Dear Dr Montacute,

I write further to your email of 27 January 2019 in which you raised continued concerns regarding the care and treatment that your late mother, Julie Montacute, received from Somerset Partnership NHS Foundation Trust in February 2018.

Your email was forwarded to Alison van Laar, Operational Service Manager for the Somerset Liaison Psychiatry Service, who has carried out a thorough investigation and I am now able to provide you with the following response to your concerns.

I will endeavour to answer your concerns as factually as I can. However, it is not without acknowledgement of the context in which you write and I offer my continued condolences for the loss of your mother.

There is no record of drowsiness in the psychiatric case notes but the investigating manager advised that psychiatric liaison staff would not have had access to the level of detail about your mother’s manner of driving which was available at the Coroner’s hearing at the time of their assessment.

The nursing staff telephoned and spoke with a member of the Bath and North East Somerset (BANES) crisis team who gave a short history of your mother’s contact with the mental health services. This included a diagnosis of mixed depressive/anxiety disorder. 13 days prior to her attendance at Musgrove Park Hospital Emergency Department it was apparent that the BANES team had assessed your mother to be at low risk of harm to self and/or others. Psychiatric liaison staff were also informed that your mother’s partner had contacted the BANES team earlier on the day she was being seen by them at Musgrove Park Hospital to report her missing. This was all of the information that was made available to the Somerset service at the time of the assessment, it is not possible for Somerset staff to access BANES clinical records electronically and so in these circumstances they are reliant on relevant information being shared by the patients’ local service. The staff that completed the assessment are experienced in Emergency Department psychiatric liaison and associated risk assessment; it is clear that they based their conclusion on your mother’s presentation at the time, the available information from the BANES service, and from her partner.

The psychiatric liaison staff checked with your mother and her partner if they had any concerns with the outcome of the assessment or the ongoing plan. I appreciate your point about your mother not always having been candid in the past, but with the information available in the context of an Emergency Department consultation this was a reasonable question to ask and for the response to be considered alongside other available information.

The investigating manager, who is also a senior clinician in liaison psychiatry has concluded that the nursing staff made an appropriate assessment of your mother upon which a plan was devised in conjunction with her and her partner.

Each patient that presents to the team undergoes a full psychosocial assessment and further information is sought from appropriate services whenever available.

The Trust had a member of the senior management team in attendance at the Coroner’s hearing and he reported that no concerns were raised by the Coroner regarding the clinical assessment or the practice of staff.

The investigating manager found no indication of the nurses requiring any further training or support.

In terms of professional regulation the investigating manager could not identify any Fitness to Practice concerns with either of the nursing staff involved in your mother’s mental health assessment.

We would very much like the opportunity to meet with you to discuss your experiences in further detail and for you to meet with representatives from the team together with Paul Milverton, Associate Director of Mental Health and Learning Disabilities Care. If you would like to have this opportunity, please do not hesitate to get in touch with Julie Browne, Complaints and PALS Manager on 01278 432022 or email julie.browne@sompar.nhs.uk

I hope that my letter has addressed your complaint and offered you reassurance that we have taken your concerns seriously.  We aim to investigate all complaints thoroughly and provide a full explanation of any issues raised in order to resolve concerns.

Finally, I would like to take this opportunity to thank you for contacting us especially given the sad circumstances.  The opinions of those who use our services do give us valuable insight and an opportunity for us to review our services and practice as we strive for continual improvement. Thank you for taking your time to share your concerns with us, I recognise that this was likely very difficult for you, and for helping us to improve our services for all our patients.

Yours sincerely

HAYLEY PETERS

Chief Nurse