William Sneddon, Lemond Milroy, David Brodie McFarlane and Agnes McCoull

When corresponding with patients or their relatives in relation to concerns expressed about their care in hospital the Trust should be careful to distinguish between medical treatment, nursing care and other concerns.

The management of the Trust and the senior medical management at Dumfries and Galloway Royal Infirmary should carry out an urgent and thorough review of the practices and procedures at the Infirmary in relation to the need to ensure that the wishes of relatives in relation to a post mortem, particularly following an unexplained death, are ascertained and recorded.

Recommendation The management of the Trust and the senior medical and nursing management at Dumfries and Galloway Royal Infirmary should carry out an urgent and thorough review of the practices and procedures at the Infirmary in relation to the fasting of patients to ensure that such fasting does not extend beyond what is medically necessary.

The management of the Trust and the senior medical management at Dumfries and Galloway Royal Infirmary should carry out an urgent and thorough review of the practices and procedures at the Infirmary in relation to the need to ensure that radiologist's reports are seen by the clinician who has viewed and interpreted any xray with particular reference to • The identification of any person who instructs any action in relation to such reports • Any need, whether caused by a shortage of medical beds or otherwise, for the discharge of patients before such reports are available

Recommendation The management of the Trust and the senior medical management at Dumfries and Galloway Royal Infirmary should carry out an urgent and thorough review of the practices and procedures at the Infirmary in relation to the provision of staff in the High Dependency Units at the Infirmary to avoid their closure in circumstances where, but for any shortage of staff, patients would have remained there.