Inadequate family communication and documentation
South London and Maudsley NHS Foundation Trust received 2 coroners' reports about this hazard between 6 Mar 2014 and 21 Mar 2018.
They came from 2 different coroners in 2 coroner areas. A similar concern was raised again 1 time after the first warning.
A published response was found for 1 of the 1 earlier reports, stating 0 specific actions.
The story, report by report
Spacing grows with the time between reports.
“Communications between staff and family were haphazard the policy of involving family in care planning was not clear.”
Original on judiciary.uk ↗ South London and Maudsley NHS Foundation Trust responded.Response (PDF) ↗
- 4 years laterClosely relatedConfidence 0.78 · moderatea different coroner
“That upon [the deceased]'s discharge into the care of his family, there should have been independent consultation with the family and this should have been documented with the tisks being explicitly discussed.”
Original on judiciary.uk ↗ Repeated from the earlier report:carefamily
The most recent report. A response may not be due or published yet.
- All reports to South London and Maudsley NHS Foundation Trust
Each row is one judged link between an earlier and a later report. Open a row to read both quotes, found word for word in the originals.
2014 → 2018Edward Lundy4 years after Natasha Raghoo · different coronerClosely relatedConfidence 0.78 · moderate
Closely relatedConfidence 0.78 · moderateBoth reports highlight problems with how the trust involves and communicates with families during patient care. The earlier report notes haphazard staff‑family communication and an unclear family‑in‑care‑planning policy, while the later report stresses the need for independent family consultation at discharge and proper documentation.
Natasha Raghoo · 6 Mar 2014
“Communications between staff and family were haphazard the policy of involving family in care planning was not clear.”
Original on judiciary.uk ↗ Edward Lundy · 21 Mar 2018
“That upon [the deceased]'s discharge into the care of his family, there should have been independent consultation with the family and this should have been documented with the tisks being explicitly discussed.”
Original on judiciary.uk ↗
No specific action could be extracted with a verified quote.
No published response from South London and Maudsley NHS Foundation Trust was found for this report. It is the most recent report, so a response may not be due or published yet.
- Each report's concerns were extracted by Nemotron 3 Nano on Nebius Token Factory, each with a quote copied from the report.
- Concerns from reports to South London and Maudsley NHS Foundation Trust at least six months apart were compared by meaning (Qwen3 embeddings) and wording (TF-IDF).
- The closest pairs were judged by Nemotron 3 Super with reasoning on. Only identical or closely related, with confidence of at least 0.70, are shown.
- Every quote was checked by code as an exact substring of the original text. Names of staff and family are redacted, and the deceased are named by report title only.
| Link | Meaning | Wording | Judge | Coroner |
|---|---|---|---|---|
| 2014 → 2018 | 0.67 | 0.06 | Closely related · 0.78 | different |
Judge model: nvidia/nemotron-3-super-120b-a12b. How Nemotron did the work · Full methodology.
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Other chains for South London and Maudsley NHS Foundation Trust
This shows that a similar concern was raised again after an earlier report. It does not say why, and it is not a finding about any organisation or person. To report an error, see the corrections route.