GLOUCESTERSHIRE
If the Coroner feels that evidence gives rise to a concern that circumstances creating a risk of other deaths will occur or continue to exist, he/she may make a Rule 43 report which is sent to the organisation that  has responsibility for the circumstances. 
​A recipient of a Rule 43 report must send a written response within 56 days to the Ministry of Justice.
                              The Coroner has sent a Rule 43 to the following organisation/s ...
HOSPITAL DEATHS:  CLINICAL PROCEDURES AND MEDICAL MANAGEMENT

NHS GLOUCESTERSHIRE 
Recommendation - Published May 2012
To consider an urgent review of the criteria and procedures for assessing patients' discharge to community hospitals.

GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST
Recommendation - Published May 2012
To consider an urgent review of the use of observation charts and to emphasise the importance of using them to all clinical staff.

RESPONSE
From:  Gloucestershire Hospitals NHS Foundation Trust
Click here to download the response ...
HOSPITAL DEATHS: OTHER

CARE QUALITY COMMISSION
Recommendation - Published May 2012
To consider a review of the patient discharge system operating at Cheltenham Hospital, in particular referrals to community care services.