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recurance

Emily Sims

9 Oct 2019 · Coroner Guy Davies · Cornwall and the Isles of Scilly

The coroner's concerns

  1. 1. care plans not updated to reflect changing needs

    “The lack of updating of care plans to reflect changing needs and how to manage changing needs”
  2. 2. care plans lack reference to multidisciplinary meetings

    “The lack of updating of care plans to include reference to multi- disciplinary meetings or care needs meetings and decisions taken to manage changing needs”
  3. 3. inadequate equipment provision

    “The lack of the provision of appropriate equipment such as adjustable beds to address changing needs”
  4. 4. lack of specialist advice access

    “The lack of the provision, or access to, specialist advice from occupational therapists and physiotherapists to assist with measures to address changing needs”
  5. 5. inadequate moving and handling training

    “The lack of appropriate training regarding the use of equipment and moving and handling”

Responses

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  • Next.js site

Source: Prevention of Future Deaths reports and responses published by the Courts and Tribunals Judiciary at judiciary.uk. Crown copyright, used under the Open Government Licence v3.0. Data updated 26 Oct 2026.

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