​Powys Teaching Health Board has confirmed it has made a series of changes after an inquest held earlier this year heard that Edward Funnell, from Llandrindod Wells, developed gangrene and was seen at four different hospitals before dying at a fifth. Mr Funnell died in 2023, aged 93, and it was heard that problems arose after he was admitted to Hereford County Hospital in December 2022. He went in for an operation on his hip, during which time he developed a pressure ulcer on his left heel, then deep vein thrombosis (DVT). Mr Funnell was later transferred to Llanidloes Hospital in January 2023, with the handover described as “poor”. Coroner Andrew Morse noted “it was clear there was a delay in photographing the heel area on admission” and “scant details in the paperwork”. Mr Funnell was admitted to Bronglais Hospital in Aberystwyth on February 2, with a doctor indicating a need for further investigation. He was admitted again on February 19, by which time his lower leg was black and his limb not salvageable. He was transferred to Morriston Hospital in Swansea, where the only viable option was amputation. Mr Funnell opted against a “significant surgery” and received palliative care in Ystradgynlais until his death. However, he issued a prevention of future death report instructing Powys Teaching Health Board to look at a series of issues raised during the hearing. These included “a lack of appreciation of the need for the deceased to see a podiatrist as recommended by a Tissue Viability Nurse” and that a “referral was not followed up or actioned”. He also raised concerns over “an identifiable lack of knowledge on the part of the nursing staff to understand the reason for referral to a podiatrist and the possible interventions a podiatrist could undertake in respect of pressure wound damage.” Mr Morse also raised concerns over the lack of knowledge “on the importance of following the recommendations of the Tissue Viability Nurse” regarding “the type of dressings to be administered and the importance of ensuring such steps were followed as opposed to using an alternative and, on the evidence, an inappropriate dressing.” In response, Powys Teaching Health Board recognised “that there was a delay of 27 days between the referral to Podiatry and the initial appointment” and that “during that delay, no follow up had occurred to express the urgency of the referral”. As a result, guidelines have been “updated to ensure that urgent referrals are responded to within five working days” The health board have said the Tissue Viability team have updated their referral process which “has been shared widely with clinical teams” and there has been the “implementation of a Vascular limb check observation chart”. It was confirmed that now “all pressure ulcers are monitored through All Wales Datix system and presented through pressure ulcer scrutiny group.” Powys