Government looking into coroner's concerns following tragic death of Sheldon Farnell

Earlier this year, an inquest heard how the ‘funny and loving’ four-year-old died of ‘overwhelming sepsis’ hours after he was discharged from Sunderland Royal Hospital.

Sheldon was never given antibiotics and had left the hospital before vital blood tests results confirmed he had life-threatening condition.

The inquest heard how medics had been unable to contact the Houghton lad’s family on three outdated numbers they had on file.

A majority jury concluded that Sheldon died of natural causes but senior coroner Derek Winter wrote to health secretary Matt Hancock to raise his concerns that there ‘is a risk that further deaths will occur unless action is taken’.

The senior coroner highlights: the possible need for ‘expedited revision’ of guidance for the recognition of sepsis with protocols reflecting up to date NICE guidelines; mandatory sepsis training delivered by doctors with relevant experience of current research and guidance; and calls for contact details for families to be positively given – not confirmed – at the time of arrival and discharge.

The letter also said: “The messaging about the timely and prompt prescribing of antibiotic medication is in need of a review, as the inquest highlighted issues of a possible overly cautious approach in their use, when there was no impediment to such use, and they may have saved Sheldon’s life.”

It is understood the letter has been received by the Department of Health and Social Care who will respond in due course.

A Department of Health and Social Care spokesperson said: “Our thoughts are with Sheldon Farnell’s family and loved ones following his tragic death.

“Patient safety is a top priority for the government and the health service, and through the new National Patient Safety Programme Board we are strengthening the oversight and governance of measures that not only uphold patient safety, but improve it.

“We work closely with regulators and other health bodies to ensure they are aware of concerning matters, such as this, and can take appropriate actions where necessary.”

Sheldon’s devoted mum, Katrina Keegan has fought for justice for her boy following his tragic passing.

She said: "I think his story has already saved a lot of kids and adult lives.

"People have told me how they were worried about their kids and have thought about Sheldon and their child has lived because of him.”

During the inquest, the jury heard how a ‘very unwell’ Sheldon was taken to hospital’s paediatric accident and emergency department three days before his death.

He was admitted and a full sceptic screening – including a lumbar puncture – was carried out but Sheldon was never given antibiotics.

Doctors said the four-year-old’s condition appeared to improve during his two-day hospital stay and he was deemed ‘clinically well’ and sent home. Less than an hour later test results confirmed Group A streptococcus – a bacteria which can cause sepsis – in his blood.

Medics were unable to contact the family and Sheldon’s condition worsened at home. He was rushed back to hospital in the early hours of the following morning and Sheldon tragically died after suffering a cardiac arrest.

The trust has previously apologised for the ‘shortcomings in the care Sheldon received’.

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