PFD Response Tracker

Prevention of Future Deaths

Total: 6,254 Responded: 4,628 No identified response (past 2 years): 60 Pending: 97 Historic with no identified response: 1,340

How statuses are calculated — 56-day deadline, Judiciary.UK data

Recipients have 56 days to respond under Regulation 28. We use the deadline stated in the report where available, otherwise we calculate it from the report date. We rely on Judiciary.UK for response data, so if a response has been provided but not yet published there, it may show incorrectly here. "No identified response", "Pending", and "Historic" only count reports where no response at all has been identified as published on Judiciary.UK. If at least one response has been published for a report, it counts as "Responded" — even if not every listed addressee has a separate published response. This is because addressee data from Judiciary.UK can be unreliable: address fragments, job titles, and redacted names are sometimes parsed as separate addressees, and a single response PDF may cover multiple parties. "Historic with no identified response" means we have not been able to identify a published response, but the report is more than two years old. We do not mark these as overdue or pending because older reports may well have received a response that was simply never made public. This is a neutral status indicating absence of an identified published record, not confirmed non-compliance.

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6,254 reports · Page 118 of 126

Date	Deceased	Addressee(s)	Status	Responses
13 Apr 2014	Lalitaben Patel A locum consultant surgeon, despite being restricted to routine procedures, operated without additional supervision, raising concerns about oversight …	Department of Health and Social …	All Responded	1/1
10 Apr 2014	Terence Dooley A critical failure in emergency triage assigned a low priority 'code green' to a call concerning the ingestion …	North West Ambulance Service	All Responded	1/1
9 Apr 2014	Stephen Bedford Ambulance staff training and assessment for life support standards are inconsistent, leading to inappropriate crew deployment for critical …	East of England Ambulance NHS …	Historic (No Identified Response)	0/1
9 Apr 2014	Sally Perrons No specific concerns were detailed in the provided text for summarization.	Association of Ambulance Chief Executives East Midlands Ambulance Service NHS …	All Responded	1/2
9 Apr 2014	Thomas Allen The illegal practice of 'fly grazing' is difficult to manage in England as it is not a criminal …	Department for Environment Suffolk Constabulary Food and Rural Affairs	Partially Responded	1/3
9 Apr 2014	Russell Long	Cumbria County Council	All Responded	1/1
9 Apr 2014	Ozan Atasoy A detained patient repeatedly absconded from a psychiatric unit's smoking area, often while escorted, indicating insufficient supervision and …	Care Quality Commission	All Responded	1/1
9 Apr 2014	Doris Taylor Staff training was inadequate regarding reportable incidents, and managers were unaware of reporting duties. Dangerously strong door-closers also …	Borough Care Limited	Historic (No Identified Response)	0/1
9 Apr 2014	Michael Anthony The deceased had dangerously high Gabapentin levels, a drug usually avoided in diabetics due to severe reaction risks, …	Princess Street Practice Guy’s Hospital	Partially Responded	1/2
8 Apr 2014	Frederick Hall Widespread deficiencies included poor staff training for NG tube insertion, erratic patient monitoring, failure to follow consultant instructions, …	Alexandra Hospital	Historic (No Identified Response)	0/1
8 Apr 2014	Andrew Horgan Doctors lacked clear understanding and training on mental health referral procedures, leading to inadequate patient assessment processes.	Great Western Hospital	All Responded	1/1
8 Apr 2014	Leslie Harding There was a failure to take prompt action and ensure robust treatment for a patient with a suspected …	Oak Side Surgery	All Responded	1/1
8 Apr 2014	Audrey Kelly Out of Hours services and hospital emergency departments critically lacked direct access to patients' electronic GP notes, a …	Department of Health and Social …	All Responded	2/1
