Mohamed Ellaboudy
30 Apr 2024 · Coroner Heidi Connor · Berkshire
The coroner's concerns
1. care coordination failure
“systems are in place for sufficiently robust care coordination for patients who have been discharged from a mental health setting, particularly in the context of detained/recently detained patients”
2. telephone-only appointments
“Reliance on telephone rather than face to face appointments”
3. inconsistent MDT meeting schedule
“Regularity / thresholds for MDT discussions”
4. family reporting barrier
“Absence of a clear route for family to report concerns, even where a patient does not wish confidential information to be given to their family”
5. lack of discharge correspondence
“Policy / expectation for correspondence with primary care, particularly in the time after discharge from hospital”