James Adams
7 Aug 2015 · Coroner Emma Carlyon · Cornwall and the Isles of Scilly
This report repeats 1 earlier warning, and was raised again 3 times later. See the linked reports.
The coroner's concerns
1. lack of acute psychiatric beds
“lack of acute psychiatric beds" in Cornwall”
Linked reports
Identical hazardConfidence 0.90 · high
Earlier report
“It was established in evidence that Mr [name redacted] death was not caused by the lack of an acute psychiatric bed.”
This report
“One continuing difficulty was the "lack of acute psychiatric beds" in Cornwall.”
Identical hazardConfidence 0.90 · high
This report
“One continuing difficulty was the "lack of acute psychiatric beds" in Cornwall.”
Later report
“there was a national shortage of acute mental health beds necessitating the use of out of county placements for patients requiring hospitalization for their mental health treatment”
Closely relatedConfidence 0.92 · high
This report
“One continuing difficulty was the "lack of acute psychiatric beds" in Cornwall.”
Later report
“at the time of [the deceased] ligaturing in May 2019 there was an national shortage of acute pyschiatric beds to treat patients in the community suffering with mental disorder of a nature or degree which necessitated immediate assessment treatment and care as an inpatient”
Identical hazardConfidence 0.90 · high
This report
“One continuing difficulty was the "lack of acute psychiatric beds" in Cornwall.”
Later report
“There appear to be insufficient beds available in psychiatric units to meet patient demand.”
Responses
2015-0315-Response-by-NHS-England.pdf ↗· Curnow Commissioning Group and NHS England
James-Adams-Response.pdf ↗· Department of Health and Social Care
Stated action
“Kernow CCG has agreed to carry out a full review both of acute psychiatric beds in Cornwall and the staffing of the place of safety service and will produce an action plan and commissioning strategy”