7 Apr 2014	Jamie Barlow There was a lack of effective inter-agency working, clear protocols for police assistance, and a joint mental health …	Suffolk Constabulary Norfolk and Suffolk NHS Foundation …	Historic (No Identified Response)	0/2
7 Apr 2014	William Winter Understaffing and unfamiliarity with escalation procedures on a Clinical Decisions Unit led to missed patient observations and delayed …	East Kent Hospitals University NHS …	Historic (No Identified Response)	0/1
7 Apr 2014	Roger Duggan An agitated patient was left unsupervised in the Emergency Department, and staff failed to take responsibility for monitoring …	Royal Devon and Exeter Hospital …	All Responded	2/1
4 Apr 2014	Eric Matthews There is limited public awareness and insufficient research regarding the risk of positional asphyxia associated with baby slings.	University College London Hospitals NHS …	All Responded	1/1
3 Apr 2014	Graham Watts The hospital's discharge procedure was severely flawed, involving blank paperwork, lack of communication with family or care home, …	Brighton and Sussex University Hospitals … Royal Sussex County Hospital Princess Royal Hospital	All Responded	1/3
3 Apr 2014	Danuta Corbett The hospital's leave policy for informal patients was not followed, and inadequate risk assessment for escorted leave, using …	Sussex Partnership NHS Foundation Trust	All Responded	1/1
3 Apr 2014	Melvin Bandtock A duty manager's decision not to grit roads based on inaccurate weather assessment led to dangerous conditions; improved …	Durham County Council	All Responded	2/1
2 Apr 2014	William Watson Poor road layout and obstructing hedgerows at a specific location compromise driver visibility, creating a significant road safety …	Island Roads Hampshire Constabulary Isle of Wight Council	Historic (No Identified Response)	0/3
2 Apr 2014	John Dodd Inadequate patient monitoring, including missed INR checks and unreported temperature rise, coupled with significant delays in A&E medical …	Dudley Group NHS Foundation Trust	All Responded	1/1
1 Apr 2014	Oliver Hiscutt Lack of mandatory formal paediatric child health training for GPs results in inadequate skills to assess and manage …	Royal College of General Practitioners General Medical Council Health Education England Royal College of Paediatrics and … Department of Health and Social …	Historic (No Identified Response)	0/5
1 Apr 2014	Vincent Gibson Police incident management suffered from unclear leadership, inadequate communication protocols, ineffective resource allocation, and unreliable electronic aids, compromising …	Northumbria Police Independent Police Complaints Commission	Historic (No Identified Response)	0/2
31 Mar 2014	Deanne Smith The practice of dispensing large quantities of methadone to drug-dependent individuals over public holidays increases the risk of …	United Pharmacy Bromley Drug and Alcohol Service	Partially Responded	1/2
31 Mar 2014	Joseph Godfrey Care staff and paramedics lacked awareness of warfarin-related bleeding risks in elderly fall patients. Care home staff failed …	BUPA UK Provision BUPA Care Homes	Historic (No Identified Response)	0/2
31 Mar 2014	Valerie Hancox Farm bale chutes are routinely left lowered and unmarked on public highways, contrary to manufacturer instructions, posing a …	AGCO Ltd	Historic (No Identified Response)	0/1
28 Mar 2014	Sebastian Davies Hourly night observations failed to check for patient immobility or movement, potentially delaying detection of unconsciousness, and lacked …	Norvic Clinic	Historic (No Identified Response)	0/1
28 Mar 2014	Susan Poore Anti-depressant medication was associated with a deterioration in the patient's depression, leading to an uncharacteristic death, despite side-effect …	NHS England	Historic (No Identified Response)	0/1
28 Mar 2014	Rosemary Simpson The bus stop's location in a busy area creates poor visibility for buses, forcing unsafe lane changes and …	London Borough of Camden	Historic (No Identified Response)	0/1
26 Mar 2014	Lee Hollman The practice had inadequate systems for maintaining accurate medical records, removing outdated repeat prescriptions, and reviewing patients' medication …	Horsham and Mid Sussex Clinical … Royal College of General Practitioners	All Responded	2/2
