Source · Investigations in the NHS

Independent investigation into the care and treatment of patient K: November 2015

Midlands Published 01 Nov 2015 Trust South Staffordshire and Shropshire Healthcare NHS Trust

Index summary

Patient K was convicted of the murder of Jane Edwards. At the time of the death patient K was under the care of South Staffordshire Shropshire Healthcare NHS Foundation Trust. The following action plan from South Staffordshire and Shropshire Healthcare NHS Foundation Trust is available.

Recommendations

3 total

Action plan published. Per-recommendation responses have not yet been extracted from the action plan. View action plan

1 Addressed to: the trust Action Plan Published

Link to recommendation 1

Recommendation · source text
In future, the trust should conduct a full case review as part of the transfer of care when it accepts a patient from a high secure setting. This case review should not simply accept the existing diagnosis but should challenge and review the diagnosis, treatment plans and the need for on-going forensic input.
2 Addressed to: The trust Action Plan Published

Link to recommendation 2

Recommendation · source text
The trust should finalise the “Recovery: Service Development and Improvement Support Worker Guide for Divisions and Directorates” policy and the planned pilot to evaluate it.
3 Addressed to: The trust Action Plan Published

Link to recommendation 3

Recommendation · source text
The trust should develop a system for monitoring investigation teams to ensure there are adequate resources to conduct the work identified in the Incident, Near Miss and Serious Incident Policy.

Acceptance status

Per recommendation
Action Plan Published
3

Total recommendations
3
About this data

Acceptance status records the published response to each recommendation. Acceptance does not establish that an action has been completed.

Independent health investigation reports and reviews commissioned by government or NHS England.

About this investigation

Source & metadata

Independent investigation report. Recommendations and any published response are extracted below.