Peter Thomas

Dear Ms Knight, Re: Regulation 28 Prevention of Future Deaths Report in respect of Peter Malcolm Thomas I write in response to your report of 3 September 2025, regarding the very sad death of Peter Malcolm Thomas. I would like to express my sincere condolences to Mr Thomas’s family. The patient safety leads at NICE have carefully considered the content of your report and the matters raised, and any action that we should take as a result. Response to the matters of concern I note that your matters of concern relate to the NICE guideline entitled Alcohol-use disorders: diagnosis and management of physical complications (reference CG100), and the recommendations within the guideline. The guideline includes the following recommendations:
1.1.2 Assessment and monitoring
1.1.2.1 Healthcare professionals who care for people in acute alcohol withdrawal should be skilled in the assessment and monitoring of withdrawal symptoms and signs. [2010]; and
1.1.2.3 People in acute alcohol withdrawal should be assessed immediately on admission to hospital by a healthcare professional skilled in the management of alcohol withdrawal. Our opinion is that these recommendations adequately convey the need for professional skill in the assessment and monitoring of patients and in the application of our recommendations. NICE

Based on the limited information available to us, we cannot see that the clinicians caring for Mr Thomas confirmed a diagnosis of alcohol withdrawal, and so cannot conclude that these recommendations were followed. A further recommendation in the same guideline, which you have referred to, states:
1.1.2.2 Follow locally specified protocols to assess and monitor patients in acute alcohol withdrawal. Consider using a tool (such as the Clinical Institute Withdrawal Assessment - Alcohol, revised [CIWA-Ar] scale) as an adjunct to clinical judgement. [2010] The CIWA-Ar protocol is a validated 10-item assessment tool that can be used to quantify the severity of the alcohol withdrawal syndrome, and to monitor and medicate patients throughout withdrawal. This recommendation suggests the CIWA-Ar as a possible option, in addition to the clinical judgment of the healthcare professionals who have responsibility for caring for their patient. Status of NICE guidelines As background regarding the status of NICE guidelines, it is important to note that the recommendations in our guidelines represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals and practitioners are expected to take NICE guidelines fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory for the NHS to apply the recommendations, and the guideline does not override the responsibility for clinicians to make decisions appropriate to the circumstances of the individual, in consultation with them (and their families and carers or guardian where appropriate). Responsibility for decisions on the most appropriate treatment stays with individual clinicians. NICE guidelines are a practical tool to be used in conjunction with and not as a substitute for clinical judgement. Action to be taken In the case of the CIWA-Ar scale, this protocol was not produced by NICE, and so we are unable to amend it, but it is appropriate for us to consider whether it is still relevant for NICE to recommend its use as an assessment and monitoring tool in our guidance. Decisions as to whether NICE will update existing guidance are overseen by an integrated, cross-organisational prioritisation board, chaired by NICE’S chief medical officer. The prioritisation board has previously considered the topic of alcohol withdrawal, and considering the volume of new evidence in this area, and the time since our guidance on this topic area was originally published, the board concluded that an update should be considered. This topic will therefore be looked at again by the prioritisation board in approximately February-March 2026, to determine what changes, if any, are needed to the guideline. This will include consideration of pharmacological treatment for acute alcohol withdrawal to optimise treatment options for patients. Page | 2

The decisions taken as a result will be published on our website at www.nice.orq.uk following the prioritisation board’s meeting, and if any changes are made to the guidance, this will also be published so that it is freely available to all. I hope that the information above is helpful and would like to reiterate my sincere condolences to Mr Thomas’s family.