Nurse died two days after concerns raised over his welfare

An investigation supervised by the Independent Police Complaints Commission was launched following a complaint that officers failed to attend the home of Francis Duffy, who worked as a mental health nurse, to detain him under the Mental Health Act on February 4.

Area paramedic Nicola Smy told the hearing that a crew spent around two hours at Mr Duffy's home, in Beaconside, Stafford, after he rang 999 making threats to kill himself.

She also said she did not report the incident to the mental health crisis team because her understanding in 19 years of doing the job was that the unit did not visit residents who had been drinking alcohol.

She said a request made to Staffordshire Police via ambulance control to detain him for his own safety was refused.

The 41-year-old was found dead at the house two days later by a police officer sent to visit him.

Sgt Melissa Byrne, of Stafford police, told the hearing she made the decision not to go Mr Duffy's house on February 4, after following a series of incident priority systems used by the force.

After Mr Duffy's death Sgt Byrne was investigated for misconduct over an allegation that she failed to recognise that he was a vulnerable person. She was later cleared of any wrongdoing.

She told the hearing that there was no information on the log to suggest that Mr Duffy was vulnerable. She said the force had no powers to detain someone in their own home, who was capable of making their own decisions.

A toxicology report said that the mental health nurse had 465 millilitres of alcohol in his blood. The legal limit for driving is 80.

In a statement read at the inquest Mr Duffy's sister Michelle Jones, 39, said the family visited him regularly and assisted him with GP and alcohol services support. She said she believed his repeated 999 calls were 'a cry for help' and they could not understand why more was not done by the authorities to help him.

She said after a relationship ended in 2012 he started drinking and attempted to take his own life three times.

The inquest was told the single man was due to appear at Cannock Magistrates to be sentenced that month for an offence under the Telecommunications Act for making 172 calls, mainly to the ambulance service.

South Staffordshire Coroner Mr Andrew Haigh said the cause of death was alcohol toxicity.

Giving a narrative conclusion he said: "He made a 999 call and had been attended to by ambulance personnel. There had been discussions between the ambulance, police and probation services, but Francis was left alone at home with a lot of alcohol at the property. He had a history of alcohol and psychological problems.

"This was an alcohol related death."

Mr Haigh added that he would be advising the mental health trust to make clearer its roles to the emergency services, particularly that of the crisis team. And advising the emergency services, and the Staffordshire Police and Crime Commissioner Matthew Ellis of the need to improve how information is communicated between control rooms and to staff on the ground.