25 Mar 2014	Margaret Walker Incomplete medication history, poor record-keeping, and failure to apply a defibrillator promptly by ward staff contributed to critical …	5 Boroughs Partnership	All Responded	1/1
25 Mar 2014	Caroline Pilkington North West Ambulance Service staff lack control and restraint training, forcing reliance on police who are not clinically …	North West Ambulance Service Department of Health and Social …	All Responded	4/2
24 Mar 2014	Phyllis Barnes A visiting GP failed to recognise the seriousness of the patient's condition. Post-operative telephone follow-ups were inadequate, and …	North East Hampshire and Farnham … Royal College of Surgeons Frimley Park Hospital NHS Trust	Historic (No Identified Response)	0/3
24 Mar 2014	Jackson Chadd Concerns include inadequate supervision for junior paediatric staff, insufficient consultant oversight for out-of-hours admissions, failure to apply national …	Royal College of Paediatrics and … Frimley Park Hospital Department of Health and Social …	Partially Responded	2/3
24 Mar 2014	Sean Morley The A444 stretch lacks pedestrian/cyclist warning signs, street lighting, and protective barriers, despite regular use by vulnerable road …	Warwickshire County Council	Historic (No Identified Response)	0/1
21 Mar 2014	Kerry Jacobs The hospital lacked a policy requiring doctors to document reasons for prescribing medication outside BNF guidelines. There was …	Surrey and Sussex NHS Trust	All Responded	1/1
21 Mar 2014	Derrick Plater There was no protocol for visiting care homes before placing patients with complex needs, relying solely on assurances. …	Cambridgeshire County Council	All Responded	1/1
21 Mar 2014	Norma Sheppard Significant confusion existed regarding the terms of Mrs. Sheppard's discharge to a care home, specifically concerning subcutaneous fluids, …	Queens Hospital Burton Upon Trent	Historic (No Identified Response)	0/1
20 Mar 2014	Robert Jones CT scan results were not made available promptly to relevant departments, nor were they acted upon without delay …	West Wales General Hospital Glangwili …	All Responded	1/1
19 Mar 2014	Christopher Williams A critical defibrillator failed due to lack of daily checks and no cross-check system. The hospital also lacked …	St Mary’s Hospital Warrington	Historic (No Identified Response)	0/1
18 Mar 2014	David Chatburn The GP failed to refer the patient to psychiatric services, inappropriately managed medication, and had poor record-keeping. Systemic …	Pennine Care NHS Trust Department of Health and Social … Rochdale Heywood and Middleton Clinical … York House Surgery	Partially Responded	1/4
17 Mar 2014	Charles Bradley Inadequate record-keeping and communication failures at Arrowe Park Hospital led to the patient not being expected upon transfer …	Arrowe Park Hospital	Historic (No Identified Response)	0/1
17 Mar 2014	Peter Banks A pedestrian crossing point was positioned too close to the main road. Protective railings should be extended and …	Casualty Reduction Team	Historic (No Identified Response)	0/1
17 Mar 2014	Daniel Taylor A specific downhill road section preceding a right-hand bend lacked appropriate warning signs or markings, warranting a review …	Casualty Reduction Team	Historic (No Identified Response)	0/1
14 Mar 2014	David Oldfield Concerns were raised about the appropriateness and justification of tasering the deceased, given discrepancies in officer accounts. Unjustified …	West Yorkshire Police Force	All Responded	1/1
14 Mar 2014	Michael Tarratt There was an unacceptable 18-month lapse in communication between the drug and alcohol team and the GP. Services …	Leicestershire Partnership NHS Trust	All Responded	1/1
14 Mar 2014	Gavin Roberts The current 60mph speed limit for a specific bend is too high, and warning signs are inadequate, particularly …	Rotherham Metropolitan Borough Council	Historic (No Identified Response)	0/1
14 Mar 2014	Matthew Simmonds An effective local action plan for commissioning complex care pathways for ventilated patient discharges is not shared nationally, …	NHS England	Historic (No Identified Response)	0/1
13 Mar 2014	Jean James Initial documentation delays and the unreviewed omission of prophylactic medication occurred. Pharmacy queries were poorly communicated, indicating that …	City Hospitals Sunderland NHS Foundation …	All Responded	1/1

