Source · Prevention of Future Deaths

Nathaniel Phillips

Ref: 2015-0375 Date: 13 Oct 2015 Coroner: Joanne Kearsley Area: Manchester (South) Responses identified: 1 / 1 View PDF

Brittle asthma, a life-threatening condition, is not covered by medical exemption certificates, causing patients to miss medication due to cost and preventing GPs from escalating care.

Date 13 Oct 2015

56-day deadline 7 Dec 2015

Responses identified 1 of 1

Community health care and emergency services related deaths

Coroner's concerns

AI summary

Brittle asthma, a life-threatening condition, is not covered by medical exemption certificates, causing patients to miss medication due to cost and preventing GPs from escalating care.

View full coroner's concerns

One of the concerns raised by the family and the GP was that & diagnosis of brittle asthma is not oe of the illnesses covered by the medical exemption certificate, despite the fact that it is life-threatening condition requiring medication. It was confirmed that illnesses such as diabetes and epilepsy which require continuous medication are covered_ As indicated earlier due to the cost of his constant medication Nathaniel did not always collect regular prescriptions and relied on family members asthma medication. This meant his GP did not escalate his case or reassess his requirements and asthma control.

Responses

1 respondent

Department of Health Central Government

13 Oct 2015 PDF

Noted

The Department of Health acknowledges the coroner's concerns regarding brittle asthma not being covered by medical exemption certificates. It explains existing routes to exemption and refers to GMC guidelines on prescribing. (AI summary)

View full response

Rt Hon Alistair Burt MP Minister of State for Community and Social Care Department of Health Richmond House 79 Whitehall London SWIA 2NS Tel: 020 7210 4850 Miss J. Kearsley, 0 DEC 2015 Area Coroner; Coroner's Court 1 Mount Tabor Street Stockport SKI 3AG Dew M.s kcw - Thank you for your letter of 13 October 2015, following the inquest into the death of Nathaniel Phillips. I was sorry to hear of Mr Phillips' death and wish to extend my condolences to his family. The main issue of concern in this case was raised by the family and GP. A diagnosis of brittle asthma is not one of the illnesses covered by the medical exemption certificate, despite the fact it is a life-threatening condition requiring medication: You noted that illnesses such as diabetes and epilepsy which require continuous medication are covered. The second concern is that the GP did not escalate Mr Phillips case or reassess his requirements and asthma control. The list of medical conditions for which patients are exempt from prescription charges was introduced in 1968, with the only addition to this list since then cancer (in 2009). Ten conditions are included in this list. [ believe; it would be unfair to sufferers from other diseases to consider asthma in isolation. However; extending the list to include all potentially life-threatening term conditions would present a very significant cost to the NHS, which is already unprecedented budget pressures. There are, however; already a number of other routes to exemption from paying prescription charges, should the individual not qualify for a medical exemption These include children under 16, people aged 60 or over and those in Nes being long facing

receipt of certain means tested benefits, leading to around 90% ofall prescription items in England currently being dispensed without a prescription charge. Anyone on a low income, and not in receipt of benefits which provide automatic entitlement; can seek help under the NHS Low Income Scheme, which provides help with health costs on an income-related basis. The level of help available is based on comparison between a person'$ income and requirements at the time a claim is received, or at the time a charge was where a refund is claimed: To assist those who do have to pay, but who have a term condition or on occasion may require a high number of prescribed items, Prescription Prepayment Certificates (PPCs) are available. The cost of annual and 3-month certificates is €104 and E29.10 respectively: There is no limit to the number of items that can be obtained through a PPC. The annual certificate benefits anyone needing more than 12 items a year; and the 3 month certificate benefits anyone needing more than 3 items in that 3 month period PPCs can be obtained by calling 0845 850 0030 (local rates) , online through the NHS Business Services Authority'$ website (wwwnhsbsa nhs uk) or by post. The application form FP9S is available pharmacies. The second concern relates to the GP'$ care and management of Mr Phillips. There appears to have been a lack of 'monitoring and re-assessment of Mr Phillips by the GP. It also appears that Mr Phillips presentations to the local emergency department following acute asthma attacks in January and February 2015, were not made known to his GP. If such information had been shared this should have initiated a review of Mr Phillips' condition by the GP. Furthermore; it is not clear whether any attempt was made to advise Mr Phillips how he could obtain help to pay for his medication. Inote that you did not send a copy of your Regulation 28 letter to the GP Practice concerned: [ would be happy for you to send a copy of our reply to the GP Practice and trust that this will prompt them to review their patient care and prescribing practice in light of this case. More generally however; the General Medical Council (GMC) helps to protect patients and improve medical education and practice in the UK by setting standards for students and doctors. For example, doctors providing clinical care are expected to adhere to the following principles: paid long from

