Noreen McGlynn

Dear Ms Hassell,

Re: Regulation 28 Report – Prevention of Future Deaths

Deceased: Norah (Noreen Philomena) McGlynn

Date of Death: 3 February 2025

Thank you for your Regulation 28 Report dated 11 July 2025 regarding the sad death of Mrs McGlynn. We wish to express our condolences to her family for their loss.

We have carefully considered your concerns regarding whether intravenous (IV) rehydration could have been offered in the home environment. After review, we must confirm that Mountfield Surgery is unable to provide IV rehydration at home. The reasons are as follows:

Clinical Safety and Monitoring IV rehydration requires continuous monitoring for complications such as fluid overload, electrolyte imbalance, and infection. Such monitoring is only safely provided within a hospital or equivalent acute setting where medical and nursing staff are available at all times.

Scope of Primary Care Services GPs and community-based clinicians do not have the resources, equipment, or staffing to deliver and monitor IV therapy at home. Current NHS community pathways do not provide for IV fluid administration in domiciliary settings for acutely unwell patients.

Alternative Community Support Where patients are unable to maintain oral hydration and hospital admission is not desired, community nursing teams may provide limited subcutaneous fluid administration (hypodermoclysis) in certain circumstances. However, this is not an equivalent substitute for IV fluids and is subject to local service availability and suitability for the patient.

Conclusion and Next Steps

We therefore respectfully submit that IV rehydration is not clinically appropriate or safe to administer at home. We will, however, raise this matter with our local NHS partners to review whether community subcutaneous rehydration pathways could be more widely available, in order to provide alternatives for patients who wish to avoid hospital admission. We will also be engaging with our local Primary Care Network (PCN 6) to gather their views on providing rehydration IV therapy at home.

We thank you for bringing this important matter to our attention and will continue to ensure our patients and their families are supported with clear explanations of available options in similar situations.

Dear Mr Hassell, Re: Response to Prevention of Future Deaths Report - Norah McGLYNN aka Noreen Philomena McGLYNN (died 03.02.25) Thank you for your Prevention of Future Deaths (PFD) report dated 11 July 2025, following the conclusion of your investigation into the death of Noreen McGlynn. Please accept my sincere condolences to the family and all those affected by this loss. We have carefully reviewed the matters raised in your report. Below is the detailed response from Central London Community Healthcare NHS Trust (CLCH) addressing the concerns you outlined.
1. Summary of Issues Raised Your enquiry specifically considered whether rehydration could have been offered at home in the care of Ms. McGlynn, and whether this could be a viable option for other patients in the future. Ms. McGlynn’s home environment was well-supported by a full-time carer and close family members. The family considered hospital admission only when they felt that she was becoming dehydrated. They expressed that if the rapid response team or GPs had been able to provide rehydration at home, this would have been a preferable option for Ms. McGlynn and her family.
2. CLCH Involvement I note that a statement dated 7 July 2025 was provided in preparation for the inquest. This statement summarises that on 29 January 2025, the Rapid Response Team received an urgent referral via the Single Point of Access (SPOA) to assess Ms. McGlynn for blood and urine tests. Ms. McGlynn had a Do Not Attempt Resuscitation (DNAR) order in place, and the referral stipulated that she was not to be conveyed to hospital. During the visit, the clinician found Ms. Your healthcare closer to home

-2- McGIynn alert but mostly non-verbal, with swallowing difficulties, reduced oral intake, and clinical signs suggestive of infection. The rapid response team clinician reported her findings and assessment via discharge letter to the GP that evening. The SPOA consultant had also sent the referral to the GP. The agreed clinical plan which was to be as coordinated by SPOA, family, and healthcare providers was to avoid hospital admission, undertake blood tests, and have her GP review the results the following day, to consider antibiotics and other treatments.
3. Could rehydration have been offered at home? The current service specification commissioned by Barnet Clinical Commissioning Group for Urgent Community Response (UCR) services does include the administration of IV fluids. It states that treatment at home may be appropriate for serious illnesses when it aligns with the patient’s preferences. Although this is included in the service specification, decisions around commencing IV fluid infusion need to be made with the clear understanding that the diagnostic and support services available in the community may not match those provided in a hospital setting, including considerations of the need for continuous observations during infusion. For IV fluids to be initiated a medical doctor would need to prescribe the fluids and equipment (whilst UCR clinicians may be non-medical prescribers, prescribing IV fluids falls outside of their current scope of practice). In this instance, the clinical plan did not include the provision of IV fluids. If the SPOA doctor had decided that IV fluid treatment was needed, they would have prescribed it and the UCR team would seek to procure the treatment.
4. Could rehydration be offered to others in the future? Typically, patients requiring IV rehydration or showing any signs of physical deterioration are conveyed to A&E or secondary care for its administration. This approach is also in accordance with our deteriorating patient procedure which states that if a patient’s condition is causing concern, then action needs to be taken either through an assessment by a doctor, appropriately qualified senior clinician, advanced practitioner or the patient should be transferred to A&E or secondary care for further care. On the occasion that a patient is severely dehydrated, the quickest and most effective treatment would be to go to hospital for IV fluid replacement. If the patient wishes to stay at home and makes that decision during GP working hours, the GP could prescribe IV fluids which could be administered by the rapid response team. Community teams would also always advise and support patients/families on oral care which can be provided by family or carers. As a Trust, we acknowledge the importance of the issues raised and are committed to ongoing improvement to prevent future occurrences. We welcome the opportunity to collaborate with relevant agencies and stakeholders to enhance patient safety and standards of care. Please do not hesitate to contact me should you require any further information or clarification.