Lalitaben Patel

All Responded

13 Apr 2014 · Leicester City & South Leicestershire · 1/1 responses

A locum consultant surgeon, despite being restricted to routine procedures, operated without additional supervision, raising concerns about oversight for consultants with identified limitations.

Department of Health and …

Terence Dooley

All Responded

10 Apr 2014 · Manchester City · 1/1 responses

A critical failure in emergency triage assigned a low priority 'code green' to a call concerning the ingestion of multiple potentially fatal tablets.

North West Ambulance Service

Stephen Bedford

Historic (No Identified Response)

9 Apr 2014 · Cambridgeshire (South & West) · 0/1 responses

Ambulance staff training and assessment for life support standards are inconsistent, leading to inappropriate crew deployment for critical patients and inadequate communication of crew capabilities.

East of England Ambulance …

Sally Perrons

All Responded

9 Apr 2014 · Nottinghamshire · 1/2 responses

No specific concerns were detailed in the provided text for summarization.

Association of Ambulance Chief … East Midlands Ambulance Service …

Thomas Allen

Partially Responded

9 Apr 2014 · Suffolk · 1/3 responses

The illegal practice of 'fly grazing' is difficult to manage in England as it is not a criminal offence, and a necessary police/local authority protocol …

Department for Environment Suffolk Constabulary Food and Rural Affairs

Russell Long

All Responded

9 Apr 2014 · Cumbria (North & West) · 1/1 responses

Cumbria County Council

Ozan Atasoy

All Responded

9 Apr 2014 · Hertfordshire · 1/1 responses

A detained patient repeatedly absconded from a psychiatric unit's smoking area, often while escorted, indicating insufficient supervision and inadequate security protocols.

Care Quality Commission

Doris Taylor

Historic (No Identified Response)

9 Apr 2014 · Manchester (South) · 0/1 responses

Staff training was inadequate regarding reportable incidents, and managers were unaware of reporting duties. Dangerously strong door-closers also posed a significant safety hazard to residents.

Borough Care Limited

Michael Anthony

Partially Responded

9 Apr 2014 · London (Inner South) · 1/2 responses

The deceased had dangerously high Gabapentin levels, a drug usually avoided in diabetics due to severe reaction risks, with no clear rationale from the GP …

Princess Street Practice Guy’s Hospital

Frederick Hall

Historic (No Identified Response)

8 Apr 2014 · Manchester (South) · 0/1 responses

Widespread deficiencies included poor staff training for NG tube insertion, erratic patient monitoring, failure to follow consultant instructions, and significant communication breakdowns. Additionally, poor record-keeping …

Alexandra Hospital

Andrew Horgan

All Responded

8 Apr 2014 · Wiltshire & Swindon · 1/1 responses

Doctors lacked clear understanding and training on mental health referral procedures, leading to inadequate patient assessment processes.

Great Western Hospital

Leslie Harding

All Responded

8 Apr 2014 · Plymouth, Torbay & South Devon · 1/1 responses

There was a failure to take prompt action and ensure robust treatment for a patient with a suspected life-threatening pulmonary embolus over a critical period.

Oak Side Surgery

Audrey Kelly

All Responded

8 Apr 2014 · Manchester (South) · 2/1 responses

Out of Hours services and hospital emergency departments critically lacked direct access to patients' electronic GP notes, a systemic failure risking patient safety and future …

Department of Health and …

Jamie Barlow

Historic (No Identified Response)

7 Apr 2014 · Suffolk · 0/2 responses

There was a lack of effective inter-agency working, clear protocols for police assistance, and a joint mental health assessment framework for high-risk patients.

Suffolk Constabulary Norfolk and Suffolk NHS …

William Winter

Historic (No Identified Response)

7 Apr 2014 · Kent (Central & South East) · 0/1 responses

Understaffing and unfamiliarity with escalation procedures on a Clinical Decisions Unit led to missed patient observations and delayed surgical review.

East Kent Hospitals University …

Roger Duggan

All Responded

7 Apr 2014 · Exeter & Greater Devon · 2/1 responses

An agitated patient was left unsupervised in the Emergency Department, and staff failed to take responsibility for monitoring him, leading to his unnoticed departure.

Royal Devon and Exeter …

Eric Matthews

All Responded

4 Apr 2014 · London Inner (North) · 1/1 responses

There is limited public awareness and insufficient research regarding the risk of positional asphyxia associated with baby slings.

University College London Hospitals …

Graham Watts

All Responded

3 Apr 2014 · Brighton & Hove · 1/3 responses

The hospital's discharge procedure was severely flawed, involving blank paperwork, lack of communication with family or care home, and discharging a medically unfit patient.

Brighton and Sussex University … Royal Sussex County Hospital Princess Royal Hospital

Danuta Corbett

All Responded

3 Apr 2014 · Brighton & Hove · 1/1 responses

The hospital's leave policy for informal patients was not followed, and inadequate risk assessment for escorted leave, using an untrained agency worker, resulted in critical …

Sussex Partnership NHS Foundation …

Melvin Bandtock

All Responded

3 Apr 2014 · County Durham & Darlington · 2/1 responses

A duty manager's decision not to grit roads based on inaccurate weather assessment led to dangerous conditions; improved information sharing and review of council procedures …

Durham County Council

William Watson

Historic (No Identified Response)

2 Apr 2014 · Isle of Wight · 0/3 responses

Poor road layout and obstructing hedgerows at a specific location compromise driver visibility, creating a significant road safety hazard.

