Sheffield City Council has made changes to its City Wide Care Alarm (CWCA) service after an 89 year-old man died at his home waiting for a response team.
A coroner’s report, published last week, revealed that Allan Shepard fell at home on February 8 last year whilst being assisted out of his wheelchair, in a hoist, by his son.
His son alerted the CWCA to seek assistance and the call was logged for a responder to attend within 30 minutes. However, one of the crews covering the city had only one responder on duty, rather than the usual two, and a CWCA policy prevented that responder from attending the call alone.
Because of this, the operator allocated the fall to the ambulance service, which had a four-hour wait time.
Whilst Mr Shepard was waiting, trapped in his hoist, for assistance, he ran into breathing difficulties. His son communicated this to the operator and the call was given a higher priority by the ambulance service. But by the time the ambulance crew attended the address, Mr Shepard had already lost consciousness, and he died in hospital later that day.
Angharad Davies, assistant coroner for South Yorkshire, concluded that the death could have been prevented and that there is a risk of future deaths unless action is taken by CWCA.
In a letter sent to John Mothersole, CEO of Sheffield City Council, she said: “This 50% reduction in responders available to answer calls may risk future deaths when a person has suffered a fall. Therefore, City Wide Alarm Service is invited to consider its staffing levels and systems for providing cover. It is also invited to consider its policy regarding one person responder units when the injured person is already attended by someone else who may be able to assist.”
She also noted in her letter, known as a Regulation 28 report, that the information provided to the call handling centre by CWCA about Mr Shepard and his family had not been updated since 2015 and it was not known that Mr Shepard’s son was visually impaired, making it harder to see the difficulty his father was in.
The report was dated October 23 last year but was only made public last week.
Phil Holmes, director of adult services at Sheffield City Council, said changes had been made to reflect the concerns raised in the report.
“The council is very sorry about the death of Mr Shepard and our thoughts remain with his family,” he told local news service, The Star.
“Our City Wide Care Alarm staff did the right thing by immediately contacting an ambulance once they were aware of the seriousness of the situation. The council has now updated procedures to ensure that, even if for any unforeseen reason only one worker is available for an urgent response, they will still visit in the event of a fall.
“Even though it won’t be safe for one person to attempt to move or lift an individual who has fallen, they can still help ensure that they remain comfortable until other support arrives. “This change was made from the beginning of January this year. City Wide Care Alarms are also ensuring that all information held about people supported is updated on at least an annual basis to help keep pace with any changing needs.”