Department of Health prescribe or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient 's health, and are satisfied that the or treatment serve the patient'$ needs provide effective treatments based on the best available evidence check that the care or treatment you provide for each patient is compatible with any other treatments the patient is receiving, including (where possible) self prescribed over-the-counter medications: Good practice in prescribing and managing medicines and devices (2013) provides more detailed advice to doctors on how to comply with the above principles when prescribing and managing medicines and medical devices, including appliances. A copy of this document is available on the GMC website. Within the is a section on Reviewing medicines and Repeat prescribing and prescribing with repeats which provides clear guidelines for doctors on the effective management of for their patients (relevant excerpts are included at Annex A) L am grateful to you for bringing the circumstances of Mr Phillips' death to my attention and hope that you find this reply helpful. Yuw 6 ,1 ccs (k(: (+t ALISTAIR BURT drugs drugs guide drugs -

Report sections

Investigation and inquest

On the 29th September 2015 [ concluded the Inquest into the death of Nathaniel Luke Phillips born on the 18th 1990 who died on the 15th April 2015 at Tameside General Hospital. The cause of death was confirmed as Hypoxic Brain Injury due to 1b) Acute Asthma Attack CIRCUMSTANCES OF THE DEATH The circumstances of Nathaniels' death are as follows: During the course of the Inquest the Court heard evidence number of witnesses including Nathaniels' Mother and also his General Practitioner Nathaniel had been diagnosed with asthma as a child. He had diagnosis of brittle asthma: For reasons which were unclear and which are currently reviewed by his GP Nathaniel seems to have been lost to Adult Asthma Services Once he was old for the Paediatric services. He was last seen in his GP practice in April 2014. His last prescription for his asthma medication was issued in July 2014. In January and February 2015 Nathaniel presented twice to the emergency department following an acute exacerbation of his asthma. The Court heard that the reason Nathaniel did not collect any prescriptions for his asthma medication was because of the cost of the regular prescriptions this time he used inhalers which were prescribed to family members, several of whom were on the same medication_ However the evidence from his GP confirmed that the lack of prescriptions issued meant that this indicated to them that Nathaniel was not requiring medication and that his asthma was therefore controlled. It was confirmed that if the accurate situation had been known this may_have led to an increase or May a) from being too During being alteration of his asthma medication; On the 13th April 2015 at 23.42 hours Nathaniel called an ambulance as he was having an acute exacerbation ofhis asthma. The Court heard his call to the ambulance service which he was able to and provide all the requested information. As a result ofthe information provided the call was classed as requiring an ambulance within 20 minutes (according to local protocols) Unfortunately there were no ambulances available. At 00.13 hours Nathaniel makes a second call to the ambulance service; in this call his condition has clearly deteriorated. The Call handler the ambulance service correctly increases the response code to a code red (requiring an ambulance within minutes) Again there were no ambulances available and it was not until 00.22 that an ambulance was allocated. At this time; Nathaniels girlfriend arrives at the property and upon seeing Daniel speaks to the call handler who is still on an open telephone line and says that she is going to take Nathaniel in the car to the hospital. She is advised that an ambulance is now on its way but decides to take him: Whilst enroute Nathaniel collapses in the car: At hospital it is confirmed that he has suffered a severe lack of oxygen to his brain. CORONER'S CONCERNS One of the concerns raised by the family and the GP was that & diagnosis of brittle asthma is not oe of the illnesses covered by the medical exemption certificate, despite the fact that it is life-threatening condition requiring medication. It was confirmed that illnesses such as diabetes and epilepsy which require continuous medication are covered_ As indicated earlier due to the cost of his constant medication Nathaniel did not always collect regular prescriptions and relied on family members asthma medication. This meant his GP did not escalate his case or reassess his requirements and asthma control. ACTION SHOULD BE TAKEN In my opinion action should be taken to prevent future deaths and | believe you have the power to take such action: YOUR RESPONSE You are under a duty to respond to this report within 56 days of the date of this report;, namely by 7 December 2015. I, the coroner; may extend the period. Your response must contain details of action taken or proposed to be taken, setting out the timetable for action. Otherwise you must explain why no action is proposed. COPIES and PUBLICATION during speak from have sent a copy of my report to the Chief Coroner and to the following Interested Persons namely, the family of Nathaniel Phillips. am also under a duty to send the Chief Coroner a copy of your response_ The Chief Coroner may publish either or both in a complete or redacted or summary form. He send a copy of this report to any person who he believes may find it useful or of interest You may make representations to me, the coroner; at the time of your response, about the release or the publication of your response by the Chief Coroner 13.10.2015 (Ium1 Joanne Kearsley HM Area Coroner may

