William Nichols

Dear Doctor Patient Name NHS Number: Patient Address DoB: MRN: Your patient was admitted as an inpatient to Freeman Ward 08 on 02/10/2023 and was discharged home on 06/10/2023. Diagnosis _ Intermittent claudication right calf Clinical Details This patient was admitted electively for a right common femoral endarterectomy. This was completed successfully and the artery closed with a bovine patch. He made an uneventful recovery. Operations & Procedures Right common femoral endarterectomy - 2/10/23 Discharge Medication Clopidogrel 75 mg daily Atorvastatin 80 mg daily Information to Patient Mild wound discomfort is common following arterial surgery in the groi~. Ifthere is concern, you can contact the vascular team via Ward 8 for advice on 0191 213 7008. If at any point there is bleeding or a blood-stained discharge from the wound, you should seek urgent medical attention via your nearest Accident & Emergency Department.

Dear Ma'am,

Inquest into the death of William Nichols

We write to formally respond to your Prevention of Future Deaths (PFD) Report, dated 18 August 2023, following the sad death of Mr Nichols. As a Trust we have learnt from the circumstances of Mr Nichols' death and have taken action following his death to try and improve communication between ourselves and the Newcastle upon Tyne Hospitals, NHS Foundation Trust (Newcastle Trust) and to educate staff on the risks following a femoral endarterectomy.

We have reviewed the concerns identified in your PFD report and note that points 2 and 3 are not applicable to our Trust. We shall therefore respond to points 1 and 4 in turn below.

Concern 1: Inconsistency in the understanding between the hospital and community teams as to the procedure to follow post discharge from vascular surgery and the points of access in the event of concern or complication (including suspected infection or bleeding.)

It is the Trust's position that we have already addressed this concern (and had done so by the time of the inquest hearing) and therefore it is unclear if this concern is directed at us, but in the event that it is, we would respond as follows.

As heard at the inquest and in our subsequent submissions made by letter in July 2023, the Trust followed the correct procedure of contacting the ward at the Newcastle Trust, when the Community team noted the presence of fresh blood and spoke with a Specialist Vascular Nurse from the Newcastle Trust for advice, who in turn spoke with a medic from the Vascular Team. Following the inquest, the Trust liaised with the Newcastle Trust, to ensure that this remains the correct procedure for contacting their team and they have confirmed it does.

Gateshead Health NHS Foundation Trust Trust Headquarters Queen Elizabeth Hospital Sheriff Hill Gateshead NE9 6SX

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Following the inquest and collaboration with the Newcastle Trust, the findings of the inquest have been shared with our District Nurses, to reiterate the process they already follow, including:

• Contacting the inpatient ward for advice (whether that be a ward within this Trust or another Trust);
• Where to locate contact information for the relevant ward; and
• A reminder of signs to look out for with patients who have undergone a femoral endarterectomy.

We have also been liaising with the Newcastle Trust and developed a professional information leaflet for District Nurses which outlines what they should be aware of in relation to this specific procedure in the post operative period and what requires escalation and intervention, We understand you have received this from Newcastle Trust. We have therefore done all we can as a Trust in relation to this concern.

Concern 4: Poor record keeping from the community team which mean that key clinical assessment information was not consistently recorded.

Having reviewed the evidence, we are unable to ascertain where this concern arises from, which makes it difficult to respond directly. However, we would be more than willing to address this further if more detail about the concern could be provided.

As a Trust, we pride ourselves on ensuring that record keeping is a priority. In Mr Nichols' case, key clinical information was recorded, with space to add to pre-populated drop-down boxes and concerns were appropriately raised with the Newcastle Trust, when fresh blood was identified in Mr Nichols' colostomy bag.

As referred to in the inquest, at the time of Mr Nichol's death, the Trust had only very recently moved to a fully electronic records system. This system is now fully embedded and since Mr Nichols' death, 4 years ago, numerous changes have been made to the electronic proformas to strengthen record keeping and capture accurate and key clinical information.

We hope that the above addresses your concerns, but please do revert back to us should you have any further comments or queries with which we can assist.