PFD report

Christopher Michael Lloyd · Prevention of Future Deaths report

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Issued 26 Aug 2022•Manchester South

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
1

Named on the report

Responses found
1

Of 1 recipient

Stated actions
6

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

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

Concerns raised1

  1. Lack of ready local access to a dual-diagnosis service
    Part of recurring concern: Unreliable dual-diagnosis care pathways
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.4

  1. Action

    Provide £532 million to local authorities to increase and improve drug treatment services.

    Stated by Department of Health and Social CareStated completedThe respondent said that this action was complete when they made their response on 4 October 2022.
  2. Action

    Work with NHS England and the wider sector to identify improvements to service integration and implementation of existing guidance.

    Stated by Department of Health and Social CareStated in progressThe respondent said that this action was in progress when they made their response on 4 October 2022.
  3. Action

    Publish guidance for commissioners and providers on co-occurring mental health and substance use conditions.

    Stated by Department of Health and Social CareStated completedThe respondent said that this action was complete when they made their response on 4 October 2022.

Respondent positions A position is what a recipient says about a concern when it does not describe a specific action.1

  1. Position

    Separate dual-diagnosis treatment services are not supported by evidence and are not recommended in published guidance.

    Stated by Department of Health and Social CareDisputes the concernThe respondent disagreed with part of the concern or the basis for it.

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 ready local access to a dual-diagnosis service

Wider context from the report

“1. Whilst Mr Lloyd had some interactions with mental health services, and was under the care of a charity who provides support as a consequence of alcohol and drug addiction, it is a matter of concern that he did not have ready access to a dual-diagnosis service locally. A unified service of this nature, employing appropriate specialists, would have the benefit of being able to assess and treat mental-health conditions existing alongside substance misuse issues in a coherent and holistic manner. ”

Is this part of a recurring concern?

Yes — Unreliable dual-diagnosis care pathways.

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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

Provide £532 million to local authorities to increase and improve drug treatment services.

Verbatim wording from the response

“Moreover, the Government published From harm to hope: a 10-year Drug Strategy in-response to Dame Carol Black’s independent review on drugs.⁵ One of the three priorities of this strategy is to deliver a world-class treatment and recovery system, backed by an additional £780m over three years. Of this, £532 million has been made available to local authorities to increase and improve treatment services to reduce harm and improve recovery rate significantly. This will include better integrating treatment services to ensure people’s mental and physical health needs are met. OHID is also currently working with NHS England and the wider sector to identify ways to improve the integration of services, including better implementation of the existing guidance.”

Source location

Response from Department of Health and Social Care
Page 2 · response
Published 4 October 2022

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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 NHS England and the wider sector to identify improvements to service integration and implementation of existing guidance.

Verbatim wording from the response

“Moreover, the Government published From harm to hope: a 10-year Drug Strategy in-response to Dame Carol Black’s independent review on drugs.⁵ One of the three priorities of this strategy is to deliver a world-class treatment and recovery system, backed by an additional £780m over three years. Of this, £532 million has been made available to local authorities to increase and improve treatment services to reduce harm and improve recovery rate significantly. This will include better integrating treatment services to ensure people’s mental and physical health needs are met. OHID is also currently working with NHS England and the wider sector to identify ways to improve the integration of services, including better implementation of the existing guidance.”

Source location

Response from Department of Health and Social Care
Page 2 · response
Published 4 October 2022

Open published response

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

Publish guidance for commissioners and providers on co-occurring mental health and substance use conditions.

Verbatim wording from the response

“The Office for Health Improvement and Disparities (OHID) has previously published Better Care for People with Co-Occurring Mental Health and Alcohol/Drug Use Conditions, a guide for commissioners and services providers informed by clinical evidence and expertise.¹ Two principles from that guide, which should be followed routinely, are that people with co-”

Source location

Response from Department of Health and Social Care
Page 1 · response
Published 4 October 2022

Open published response

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

Publish a 10-year drug strategy to deliver an improved treatment and recovery system.

Verbatim wording from the response

“Moreover, the Government published From harm to hope: a 10-year Drug Strategy in-response to Dame Carol Black’s independent review on drugs.⁵ One of the three priorities of this strategy is to deliver a world-class treatment and recovery system, backed by an additional £780m over three years. Of this, £532 million has been made available to local authorities to increase and improve treatment services to reduce harm and improve recovery rate significantly. This will include better integrating treatment services to ensure people’s mental and physical health needs are met. OHID is also currently working with NHS England and the wider sector to identify ways to improve the integration of services, including better implementation of the existing guidance.”

Source location

Response from Department of Health and Social Care
Page 2 · response
Published 4 October 2022

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

Separate dual-diagnosis treatment services are not supported by evidence and are not recommended in published guidance.

Verbatim wording from the response

“In response to your recommendation for further, separate provision of specific dual diagnosis treatment services alongside mental health and substance misuse services, it is important to point out such service structures are not backed by evidence and so not recommended in the published guidance.”

Source location

Response from Department of Health and Social Care
Page 2 · response
Published 4 October 2022

Open published response

Other statements in published responses

These actions and other statements could not be clearly connected to one concern in this report.

Recipient-stated actions An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised.2

  1. 1

    Publish a full response to the mental health call for evidence with further detail on next steps.

    Stated by Department of Health and Social CareStated plannedThe respondent said that this action was planned when they made their response on 4 October 2022.
  2. 2

    Consider call-for-evidence responses and undertake wider stakeholder engagement to inform a new 10-year mental health plan.

    Stated by Department of Health and Social CareStated in progressThe respondent said that this action was in progress when they made their response on 4 October 2022.

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

Publish a full response to the mental health call for evidence with further detail on next steps.

Verbatim wording from the response

“Finally, through its Long-Term Plan, the NHS has committed additional funding to improve mental health provision. The Department has also recently held a 12-week call for evidence to inform a new 10-year plan to improve mental health. We are currently considering the responses to this and undertaking wider stakeholder engagement. We will”

Source location

Response from Department of Health and Social Care
Page 2 · response
Published 4 October 2022

Open published response

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

Consider call-for-evidence responses and undertake wider stakeholder engagement to inform a new 10-year mental health plan.

Verbatim wording from the response

“Finally, through its Long-Term Plan, the NHS has committed additional funding to improve mental health provision. The Department has also recently held a 12-week call for evidence to inform a new 10-year plan to improve mental health. We are currently considering the responses to this and undertaking wider stakeholder engagement. We will”

Source location

Response from Department of Health and Social Care
Page 2 · response
Published 4 October 2022

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