A coroner has urged the North West Ambulance Service (NWAS) to take action after it declined to attend a welfare call to an elderly resident who was later found dead. NWAS has defended the decision as appropriate, stating that the woman's location could not be determined, nor whether there was a confirmed medical need.
72-year-old Lesley Higginson was found dead at her home in Appleton near Warrington on January 18 this year, according to a prevention of future deaths report.
Background and welfare checks
In the report, senior coroner for Cheshire Jacqueline Devonish detailed how Ms Higginson was a 'medically vulnerable adult' who was under a programme of 'remote welfare checks'. She wished to remain in her own home and did not wish to be attended by carers, instead receiving a package of care which included medication management through the Medication Support Company, and the 'Okay Each Day' service.
Carried out by company Alertacall, this was used to establish remote and daily contact with Ms Higginson through a call button service - but Alertacall had been 'unable' to speak to her on the weekend she died. A new medication safe and computer screen had also been installed on January 13. She had not answered the calls on January 16, resulting in a medication support worker visiting her home when she was present.
Events leading to death
The next day the medication team were not able to get in touch with her, which triggered an escalation visit after 24 hours of no contact as per policy, with a neighbour asked to check on her, but no contact could be established.
"The police declined attendance for a welfare call," the report said. "The ambulance service accepted the welfare call initially but later called back rejecting the request to attend, stating it was not their policy to accept welfare checks if there is no confirmation someone is in the property."
The same neighbour who conducted the welfare check 'reported having seen Ms Higginson out that day', after which the escalation was closed. On January 18 there was once again no answer from Ms Higginson and the emergency services were called again, after a neighbour reported seeing a 'foot on the floor' through the window.
"The ambulance service arrived at 12:34, and entry was forced by the Cheshire Fire and Rescue Service, finding Mrs Higginson deceased on her bed, and confirmed her death at 13:03," the report stated.
Coroner's concerns and NWAS response
Ms Devonish said that there was a 'risk that future deaths could occur'. "It is important to know whether there is an established policy for declining welfare calls," she wrote. "The Right Care, Right Person, policy states that the police in Cheshire will not respond to welfare check calls when healthcare are best placed to support those who may be in crisis. It is unclear whether a request for a welfare check is to be deemed to be healthcare related and whether the ambulance service properly rejected the request."
But in their response, the chief executive of NWAS defended the service's actions, saying that their response had been correct according to guidelines. "When the emergency call was made on January 17, the caller was advised that there was 'a 1 hour 20 minute to 1 hour 50 minute response time," their response read. A paramedic called back at 3:30pm and advised that 'due to the location of Ms Higginson being unknown and a medical need for an ambulance also being unknown, an ambulance would not be deployed'.
"Guidelines provide that the patient’s location needs to be known and there needs to be a confirmed medical need," the response said. "NWAS need a verified location and assurance that a patient is indeed present at the specified location. NWAS does not have the legal powers, nor the equipment, to force entry to properties. Our primary function is to prioritise and respond to the medical needs of our patients. It cannot be assumed that an individual being uncontactable, means that they require medical assistance. Nor do NWAS have the capacity to conduct thorough enquiries to determine whether an individual is experiencing physical or mental health concerns."
The response continued that the service's lead for mental health and suicide prevention had listened to the 999 calls and confirmed that the call on January 17 'was handled appropriately and in line with the Concern for Welfare policy'. "It could not be determined that Ms Higginson was at the specified location or that she had a confirmed health complaint," it concluded. "It was therefore correct that NWAS did not deploy an ambulance to Ms Higginson based on the information provided at the time of the call."
