB plans to implement commissioned crisis text services as part of crisis transformation, with a phased approach: a contracted service will be launched first, followed by a fully established service. The Department of Health and Social Care acknowledges concerns about the delayed rollout of crisis text support services, highlights existing mental health support initiatives, and notes that NHS England and Greater Manchester ICB are addressing the specific concerns raised.

Noted (AI summary) NWAS has reviewed the use of NHS Pathways for overdose calls, implementing an automatic prompt for an advanced questionnaire if 'risk of suicide' or 'accidental poisoning' is recognised, leading to an automatic upgrade to Category 2 for patients who have taken higher-risk medications. Clinicians in the Clinical Navigation, CSD, and CCD teams have undergone extended training and will use TOXBASE to support decision-making. The Minister acknowledges the concerns raised and explains that national guidance is in place for ambulance services regarding overdose calls, including clinical intervention within 30 minutes or automatic upgrade to Category 2. NWAS is best placed to respond on specific local actions.

Noted (AI summary) The Minister acknowledges concerns about mental capacity assessments for patients with chronic alcohol dependence and refers to existing legal frameworks like the Deprivation of Liberty Safeguards (DoLS) under the Mental Capacity Act 2005, noting practitioners must stay up-to-date with case law.

Noted (AI summary) North West Ambulance Service has revised its 111 policy to remove exclusions for self-conveyance to hospital, save for Category 1 incidents, and to directly confirm patient refusal of an ambulance where possible. The updated SOP went live on 5th September 2023 and staff were informed. The Department for Levelling Up, Housing and Communities will pilot measures to improve enforcement of damp and mould with £10m funding and intends to introduce the Decent Homes Standard to the private rented sector. They will also introduce new regulations following a review of the Housing Health and Safety Rating System (HHSRS). The Department of Health and Social Care states that NHS England has confirmed with ambulance trusts that no blanket policies are in place advising patients with chest pain not to travel to A&E. NHS111 calls are dealt with on a case-by-case basis, and patients are provided with interim advice.

Noted (AI summary) NICE acknowledges the concerns but states that existing guidelines on fever, sepsis, and sore throat should be considered. They highlight that a specific guideline on Group A streptococcus has not been requested and that rapid tests were not recommended for routine adoption. MFT expresses concern for better clinician awareness of GAS and its management, and has liaised with relevant bodies to raise their concerns. They recommend the development of comprehensive, nationwide guidance for clinicians on GAS, similar to existing guidance for meningococcal disease. The Department of Health and Social Care highlights NHS England's interim clinical guidance on Group A Streptococcus and a public campaign to inform parents about symptoms. They also mention plans to implement Martha's Rule to allow rapid review of deteriorating patients. The RCPCH has shared information and suggestions for local improvement from the report with its paediatric members via its patient safety portal and will share the information for discussion with the RCPCH Clinical Quality in Practice group in October.

Noted (AI summary) The MHRA convened the Isotretinoin Expert Working Group (IEWG) to evaluate data on risks associated with isotretinoin and the Implementation Working Group has had two meetings in March 2023 and is making good progress with a further meeting planned in mid May 2023; the report of this review will be published shortly. The MHRA published a report on isotretinoin's side effects and issued a Drug Safety Update. An Implementation Working Group is developing recommendations for safe introduction of new measures, with outputs to be made public. The Department of Health and Social Care acknowledges concerns regarding Isotretinoin and refers to the MHRA's response; they note that the Isotretinoin Implementation Working Group has met and is drafting a report for the Commission for Human Medicines, with the aim of presenting their advice in July 2023.