Jacqueline Anne Cobain · Prevention of Future Deaths report

Pin Get email alerts Request correction

Issued 25 Mar 2024•Inner South London

Published report and response evidence

This report’s concerns and statements found in recipients’ published responses. Statements are included even where no link to an individual concern is recorded. A link shows an evidence connection; it does not assign responsibility.

View original report
Concerns
2

Raised in this report

Recipients
1

Named on the report

Responses found
1

Of 1 recipient

Stated actions
1

Described in responses

Full report text

This is the full text from the original published report.

Open published report

Concerns and recipient responses

Select any concern, action or position to view the source wording.

Report evidence summary

Concerns raised2

  1. Failure of the questionnaire system to recognise cancelled assessment appointments
  2. Lack of a system or protocol for timely clinical review and escalation of concerning questionnaire responses when assessment appointments are delayed
    Part of recurring concern: Unreliable safety review and escalation when clinical appointments are delayed or cancelled

Stated actions An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised.1

  1. South London and Maudsley NHS Foundation Trust

    Update questionnaire practices and webform messaging to clarify that questionnaires are not for urgent support and provide routes to emergency mental-health help.

Respondent positions A position is what a recipient says about a concern when it does not describe a specific action.3

  1. South London and Maudsley NHS Foundation Trust

    Service capacity constraints prevent automatic follow-up of every cancelled appointment because this would delay assessments and potentially increase population risk.

    Unable to actThe respondent said that a constraint prevented them from taking the relevant action.
  2. South London and Maudsley NHS Foundation Trust

    PHQ-9 responses are not diagnostic or predictive of suicidality and should not be used as a suicide risk assessment.

    Disputes the concernThe respondent disagreed with part of the concern or the basis for it.
  3. South London and Maudsley NHS Foundation Trust

    Existing cancellation practices and repeated urgent-help information make it clinically reasonable not to chase patients who provide a good explanation and request rebooking.

    Existing arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.

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

Failure of the questionnaire system to recognise cancelled assessment appointments

Wider context from the report

“1. When Mrs Cobain cancelled her appointment scheduled for Monday 6 September 2021 by email on Saturday 4 September 2021, the system nevertheless generated an automatic questionnaire which is normally is sent 24 hours prior to a scheduled assessment appointment. The system had not recognised that Mrs Cobain had cancelled her appointment. She completed the questionnaire. 2. Mrs Cobain’s responses to the questionnaire contained what were accepted to be concerning responses. 3. Due to the cancellation the questionnaire was not reviewed by a clinician until after Mrs Cobain’s sad death. 4. Changes have been made to the protocols around cancellation, and language has been added to the assessment template. 5. However, there is no system or protocol to alert a clinician to review concerning responses and to consider appropriate next steps, where (outside the usual protocol and time frame of submission and review within 24 hours of the assessment appointment) the patient has completed the questionnaire, and for whatever reason, the assessment appointment with the clinician is not for a period of several days/weeks as was the case in Mrs Cobain’s case. ”

Is this part of a recurring concern?

No recurring-concern membership is currently published.

Open source report

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

Lack of a system or protocol for timely clinical review and escalation of concerning questionnaire responses when assessment appointments are delayed

Wider context from the report

“1. When Mrs Cobain cancelled her appointment scheduled for Monday 6 September 2021 by email on Saturday 4 September 2021, the system nevertheless generated an automatic questionnaire which is normally is sent 24 hours prior to a scheduled assessment appointment. The system had not recognised that Mrs Cobain had cancelled her appointment. She completed the questionnaire. 2. Mrs Cobain’s responses to the questionnaire contained what were accepted to be concerning responses. 3. Due to the cancellation the questionnaire was not reviewed by a clinician until after Mrs Cobain’s sad death. 4. Changes have been made to the protocols around cancellation, and language has been added to the assessment template. 5. However, there is no system or protocol to alert a clinician to review concerning responses and to consider appropriate next steps, where (outside the usual protocol and time frame of submission and review within 24 hours of the assessment appointment) the patient has completed the questionnaire, and for whatever reason, the assessment appointment with the clinician is not for a period of several days/weeks as was the case in Mrs Cobain’s case. ”

Is this part of a recurring concern?

Yes — Unreliable safety review and escalation when clinical appointments are delayed or cancelled.

Open source report

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

Update questionnaire practices and webform messaging to clarify that questionnaires are not for urgent support and provide routes to emergency mental-health help.

Verbatim wording from the response

“As you have noted, following the investigation into this very sad death, our Talking Therapies Services have made some changes to practices around these questionnaires. Our patient record system, IAPTUS, sends these questionnaires out in advance of an assessment appointment automatically via a webform. The use of these questionnaires as part of assessment is a nationally mandated requirement for all Talking Therapies Services. Patients receiving this webform from our Talking Therapies Services now receive a message which states the following:”

Source location

Response from South London and Maudsley NHS Foundation Trust
Page 2 · response
Published 26 March 2024

Open published response

Source evidence

How this respondent position was interpreted

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

PFD Monitor interpretation

Service capacity constraints prevent automatic follow-up of every cancelled appointment because this would delay assessments and potentially increase population risk.

Verbatim wording from the response

“In an average month, the Talking Therapies Southwark Service receives between 1100 and 1200 referrals and carries out approximately 800 assessments. In line with most primary care services, they have a relatively high rate of patient cancellations. In an extremely busy service such as this, resources are structured carefully to ensure first assessment appointments are offered as quickly as possible. As we have noted, scores such as Mrs Cobain’s on the PHQ-9 are common in self-referring patients and most will not be presenting with high risk. If the service were to follow up by telephone every cancelled appointment, this would have an inevitable impact on the speed with which assessment appointments could be offered. An increase in assessment waits would, we know from clinical experience, be more likely to increase risk to our population.”

Source location

Response from South London and Maudsley NHS Foundation Trust
Page 3 · response
Published 26 March 2024

Open published response

Source evidence

How this respondent position was interpreted

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

PFD Monitor interpretation

PHQ-9 responses are not diagnostic or predictive of suicidality and should not be used as a suicide risk assessment.

Verbatim wording from the response

“Mrs Cobain completed a number of short questionnaires. The questionnaire completed by Mrs Cobain which has caused some concern was the Patient Health Questionnaire-9. This is a measure used to give an indication of possible symptoms of depression experienced by an individual over the past two weeks. It is not a diagnostic tool nor is it a risk assessment. The questions are intended only to help inform and structure an in-person assessment. They are also used to provide a quantitative baseline against which progress in later treatment can be measured. Clinical research indicates that these types of measures have no predictive value as an assessment of suicidality and, indeed, recently published NICE guidance confirms that they must not be used in this way.”

Source location

Response from South London and Maudsley NHS Foundation Trust
Page 2 · response
Published 26 March 2024

Open published response

Source evidence

How this respondent position was interpreted

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

PFD Monitor interpretation

Existing cancellation practices and repeated urgent-help information make it clinically reasonable not to chase patients who provide a good explanation and request rebooking.

Verbatim wording from the response

“This message now makes it very clear that the service does not provide urgent help in an emergency and gives advice as to how this type of help can be accessed. Information around how to access urgent or emergency help is repeatedly provided to patients including at the time of booking an appointment and with appointment confirmation documents.”

Source location

Response from South London and Maudsley NHS Foundation Trust
Page 2 · response
Published 26 March 2024

Open published response
Back to top

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

Official responses located
1/1

Data last updated 7 September 2026