Joan Hoggett

Dear Sir Inquest into the death of Joan Hoggett This letter is written in response to the Regulation 28 Report, which you directed to the Trust following the inquest into the death of Mrs Joan Hoggett. As you are aware, the Trust has taken Mrs Hoggett’s death very seriously, as would be expected in such circumstances, and it has been investigated both internally by the Trust and externally by NHS England (via Niche) to establish where lessons can be learned and/or services improved. An independent peer review of the Early Intervention in Psychosis Service South Locality was also carried out by Professor

. A significant amount of work has been carried out by the Trust in response to concerns highlighted by each of these investigations. The details of the actions implemented and embedded by the Trust following this incident and receipt of the relevant reports were discussed at length during the inquest process and we do not intend to repeat the detail in this response save for where it is relevant to the specific concerns raised in the Regulation 28 Report. For the purpose of responding to your specific concerns raised in the Regulation 28 Report, I have addressed them as one entity as they both relate to involving family members in the care of the perpetrator in this matter. Your concerns were as follows: “The family of the perpetrator were not as engaged by the Trust as much as they could have been in terms of:
a. Sharing information with them; and
b. Acting upon information provided by them. A more proactive approach may have been appropriate. ”

Trust Response

As you will be aware, one of the recommendations made by Niche in the Independent Investigation Report was as follows:

“The EIP Service should review within three months, how to ensure that a carers’ needs assessment is offered and facilitated and include an audit of the ‘Getting to Know You’ documentation.”

By way of background, the ‘Getting to know you’ (‘GTKY’) process is designed to support staff to get to know the whole family of the person being cared for. By applying a ‘Think Family’ approach our staff aim to gain a better understanding of the patient’s background and family circumstances as well as identifying more quickly the patient’s main carer(s). Within a few days of coming into contact with Trust services, a member of staff is expected to arrange to spend some time with the carer/family member, to get to know them. The GTKY process was reviewed in 2018 in collaboration with carers. The outcome of the review led to the design of improved information leaflets and a new carer specific folder within the Electronic Care Record which will capture the needs of carers and record a plan on who best to support their needs.

Since the above recommendation was made, the Trust has completed a number of caseload reviews to seek assurance that the GTKY process has been fully embedded into clinical practice and that carers are being signposted and referred for carers’ assessments as appropriate. This ensures that staff are proactively engaging with family members/carers in the provision of a service user’s care. The findings and actions following these caseload reviews have been shared across the EIP Team, Central Business Unit and locality meetings via the Trust-wide EIP steering group.

This issue is also now routinely discussed with staff as part of clinical supervision each month and compliance is monitored during the monthly random audit of casefiles, the results of which are showing good compliance. The EIP service has also developed a documentation checklist for staff to refer to as a guide to ensure that the GTKY documentation is accurate and central to a service user’s care, within the parameters of consent and confidentiality.

The Trust has also had the following feedback regarding family interventions in the EIP service following the Independent Peer Review of EIP Service South Locality by Professor , 13 November 2019 as follows:

“I was impressed with the delivery of Family Interventions within the team. Often this is seen as a discreet intervention that is considered as and when the team feels it may be helpful, however, the model applied within the team is that family support is an integral part of the core offer. All families are offered an assessment with a qualified family therapist who will assess and formulate their individual needs and then an appropriate family intervention will be delivered. This offer incorporates the types of family intervention associated with reducing relapse rates for people with psychosis and schizophrenia although this aspect may be delivered by care coordinators within the team.”

The Trust is planning further improvement work in 2022/23 through their delivery of Quality Priority 3: Patient Care, which will increase the time staff are able to spend with service users and carers. This will include engagement with stakeholders and reviews to measure the use of the Getting to Know You documentation. This work has been delayed due to the Covid19 pandemic however, as acknowledged in the final Niche investigation report (published on 29 June 2022), this issue as a whole has been significantly progressed.

All of the above actively encourages proactive engagement with family members of service users at an early stage to ensure that the channels of communication are open to allow family members/carers to share information with the Trust and vice versa and to use that information in a meaningful way.

As stated above, the Trust are continuing to monitor compliance in this area via regular audit and are planning further improvement works which will enhance and further embed the processes which are already in place.

I hope that the information provided offers you the assurance that the Trust have invested significant time, effort and resource into investigating this incident and looked again at the findings of the inquest and the final independent report of Niche with a view to improving patient care and safety.