Circumstances of the death

The circumstances of Nathaniels' death are as follows: During the course of the Inquest the Court heard evidence number of witnesses including Nathaniels' Mother and also his General Practitioner Nathaniel had been diagnosed with asthma as a child. He had diagnosis of brittle asthma: For reasons which were unclear and which are currently reviewed by his GP Nathaniel seems to have been lost to Adult Asthma Services Once he was old for the Paediatric services. He was last seen in his GP practice in April 2014. His last prescription for his asthma medication was issued in July 2014. In January and February 2015 Nathaniel presented twice to the emergency department following an acute exacerbation of his asthma. The Court heard that the reason Nathaniel did not collect any prescriptions for his asthma medication was because of the cost of the regular prescriptions this time he used inhalers which were prescribed to family members, several of whom were on the same medication_ However the evidence from his GP confirmed that the lack of prescriptions issued meant that this indicated to them that Nathaniel was not requiring medication and that his asthma was therefore controlled. It was confirmed that if the accurate situation had been known this may_have led to an increase or May a) from being too During being alteration of his asthma medication; On the 13th April 2015 at 23.42 hours Nathaniel called an ambulance as he was having an acute exacerbation ofhis asthma. The Court heard his call to the ambulance service which he was able to and provide all the requested information. As a result ofthe information provided the call was classed as requiring an ambulance within 20 minutes (according to local protocols) Unfortunately there were no ambulances available. At 00.13 hours Nathaniel makes a second call to the ambulance service; in this call his condition has clearly deteriorated. The Call handler the ambulance service correctly increases the response code to a code red (requiring an ambulance within minutes) Again there were no ambulances available and it was not until 00.22 that an ambulance was allocated. At this time; Nathaniels girlfriend arrives at the property and upon seeing Daniel speaks to the call handler who is still on an open telephone line and says that she is going to take Nathaniel in the car to the hospital. She is advised that an ambulance is now on its way but decides to take him: Whilst enroute Nathaniel collapses in the car: At hospital it is confirmed that he has suffered a severe lack of oxygen to his brain.

Action should be taken

In my opinion action should be taken to prevent future deaths and | believe you have the power to take such action:

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Report details

Reference: 2015-0375
Date of report: 13 October 2015
Coroner: Joanne Kearsley
Coroner area: Manchester (South)

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: 7 Dec 2015.

Sent to

Department of Health and Social Care

Source links

Judiciary.uk page → Report PDF →

Data: judiciary.uk under OGL.