Island Roads Hampshire Constabulary Isle of Wight Council

John Dodd

All Responded

2 Apr 2014 · Black Country · 1/1 responses

Inadequate patient monitoring, including missed INR checks and unreported temperature rise, coupled with significant delays in A&E medical assessment, compromised patient safety.

Dudley Group NHS Foundation …

Oliver Hiscutt

Historic (No Identified Response)

1 Apr 2014 · Manchester City · 0/5 responses

Lack of mandatory formal paediatric child health training for GPs results in inadequate skills to assess and manage sick children effectively.

Royal College of General … General Medical Council Health Education England Royal College of Paediatrics … Department of Health and …

Vincent Gibson

Historic (No Identified Response)

1 Apr 2014 · Gateshead & South Tyneside · 0/2 responses

Police incident management suffered from unclear leadership, inadequate communication protocols, ineffective resource allocation, and unreliable electronic aids, compromising response safety and efficiency.

Northumbria Police Independent Police Complaints Commission

Deanne Smith

Partially Responded

31 Mar 2014 · London (South) · 1/2 responses

The practice of dispensing large quantities of methadone to drug-dependent individuals over public holidays increases the risk of future deaths and needs policy review.

United Pharmacy Bromley Drug and Alcohol …

Joseph Godfrey

Historic (No Identified Response)

31 Mar 2014 · London (East) · 0/2 responses

Care staff and paramedics lacked awareness of warfarin-related bleeding risks in elderly fall patients. Care home staff failed to follow observation protocols, document checks, or …

BUPA UK Provision BUPA Care Homes

Valerie Hancox

Historic (No Identified Response)

31 Mar 2014 · Shropshire, Telford & Wrekin · 0/1 responses

Farm bale chutes are routinely left lowered and unmarked on public highways, contrary to manufacturer instructions, posing a significant, unlit obstruction hazard to other road …

AGCO Ltd

Sebastian Davies

Historic (No Identified Response)

28 Mar 2014 · Norfolk · 0/1 responses

Hourly night observations failed to check for patient immobility or movement, potentially delaying detection of unconsciousness, and lacked continuity among observing staff.

Norvic Clinic

Susan Poore

Historic (No Identified Response)

28 Mar 2014 · Norfolk · 0/1 responses

Anti-depressant medication was associated with a deterioration in the patient's depression, leading to an uncharacteristic death, despite side-effect warnings.

NHS England

Rosemary Simpson

Historic (No Identified Response)

28 Mar 2014 · London Inner (North) · 0/1 responses

The bus stop's location in a busy area creates poor visibility for buses, forcing unsafe lane changes and posing risks to pedestrians and vehicles.

London Borough of Camden

Lee Hollman

All Responded

26 Mar 2014 · West Sussex · 2/2 responses

The practice had inadequate systems for maintaining accurate medical records, removing outdated repeat prescriptions, and reviewing patients' medication within guidelines.

Horsham and Mid Sussex … Royal College of General …

Margaret Walker

All Responded

25 Mar 2014 · Manchester (West) · 1/1 responses

Incomplete medication history, poor record-keeping, and failure to apply a defibrillator promptly by ward staff contributed to critical care delays.

5 Boroughs Partnership

Caroline Pilkington

All Responded

25 Mar 2014 · Manchester (West) · 4/2 responses

North West Ambulance Service staff lack control and restraint training, forcing reliance on police who are not clinically trained, leading to delayed patient care and …

North West Ambulance Service Department of Health and …

Phyllis Barnes

Historic (No Identified Response)

24 Mar 2014 · Surrey · 0/3 responses

A visiting GP failed to recognise the seriousness of the patient's condition. Post-operative telephone follow-ups were inadequate, and there was no effective communication channel for …

North East Hampshire and … Royal College of Surgeons Frimley Park Hospital NHS …

Jackson Chadd

Partially Responded

24 Mar 2014 · Surrey · 2/3 responses

Concerns include inadequate supervision for junior paediatric staff, insufficient consultant oversight for out-of-hours admissions, failure to apply national guidelines for fever in children, and disregarding …

