IN THE SHERIFFDOM OF LOTHIAN AND BORDERS AT EDINBURGH
COURT REF: EDI-B1740-24
RESPONSE
to the
DETERMINATION OF SHERIFF WALLS
UNDER THE INQUIRIES INTO FATAL ACCIDENTS AND SUDDEN DEATHS ETC. (SCOTLAND) ACT 2016
On behalf of
MANSFIELD CARE LIMITED
In the Inquiry into the death of
ANNE AMOS

TO: The Scottish Courts and Tribunals Service

1. Mansfield Care Limited, being a person to whom a recommendation under section 26(1)(b) was addressed, do respond as follows.

2. Mansfield Care Limited was a participant in the Inquiry.

3. In terms of section 26 (1)(b) the Sheriff made the following recommendations:

(i) That any pre-admission form designed to elicit information regarding a resident’s care needs, issued to the family or legal guardian of a resident, contains a series of questions, worded in laypersons’ language, sufficient to highlight the presence or potential risk of dysphagia or choking.
(ii) That a choking policy and pathway is put in place to identify and manage symptoms of dysphagia and the risk of choking, and that appropriate staff training is given in relation to any such policy and pathway.

4. In relation to (i), Mansfield Care Limited have introduced a comprehensive pre-admission form which is in plain and straightforward terms. It includes a section specific to “choking risk” with a list of questions to be considered in addressing the risk or potential risk for the resident associated with choking. It seeks details of inter alia previous choking episodes, any support required, level of supervision required, any swallowing difficulties and Speech and Language Therapy (SALT) input. In addition, there are sections in relation to cognitive abilities, communication and eating and drinking which are all of direct relevance to choking risk within the care context. A copy of the revised form is appended to this response.

5. Mansfield Care had developed a choking policy in advance of the recommendations being made. A copy is appended to this response. The choking pathway is in the process of being developed. The pathway has been internally peer reviewed. SALT pathways however vary from one local authority area to another. Care home support provision also varies according to local authority areas. These matters are determined by the availability of government funding. Accordingly, and recognising the complexities associated with all of that relevant to ensuring a pathway aligns with those provisions, Mansfield Care have sought input from external stakeholders. Those stakeholders include the NHS, SALT, East Lothian Care Home Support Team, Borders Care Home Support Team, the Scottish Care Collaborative group and the Scottish Care Strategic Nursing group. They continue to await some feedback. In that connection, there are two possible pathway routes one which involves the use of “LiveVac” and one without. The pathway ultimately adopted will be dependent on the feedback received. Feedback from NHS indicates reticence around using such a tool with competing views as to whether it is a tool of first or last resort, and with some professionals considering it may delay CPR initiation in the event of arrest. At the current time, LifeVac equipment is not being used by Mansfield Care. They continue to consult with relevant authorities and other professional colleagues in care with a view to finalising their future approach.

6. All staff have been trained in recognising and responding to choking risks. They have immediate real-time access to all care plans which are continually reviewed. First aid training for staff supports immediate action in choking intervention. They will receive further training at appropriate intervals with training aligned with Mansfield Care’s procedures and policies.

IN RESPECT WHEREOF
Clare L Crawford
Solicitor Advocate
For Mansfield Care Limited

Pre Admission Form

Choking Policy