Levi Alleyne

Dear Ms Thorne NHS Digital Response to Prevention of Future Deaths Report - Inquest touching the death of Levi Louis Alleyne

I am writing in response to the Prevention of Future Deaths Report received from HM Coroner, dated 4th November 2022. This follows the death of Levi Louis Alleyne who sadly passed away on 16 November 2020. This was followed by an investigation and inquest which concluded on 3rd October 2022. NHS Digital were not aware that this inquest was occurring, and therefore we did not have the opportunity to provide information to assist your inquiry.

Firstly, I would like to offer my sincerest condolences to the family of Levi Alleyne.

I am and am writing in my capacity as Clinical Director, NHS Pathways, NHS Digital.

NHS Pathways is the clinical decision support software (CDSS) used by all 111 service providers, and some 999 ambulance trusts in England. For information, we have included a short summary of the functions that NHS Pathways performs and the governance that underpins it (containing background information on NHS Pathways) in Appendix A.

HM Coroner has raised a number of matters of concern in the Regulation 28 Report. None of these directly reference NHS Pathways, but we believe concerns 4 and 5 are the most applicable. We have set out below relevant information about NHS Pathways, and NHS Digital’s role.

enquiries@nhsdigital.nhs.uk

1) Standard operating procedures and DNO contact numbers

NHS Pathways remit does not extend to preparing or overseeing local or national standard operating procedures or providing national oversight of 111 or 999 operations. Standard operating procedures relating to a range of operational requirements are locally set by 111 and 999 providers. NHS Pathways is a clinical decision support system and more operationally focused content such as how to contact a utility provider sits outside the remit of the NHS Pathways system.

2) NHS Pathways assessment of electrocution, including where there are scene safety concerns

NHS Pathways is a clinical triage system which provides the means to assess a patient's clinical presentation at the time of the call and signposts to the care skill set and time frame that a patient requires at that point in time. There are 2 main routes within the NHS Pathways system where electrocution from a non-domestic hazard (such as overhead power lines) can be identified:

1) following identification of cardiac arrest, which leads straight to a Category 1 ambulance disposition being reached, the system seeks to establish if the scene is safe. If a negative (‘no’) response is given the ‘unsafe’ route asks whether an electrical hazard is present.

2) via the major trauma route in Module 0, if it has been identified that the patient is conscious (as occurred initially with the deceased in this case). The route asks questions about the nature of the trauma and if the option for ‘electrical injury’ is selected the NHS Pathways system asks whether the shock was caused by a non-domestic supply. If so this generates a Category 2 ambulance.

Following either of the above routes being followed the NHS Pathways system makes a further assessment of scene safety. If ‘the scene is unsafe’ is selected, this prompts identification of an electrical hazard. There is further questioning about whether the electrical hazard has been made safe. In the case of a non-domestic electrical hazard that hasn’t been made safe, further advice presents where the caller is advised;

• Not to put themselves at risk

• Not to go closer than 20 yards as high voltage electricity can jump

• Keep away from liquid spills, wet floors and puddles due to the conduction of electricity in water.

enquiries@nhsdigital.nhs.uk

There are also system prompts for the Health Advisor to consider whether the situation also requires the attendance of other emergency services for any type of electrical hazard that has the potential to make the scene ‘unsafe’. Although such tragic incidents are rare, NHS Pathways are fully supportive of identifying any further learning from this case and are currently reviewing the scene safety elements within the triage system. The initial discovery has commenced, and any identified changes would be subject to review and sign off from the National Clinical Assurance Group and, if relevant, from the Emergency Call Prioritisation Advisory Group (ECPAG). The purpose of the ECPAG is to advise NHS England and Department of Health & Social Care (DHSC) on issues of ambulance call prioritisation. Its principal remit is to recommend which disposition codes should be mapped to which ambulance responses. The group consists of membership from Association of Ambulance Chief Executives (AACE), College of Paramedics, NHS England, DHSC, NHS Digital, AMPDS, National Ambulance Commissioning Network (NACN), NASMeD and ambulance Heads of Control.

Conclusion
• NHS Pathways assesses symptoms presented at the time of the call and signposts to the care skill set and time frame that a patient requires at that point in time. NHS Pathways identifies electrical hazards and advises callers on scene safety.
• NHS Pathways remit does not extend to preparing or overseeing local or national standard operating procedures or providing national oversight of 111 or 999 operations.
• The NHS Pathways content is continually under review to take account of clinical issues, user feedback, the latest available data and evidence, guidelines from Royal Colleges and other respected bodies and Coroner feedback. Any changes to NHS Pathways clinical content are overseen by the National Clinical Assurance Group and Coroner referrals are submitted to the National Clinical Assurance Group as a standing agenda item.

NHS Digital takes its role in such enquiries and any Prevention of Future Deaths Reports received very seriously. I would like to take this opportunity again to offer my sincere condolence to Levi Alleyne’s family. If I can be of any further assistance, please contact me.