Royal College of Paediatrics … Frimley Park Hospital Department of Health and …

Sean Morley

Historic (No Identified Response)

24 Mar 2014 · Warwickshire · 0/1 responses

The A444 stretch lacks pedestrian/cyclist warning signs, street lighting, and protective barriers, despite regular use by vulnerable road users and a 70mph speed limit, creating …

Warwickshire County Council

Kerry Jacobs

All Responded

21 Mar 2014 · West Sussex · 1/1 responses

The hospital lacked a policy requiring doctors to document reasons for prescribing medication outside BNF guidelines. There was also no protocol for pharmacists and clinicians …

Surrey and Sussex NHS …

Derrick Plater

All Responded

21 Mar 2014 · Norfolk · 1/1 responses

There was no protocol for visiting care homes before placing patients with complex needs, relying solely on assurances. A lack of clear guidelines for when …

Cambridgeshire County Council

Norma Sheppard

Historic (No Identified Response)

21 Mar 2014 · Staffordshire South · 0/1 responses

Significant confusion existed regarding the terms of Mrs. Sheppard's discharge to a care home, specifically concerning subcutaneous fluids, with conflicting information between the written discharge …

Queens Hospital Burton Upon …

Robert Jones

All Responded

20 Mar 2014 · Carmarthenshire and Pembrokeshire · 1/1 responses

CT scan results were not made available promptly to relevant departments, nor were they acted upon without delay and within a reasonable timeframe.

West Wales General Hospital …

Christopher Williams

Historic (No Identified Response)

19 Mar 2014 · Cheshire · 0/1 responses

A critical defibrillator failed due to lack of daily checks and no cross-check system. The hospital also lacked a policy for managing sudden or unexpected …

St Mary’s Hospital Warrington

David Chatburn

Partially Responded

18 Mar 2014 · Manchester (North) · 1/4 responses

The GP failed to refer the patient to psychiatric services, inappropriately managed medication, and had poor record-keeping. Systemic issues included bureaucratic barriers to mental health …

Pennine Care NHS Trust Department of Health and … Rochdale Heywood and Middleton … York House Surgery

Charles Bradley

Historic (No Identified Response)

17 Mar 2014 · Liverpool · 0/1 responses

Inadequate record-keeping and communication failures at Arrowe Park Hospital led to the patient not being expected upon transfer and unclear documentation of a significant fall.

Arrowe Park Hospital

Peter Banks

Historic (No Identified Response)

17 Mar 2014 · Staffordshire South · 0/1 responses

A pedestrian crossing point was positioned too close to the main road. Protective railings should be extended and the crossing moved further into Westhead Avenue …

Casualty Reduction Team

Daniel Taylor

Historic (No Identified Response)

17 Mar 2014 · Staffordshire (South) · 0/1 responses

A specific downhill road section preceding a right-hand bend lacked appropriate warning signs or markings, warranting a review to prevent future collisions.

Casualty Reduction Team

David Oldfield

All Responded

14 Mar 2014 · West Yorkshire (East) · 1/1 responses

Concerns were raised about the appropriateness and justification of tasering the deceased, given discrepancies in officer accounts. Unjustified tasering unnecessarily increases the risk of serious …

West Yorkshire Police Force

Michael Tarratt

All Responded

14 Mar 2014 · Leicester City & South Leicestershire · 1/1 responses

There was an unacceptable 18-month lapse in communication between the drug and alcohol team and the GP. Services failed to exchange information on inappropriate prescriptions …

Leicestershire Partnership NHS Trust

Gavin Roberts

Historic (No Identified Response)

14 Mar 2014 · Rotherham · 0/1 responses

The current 60mph speed limit for a specific bend is too high, and warning signs are inadequate, particularly as the limit increases on approach, contributing …

Rotherham Metropolitan Borough Council

Matthew Simmonds

Historic (No Identified Response)

14 Mar 2014 · Hampshire (Central) · 0/1 responses

An effective local action plan for commissioning complex care pathways for ventilated patient discharges is not shared nationally, posing a risk that other Clinical Commissioning …

NHS England

Jean James

All Responded

13 Mar 2014 · Sunderland · 1/1 responses

Initial documentation delays and the unreviewed omission of prophylactic medication occurred. Pharmacy queries were poorly communicated, indicating that existing systems and protocols may be insufficiently …

City Hospitals Sunderland NHS …