Learning from Preventable Deaths (submission to Health and Social Care Committee's Prevention Inquiry, Richards et al.)

Summary

In January 2023, the Health and Social Care Select Committee opened an inquiry into Prevention.

An interdisciplinary group of six academics, clinicians, and a coroner from the University of Oxford, the University of Birmingham, and London made a submission to that inquiry. They made their submission to the Prevention inquiry after reading and analysing more than 4,000 PFDs and working with coroners and bereaved families, which has highlighted that more must be done in health and social care to learn lessons from preventable deaths.

Their full submission has now been published which included a table summarising 12 of their research studies relating to preventable deaths and providing recommendations.

We have extracted the table which highlights several patient safety concerns and system safety recommendations.

Content

About the author

Dr Georgia Richards is a Health Scientist and Epidemiologist that has been leading and conducting work on Prevention of Future Deaths reports (PFDs) and the Preventable Deaths Tracker (https://preventabledeathstracker.net/) for more than five years, including completing a Doctor of Philosophy (DPhil/PhD) at the University of Oxford on preventable deaths involving opioids.

Dr Jeffrey Aronson and Professor Robin Ferner are Clinical Pharmacologists that have acted as expert witnesses in coronial courts and other legal cases for decades.

Dr Richard Brittain is a medically trained Assistant Coroner that has professional experience writing PFDs in practice and has been contributing to our research.

Professor Anthony Cox is a Clinical Pharmacist and Head of the School of Pharmacy at the University of Birmingham with extensive research experience on drug safety and PFDs.

Professor Carl Heneghan is an NHS urgent care general practitioner, Clinical Epidemiologist and Director of the Centre for Evidence-Based Medicine at the University of Oxford with decades of experience synthesising evidence on excess and preventable deaths.