Coroner: DWP ‘must act’ after it told severely ill patient to leave hospital to make claim

A coroner has called on the Department for Work and Pensions (DWP) to make urgent policy changes, after it ordered a disabled patient to leave hospital to visit a jobcentre despite being severely ill with a condition that later killed him.

The call for urgent action has come in a prevention of future deaths (PFD) report, the latest in a series of such letters to be sent to DWP by coroners over the last 12 years following the department’s repeated failure to ensure the safety of disabled benefit claimants.

Health professionals had told an inquest into the death of Terence Talbot that they had never heard of such a “severely ill inpatient” being told by DWP to leave hospital to make a benefit claim in person.

Talbot was being treated for drug hypersensitivity syndrome, while also being detained under the Mental Health Act, because of a rare reaction to medication that had been prescribed for his mental distress.

The severe allergic reaction had left him “very vulnerable to infection”, but DWP refused to allow him to submit a claim for benefits electronically.

Instead, he was told to leave hospital and attend his local jobcentre in person.

He later died in Maidstone Hospital, on 9 April 2020, aged 58, from multi-organ failure caused by the lung conditions pneumonia and empyema, which themselves were caused by drug hypersensitivity syndrome (also known as DRESS syndrome).

Sonia Hayes, assistant coroner for Mid Kent and Medway, wrote to work and pensions secretary Therese Coffey last month to warn her that other claimants could die if she did not make urgent changes to how DWP deals with such cases.

She told Coffey in the PFD letter – also known as a Regulation 28 report – that DWP had “required Terence Talbot to attend in person to make a claim for benefits rather than accept an electronic claim”.

The coroner said she had been told by “all the doctors and a senior nurse in this case” that they had “never experienced nor heard of a case” where such a “severely ill inpatient” was required by DWP to “leave hospital to attend its offices in person to make a claim for welfare benefits”.

She said Talbot had been experiencing mental distress and “an exceptionally rare and complex disease with a risk of death and suffering severe exfoliative dermatitis that rendered him very vulnerable to infection”.

Coffey has to respond to the coroner’s report by 28 January.

A DWP spokesperson told Disability News Service: “Our condolences are with Mr Talbot’s family.

“We are considering the report and will respond in due course.”

The coroner was also highly critical of Kent and Medway NHS and Social Care Partnership Trust (KMSCPT) – which provides mental health services across Kent and Medway – and Maidstone and Tunbridge Wells NHS Trust (MTW) for their failures.

She said there had been a failure to carry out regular reviews of Terence Talbot’s skin condition, and to apply moisturising treatments to his skin – they were recorded as “self-administered” even though he could not apply them effectively himself – while he experienced malnutrition because he did not receive the food, fluid and nutrition he needed.

The coroner said this “amounted to a gross failure to provide basic medical care that would have prolonged but probably would not have saved his life”.

She told KMSCPT that it had failed to subject all the decisions about Talbot’s care and treatment to formal Mental Capacity Act assessments at a time when he was “refusing medical interventions that were in his best interests”.

And she said MTW had failed to consider a specialist dermatology referral for his severe dermatitis, caused by the DRESS syndrome, and had failed to ensure regular input from a dietician to deal with his malnutrition.

Instead, she said, MTW had focused in meetings on problems relating to his discharge rather than the treatment he needed.

MTW had also failed to carry out mental capacity assessments of Talbot’s decisions on all the occasions it should have done, she said.

MTW is preparing a response to the PFD report.

But KMSCPT has already responded to the report, apologising for its failures, and telling the coroner that it had “identified a need for more joined up working with [MTW] particularly when it comes to accessing care for physical health for our in-patients at the Priority House site in Maidstone”.

The mental health trust said it also knew that it was “extremely important for us to thoroughly assess capacity and to document it when any of our patients are refusing to accept treatment for their physical health conditions”.

And it said it recognised “the importance of engaging with families and seeking their support with situations where the patient might appear to be refusing care and treatment for a deteriorating physical health condition”.

It described several measures it had taken to address the concerns raised by the coroner.

The trust said it was “sincerely sorry for the shortcomings in our care of Mr Talbot and are committed to ensuring that the improvements we have made are sustained”.

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