2023

Noted (AI summary) NHS England refers to the RCOG guidance on assisted vaginal birth and highlights the need for clinicians to be aware of the guidance and assess the advantages and disadvantages of available delivery techniques; the results of the ROTATE trial will be carefully reviewed. Following inaccurate assessments of fetal head position by clinicians prior to starting procedures, RCOG advises that ultrasound assessment of the fetal head position prior to application of forceps is more reliable than clinical examination. Updated RCOG Green-top Guideline No. 26 provides recommendations to support practitioners around the use of instruments for assisted vaginal births.

Noted (AI summary) Leeds City Council acknowledges the coroner's concerns regarding a lack of legal powers to access properties for safety works without tenant consent. The council states that granting additional legal powers to landlords is a matter for central government. The Home Office acknowledges the coroner's concerns about fire risks in social housing but explains the existing regulatory framework, including the Regulatory Reform (Fire Safety) Order 2005 and the Housing Health and Safety Rating System. It highlights the role of Fire and Rescue Authorities and the Home Office's Fire Kills campaign.

Noted (AI summary) The Trust is implementing a fully electronic outpatient outcome system and rolling out LUNA, a digital monitoring tool for patient tracking lists, expected by the end of September 2023. They have sought expert advice regarding limitations of the VTE risk assessment and will continue to monitor information from national bodies. The Department acknowledges the concerns raised, notes the actions taken by the Trust, including implementing a digital monitoring tool and seeking expert advice on VTE risk assessment, and refers to broader government efforts to advance patient safety.

Noted (AI summary) NHS Greater Manchester Integrated Care acknowledges concerns about the demand and availability of social care and has connected with Trafford Local Authority. Supported by NHS GM funding, localities have commissioned home from hospital support; NHS GM has undertaken capacity and demand modelling of home care and care home markets and will share learning across Greater Manchester. The Department of Health and Social Care acknowledges concerns over delayed hospital discharge due to social care package challenges. It notes that Trafford Council has redesigned the homecare offer, and Greater Manchester ICB has undertaken capacity and demand modelling of home care. The response also mentions national initiatives like the Hospital Discharge and Community Support Guidance.

Noted (AI summary) HM Inspectorate of Prisons acknowledges receipt of the report but states its remit is limited to the inspection process, referring to published inspection reports and stating the information will inform future risk assessments at HMP Thameside. HM Inspectorate of Prisons acknowledges receipt of the report but states its remit is limited to the inspection process, referring to published inspection reports and stating the information will inform future risk assessments at HMP Thameside. Serco (HMP Thameside) details actions taken, including the introduction of MS Teams folders for data retention, enhanced security strategies with trained analysts, and the implementation of a bodyscanner, with learnings from the inquest shared with senior management. They will also share learnings of the inquest with the senior management team, with advice that where there is a suspected 'swallow' and absence of a positive bodyscanner result, they should re-locate to healthcare. HM Prison and Probation Service acknowledges the concerns regarding record keeping and data retention at HMP Thameside, confirms receipt of the prison director's response, and outlines the contract delivery indicators and monitoring processes in place.