Source · Prevention of Future Deaths
Peter Embra
Ref: 2016-0087
Date: 1 Mar 2016
Coroner: S McGovern
Area: Warwickshire
Responses identified: 0 / 1
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A local authority failed to act on an urgent GP referral for a patient assessment, leading to a significant one-week delay before a social worker visit.
Date
1 Mar 2016
56-day deadline
26 Apr 2016 est.
Responses identified
0 of 1
Coroner's concerns
A local authority failed to act on an urgent GP referral for a patient assessment, leading to a significant one-week delay before a social worker visit.
View full coroner's concerns
The local authority failed to act on an urgent referral from & GP GP) visited Mvr Embra at his home on 9 March 2015 and contacted the local authority asking for an urgent assessment On 16 March he made a written referral to the local authority asking for an urgent assessment preferably that There was an approximately week delay before a Social Worker visited Mr Embra_
Report sections
Investigation and inquest
On 27 November 2015 commenced an investigation into tne death of Peter Embra. The investigation concluded at the end of the inquest on March 2016. The conclusion of the inquest was a Narrative Verdict (Copy attached)
Circumstances of the death
See Narrative Verdict
Action should be taken
In my opinion action should be taken t0 prevent future deaths and believe you as Chief Executive of Wanwvickshire County Councii have the power to take such action:
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Report details
- Reference
- 2016-0087
- Date of report
- 1 March 2016
- Coroner
- S McGovern
- Coroner area
- Warwickshire
Responses identified
Responses identified
0 of 1
1 response not yet linked
Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 26 Apr 2016 (estimated).
Sent to
- Warwickshire County Council