PFD report

Andrew Ralph Mitchell Farrow · Prevention of Future Deaths report

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Issued 20 Apr 2015•Wiltshire and Swindon

Report record

Published report and response evidence

This page connects the concerns raised in this report with statements found in recipients’ published responses. A link shows a clear evidence connection; it does not assign responsibility.

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Concerns
1

Raised in this report

Recipients
2

Named on the report

Responses found
1

Of 2 recipients

Stated actions
2

Described in responses

Recipients and published responses

Source document

Full report text

This is the full text from the original published report.

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Concerns and recipient responses

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Concerns raised1

  1. Unavailability of hospital beds for patients requiring admission at Green Lane Hospital Devizes
    Part of recurring concern: Failure to provide timely hospital admission
Responses linked to these concerns

Each statement is shown once, even when linked to more than one concern.

Actions described in response An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised.2

  1. Action

    Monitor bed pressures and out-of-area placements.

    Stated by Avon and Wiltshire Mental Health Partnership NHS TrustStated completedThe respondent said that this action was complete when they made their response on 20 April 2015.
  2. Action

    Work with commissioners and NHS England to manage bed pressures and out-of-area placements.

    Stated by Avon and Wiltshire Mental Health Partnership NHS TrustStated in progressThe respondent said that this action was in progress when they made their response on 20 April 2015.

Source evidence

How this individual concern was interpreted

PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.

PFD Monitor interpretation

Unavailability of hospital beds for patients requiring admission at Green Lane Hospital Devizes

Wider context from the report

“He was known to have suicidal ideation but no actual plan had been formulated. I did not find that he ought to have been admitted. My concern however is that had he needed admitting it is apparent no beds would have been available at Green Lane Hospital Devizes when an enquiry was made on 6 July 2014 by North Wiltshire Intensive Services. ”

Is this part of a recurring concern?

Yes — Failure to provide timely hospital admission.

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Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Monitor bed pressures and out-of-area placements.

Verbatim wording from the response

“When there is a bed pressure in a locality, clinical staff may take a number of different actions, depending upon the requirements of the individual patient. These actions may include seeking alternatives to admission such as intensive home treatment, seeking an bed in another part of the Trust, making a bed available by seeing if there are patients who need to be discharged, or sending a patient out of the Trust’s area. The decision is always risk based, and takes account as far as is possible the wishes of the patient and their family. When a patient is sent out of area, every effort is made to repatriate them locally as soon as it is possible and in their best interests to do so. The Trust Board closely monitors bed pressures and out of area placements and is continually working with its Commissioners and NHS England to manage the situation optimally.”

Source location

2015-0147-Response-by-Avon-and-Wiltshire-NHS-Trust
Page 1 · response
Published 20 April 2015

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Source evidence

How this respondent action was interpreted

PFD Monitor created a concise, searchable interpretation from the published response wording shown below.

PFD Monitor interpretation

Work with commissioners and NHS England to manage bed pressures and out-of-area placements.

Verbatim wording from the response

“When there is a bed pressure in a locality, clinical staff may take a number of different actions, depending upon the requirements of the individual patient. These actions may include seeking alternatives to admission such as intensive home treatment, seeking an bed in another part of the Trust, making a bed available by seeing if there are patients who need to be discharged, or sending a patient out of the Trust’s area. The decision is always risk based, and takes account as far as is possible the wishes of the patient and their family. When a patient is sent out of area, every effort is made to repatriate them locally as soon as it is possible and in their best interests to do so. The Trust Board closely monitors bed pressures and out of area placements and is continually working with its Commissioners and NHS England to manage the situation optimally.”

Source location

2015-0147-Response-by-Avon-and-Wiltshire-NHS-Trust
Page 1 · response
Published 20 April 2015

Open published response
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Information checked against the published report and official responses · Data reviewed 7 Sep 2026 · About data quality and limitations

Data last updated 7 September 2026