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A coroner has given health secretary Wes Streeting until May 14 to set out what steps he has taken to ensure epilepsy patients can get hold of sufficient quantities of medication to control their seizures following the death of a patient in Bedfordshire.

Emma Whitting, the senior coroner for Bedfordshire and Luton, said there were concerns patients do not have quick access to antiseizure medications during her investigation into the death of 58-year-old Paul Nash, who died following an epileptic seizure after he ran out of his epilepsy medication.

In her report, Whitting concluded he missed three doses but said “the reasons for him suffering a seizure” were “unclear”. The inquest heard Nash suffered from epilepsy secondary to HSV encephalitis which he developed in 2014 and resulted in him sustaining a “significant brain injury”.

Prescription was not ready for collection the following day

He controlled his epilepsy in subsequent years with carbamazepine and had not suffered a seizure since 2016. He had been taking the anticonvulsant drug carbamazepine at 500mg twice a day since June last year but in September, Whitting wrote, “he did not appear to have requested all of his prescriptions for this”.

Nash’s full prescription was requested on October 20, 2025, but on the following morning, he told the brain injury association Headway Luton that he had taken his last dose of epilepsy medication.

The inquest heard Headway Luton contacted his GP to “urgently” request a prescription but it was not ready for collection the following day. Nash was found dead in bed at his home on the evening of October 22, 2025. Whitting said “evidence at the scene suggested he had suffered a seizure during the night”.

Her report said Nash’s consultant neurologist “indicated that many epilepsy patients across the country currently experience difficulties in obtaining sufficient quantities of medication to ensure optimum seizure control”, for example “batch quantities” in case they run low of medication or “there are delays in the pharmacy processing a repeat prescription”.

Calling on Streeting for a response, Whitting noted that processing a repeat prescription can take up to 10 days in some areas.

She also asked Sundon Medical Centre to detail what action it has taken or proposes to take to prevent deaths occurring in future, having heard Headway Luton “made it clear” to the surgery in a phone call on October 21, 2025, that Nash had run out of carbamazepine.

Whitting said the surgery was told that “although he had taken that morning’s dose, if he did not receive more medication that day, he would not have his evening dose or any other doses”. 

“Although Headway was reassured that the GP would be notified that the deceased had run out of his seizure medication, this fact did not appear to have been conveyed to the GP and the prescription was not prioritised to ensure he received it the same day,” she said in her report, which was also sent to Headway Luton and Bedfordshire Hospitals NHS Trust.