Source · Prevention of Future Deaths

Neville Bardoliwalla

Ref: 2020-0258 Date: 26 Nov 2020 Coroner: Andrew Walker Area: North London 1 response identified · 1 indexed addressee View PDF

AI-generated concerns summaryThe coroner noted that Mr Bardoliwalla had accumulated prescribed controlled medication and there was no process for collecting and disposing of this medication.

Date 26 Nov 2020
56-day deadline 24 Feb 2021 est. estimated from the Judiciary.uk publication date
Responses identified 1 of 1
Other related deaths Suicide (from 2015)

Coroner's concerns

AI summary
The coroner noted that Mr Bardoliwalla had accumulated prescribed controlled medication and there was no process for collecting and disposing of this medication.
View full coroner's concerns
1. Evidence was heard regarding the fact that prescribed controlled medication had been accumulated by Mr Bardoliwalla and that there was no process for of collecting and disposing of this medication.

Responses

1 respondent

Dept Health and Social Care

Central Government
Letter dated 15 Dec 2020 PDF
AI-classified response stance Noted
AI-generated response summary

• The NHS Community Pharmacy Contractual Framework requires all community pharmacies in England to accept unwanted medicines from households and care homes for safe disposal. • National Institute for Health and Care Excellence (NICE) Guideline 46 recommends advising patients and carers to return unwanted medicines to community pharmacies. • A review of over-prescribing in the NHS is being conducted, which will provide recommendations to reduce overprescribing and medicines wastage.

View full response
Dear Andrew, Thank you for your letter of 26 November 2020 about the death of Neville Bardoliwalla am replying as Minister with responsibility for medicines: Firstly, would like to say how sorry was t0 read the circumstances of Mr Baroliwalla's death and | offer my most heartfelt condolences to Mr Bardoliwalla's family and loved ones at what must be a distressing time. note that this is the second Prevention of Future Deaths report you have issued to the Department of Health and Social Care about the disposal of controlled drugs: wish to assure you that we recognise the importance of having methods to dispose of medicines waste safely, that protect the public from harm. Disposal of unwanted medicines is an essential service of the NHS Community Pharmacy Contractual Framework' , to be provided by all community pharmacies in England. This requires them to accept unwanted medicines from private households, residential care homes and children's homes: These returned medicines are then stored securely and safely by pharmacies until they are collected for safe disposal: NHS England and NHS Improvement; as commissioners of NHS Pharmaceutical Services, have arrangements in place for a waste contractor to collect the unwanted medicines from pharmacies at regular intervals for safe disposal. This ensures that the public have an easy method of retuming unwanted medicines to pharmacies for safe disposal, helping to reduce harm to themselves and environmental damage caused by inappropriate disposal methods. Patients or their families and carers, should be advised by community nursing staff; GPs or pharacists to return any unwanted or unrequired medicines to their local community pharmacy for safe disposal: This recommendation is made in National Guideline 46 Controlled Drugs: safe use and management?, published by the National Institute for Health and Care Excellence (NICE) in 2016. https Ilgov uklgovernmentpublicationslcommunity-pharmacy-contractual-framework-2019-to-2024 https Ilnice org uklquidancelng4e [1.5.11]

should also explain that work is underway to reduce waste medicines in the first place. Medicines optimisation is a key workstream within NHS England's Medicines Value Programmes that aims to ensure that the right patients get the right choice of medicine , at the right time. Through focusing on patients and their experiences, the goal is to help patients t0 improve their outcomes; take their medicines as intended; avoid taking unnecessary medicines; reduce wastage of medicines; and improve medicines safety. In additionthe Secretary of State for Health and Social Care, Matt Hancock, has asked Dr the Chief Pharmaceutical Officer for England, to carry out a review of over- prescrbing in the NHS. This work is looking at reducing inappropriate prescribing, with particular focus on the role of digital technologies; research; culture change and social prescribing; repeat prescribing; and transfer Of care. The report of the review will provide recommendations to reduce overprescribing to improve patient safety and reduce medicines wastage_ hope this response is helpful. am grateful to you for bringing these concerns to my attention 6 %hen LORD BETHELL https Il england nhs uklmedicines-ZIvalue-programmel

Report sections

Investigation and inquest
On 13th March 2020 I commenced an investigation into the death of Neville Bardoliwalla. The investigation concluded at the end of the inquest held on the 9th October 2020. The conclusion of the inquest was a short form conclusion;

Suicide.
Circumstances of the death
On the 10th March 2020 Mr Bardoliwalla was found having hanged himself from two screws screwed into the top panel of the door frame at his home.

Similar PFD reports

Shared signals

Report details

Reference
2020-0258
Date of report
26 November 2020
Coroner
Andrew Walker
Coroner area
North London

Responses identified

Responses identified 1 of 1
All listed responses identified

Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 24 Feb 2021 (estimated from the Judiciary.uk publication date).

Sent to

Department of Health and Social Care

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