“The consultant who was involved in performing CPR on Mrs Ley agreed that she had been in…”

The coroner’s concerns

– (1) The consultant who was involved in performing CPR on Mrs Ley agreed that she had been in bed at the time. When asked why he had not moved her to a solid surface he replied that he had attended many advanced life support training sessions and had never been told this was necessary. In their article "The impact of compliant surfaces on in-hospital chest compressions: Effects of common mattresses and a backboard" in the journal Resucitation (Vol 80, Issue 5, May 2009) the authors notes that carrying out CPR in a hospital bed may be 50% less effective. I am concerned that despite receiving training a senior clinician was unaware of this and consider that it gives rise to a risk of future deaths. 6) ACTION SHOULD BE TAKEN In my opinion action should be taken to prevent future deaths and I believe you Lancashire and South Cumbria NHS Foundation Trust have the power to take such action. 7) YOUR RESPONSE You are under a duty to respond to this report within 56 days of the date of this report, namely by 12th June 2026. I, the coroner, may extend the period.

An extract. Read the full report, including the circumstances of the death, on the Courts and Tribunals Judiciary website.

Source

judiciary.uk, Prevention of Future Deaths reports, 2026-0318

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8 Oct 2026

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Contains public sector information licensed under the Open Government Licence v3.0. Source: Courts and Tribunals Judiciary, judiciary.uk. Open Government Licence v3.0