Michelle Moore

Dear Coroner, Re: Regulation 28 Report to Prevent Future Deaths – Michelle Patricia Moore who died on 31 October 2023.

Thank you for your Report to Prevent Future Deaths (hereafter “Report”) dated 26 June 2024 concerning the death of Michelle Patricia Moore on 31 October 2023. In advance of responding to the specific concerns raised in your Report, I would like to express my deep condolences to Michelle’s family and loved ones. NHS England are keen to assure the family and the Coroner that the concerns raised about Michelle’s care have been listened to and reflected upon.

I am grateful for the further time granted to respond to your Report, and I apologise for any anguish this delay may have caused Michelle’s family or friends. I realise that responses to Coroner’s Reports can form part of the important process of family and friends coming to terms with what has happened to their loved ones, and I appreciate this will have been an incredibly difficult time for them.

Your Report raises concerns over the lack of understanding and appreciation of the potential link between menopause and mental health decline, the need for joined up care and associated training and learning.

It is acknowledged that mental health problems can decline in women of menopausal age. There are often biological, social and psychological reasons why women may experience mental health problems at this stage in their lives. Changes in hormones during the menopause can cause existing mental health problems to worsen or can cause women to experience symptoms afresh. This means that women often need some help with their mental health as well as their physical health during the menopause. However, women are not universally or uniformly at risk of psychological symptoms over the menopause transition. It is important to ensure that women understand common symptoms such as anxiety, stress and depression which they might experience during the menopause and where and when to seek help. The NHS website has resources which help to guide women in terms of what to expect and where to seek help: Menopause - Symptoms - NHS (www.nhs.uk). This includes information on the mood changes that women may experience in menopause and the potential benefits of HRT. There is also a ‘help and National Medical Director NHS England Wellington House 133-155 Waterloo Road London SE1 8UG

26/09/2024

support’ page which provides some clinical advice along with the details of charities that are able to offer further information and support. It is, however, acknowledged that Michelle had multiple contacts with healthcare professionals, particularly between January 2023 and October 2023, and had raised concerns about menopausal / perimenopausal symptoms, and she could not identify any specific event, trigger or stressor for the decline in her mental health in the 18 months prior to her death. NHS England is currently supporting the development of a range of tools and interventions that will help to upskill more GPs in providing menopause care, and to improve access to treatments that can be helpful. GPs are well placed to take a holistic approach to mental health assessment, including menopause as one of the potential causes of mental distress or a decline in mental health. Women’s health hubs are in the process of being rolled out, which will offer specialist menopause care to more women when they need it. A toolkit that supports local areas to provide menopause information, events and group consultations is also under development to improve access and provide a forum for learning for other healthcare professionals. Existing NHS Talking Therapies, like cognitive behavioural therapy (CBT), or counselling can be used to help patients who experience depression or anxiety linked to menopause and perimenopause. NHS Talking Therapies operates a ‘hub and spoke’ model, which typically includes a central management and administration office with strong primary care and community links, that enables treatment to be provide in local settings that are as easy for people to access as possible (such as GP practices, community settings and voluntary organisations). Your Report also raised concerns about a lack of national guidance regarding the issues of menopause and mental health decline. I am aware that your Report has also been sent to the National Institute for Health and Care Excellence (NICE) and the Somerset NHS Foundation Trust. I have not yet had sight of their responses, but I would like to refer you to the NICE guidance on menopause diagnosis and management [NICE guideline NG23], which was published on 12 November 2015. This guideline recommends it is explained to women that they may experience a variety of symptoms associated with menopause, including low mood or anxiety, and sets out some of the available treatments, including HRT and cognitive behavioural therapy. NICE will be best placed to provide you with further information around national guidance.

I would also like to provide further assurances on the national NHS England work taking place around the Reports to Prevent Future Deaths. All reports received are discussed by the Regulation 28 Working Group, comprising Regional Medical Directors, and other clinical and quality colleagues from across the regions. This ensures that key learnings and insights around events, such as the sad death of Michelle, are shared across the NHS at both a national and regional level and helps us to pay close attention to any emerging trends that may require further review and action.

Thank you for bringing these important patient safety issues to my attention and please do not hesitate to contact me should you need any further information.