An NHS trust has admitted guilt over the death of a teenaged patient who drowned in the bath while in its care.
Southern Health Trust pleaded guilty at Banbury Magistrates’ Court earlier to breaching health and safety law in the case of Connor Sparrowhawk, 18, who died at Slade House in Oxford in 2013.
His death led to the discovery the trust had not properly investigated 272 unexplained deaths in its care.
Sentencing is due to take place on 12 October at Oxford Crown Court.
The trust was prosecuted by the Health and Safety Executive (HSE) under Section 3 of the Health and Safety at Work Act 1974 following its investigation into the death of a patient under its care.
‘Devastating impact’
Paul Spencer, defending the trust, said Mr Sparrowhawk’s death was “deeply tragic” and should “never have happened”.
District Judge Tim Pattinson said the court expressed its “deepest sympathy” over the teenager’s death.
In a statement following the hearing, attended by Mr Sparrowhawk’s mother Sara Ryan and other members of his family, Julie Dawes, the trust’s interim chief executive, described his death as “entirely preventable”.
She said: “Connor’s loss continues to have a devastating impact on his family and we are truly sorry that we didn’t keep him safe.”
She continued: “There have been times when our actions unintentionally added to the distress of Connor’s family.”
Ms Dawes said his death had led to “significant changes and improvements” at the trust and added she hoped “all families and service users will now experience a more compassionate approach from Southern Health”.
Image captionThe trust’s former boss Katrina Percy resigned in October 2016
Southern Health NHS Foundation Trust provides specialist mental health and learning disability services to patients in Hampshire and parts of Oxfordshire.
July 2013 – Connor Sparrowhawk, 18, drowns after an epileptic seizure at Oxford unit Slade House. An inquest later rules neglect contributed to his death
10 December 2015 – The BBC reveals details of a leaked independent report into the trust, produced by Mazars, which highlights a “failure of leadership”. Health Secretary Jeremy Hunt says he is “profoundly shocked”
17 December 2015 – The report is officially published and shows out of 722 unexpected deaths over four years, only 272 were properly investigated
6 April 2016 – The Care Quality Commission (CQC) issues a warning notice to significantly improve protection for mental health patients
29 April 2016 – A full CQC inspection report is published which says the trust is continuing to put patients at risk
30 June 2016 – Following a review of the management team competencies, it is announced that the trust’s boss Katrina Percy is to keep her job
29 July 2016 – The BBC reveals the trust paid millions of pounds in contracts to companies owned by previous associates of Ms Percy
30 August 2016 – Ms Percy announces she is standing down as chief executive, but is staying on in an advisory role
19 September 2016 – Interim chairman Tim Smart resigns after admitting he created a job for Ms Percy
7 October 2016 – Ms Percy resigns completely from the trust
13 December 2016 – A CQC report, the culmination of a one-year inquiry, says investigations into patient deaths are inadequate
16 March 2017 – All the non-executive directors resign from trust
19 August 2017 – Medical tribunal finds a doctor failed to carry out risk assessments for Connor Sparrowhawk
12 September 2017 – The trust announces Dr Nick Broughton, leader of Somerset Partnership NHS Foundation Trust, will takes up the Southern Health’s chief executive role in November
18 September 2017 – The trust admits breaching health and safety law in the case of Connor Sparrowhawk
The Nottinghamshire child abuse whistleblower’s treatment in jail has once again degenerated into something out of Solzhenitsyn, or worse.
This morning, I received one of the most harrowing letters I have read in my life. It came from Melanie Shaw’s prison cell.
UK Column News stands by its description of Melanie Shaw as a political prisoner convicted of undisclosed crimes in a secret hearing.
The clarity of both her handwriting and her analysis throughout this letter reconfirms to me that she is of clear mind and is being subjected to a cynical psikhushka regime to break her spirit and discredit or delete her testimony of Establishment child abuse in the Thatcher era.
Many of the prison “staff” who have neglected, mocked and abused her (including by threatening effective rape in her cell) at various East Midlands jails appear to be private corporate employees and/or to lack any suitable warder training, and they certainly seem to have no shred of humanity or intention to abide by the common law.
We reproduce her entire letter below, above which Melanie wrote “SHARE PUBLICALLY“. Please share this transcript far and wide and hold your public servants and representatives to account on her outrageous case; particularly, at her own express request, her own supposed Member of Parliament, Chris Leslie, for whom she previously volunteered and who promised to help her.
Melanie Shaw
A4126DE HMP New Hall Dial Wood
Flockton
WAKEFIELD
WF4 4XX
12 June 2017
Hello Brian,
I hope you’re well.
I’m in a mess here. I’ve been kept in a locked cell for four weeks, 24/7. I’m not allowed toilet paper or able to wash my hair. My Tourette’s [nervous symptoms] are back this morning.
Brian, please can you help me? I don’t even know if you will get this letter. Please. I’ve got nothing to do, no smokes or anything.
It hurts me that I’m being treated in such a disgusting way. I don’t know who’s authorised it or why. I’m not strong, as I’ve let myself down alone here in this cell. The odd staff utter a few words at you. At least in Foston [Prison] they would speak to me and treat me decently. I’ve no mental health support here, nothing. I’m just locked permanently in a cell like a Romanian circus bear. They want me to suffer and have cabin fever.
Please contact Chris Leslie on 0115 711 7666* as he has a signed form of authority to info share [on my case].
I hereby authorise Brian Gerrish to act on my behalf in respect of tackling the failings I’ve mentioned in this letter. Melanie Shaw, date of birth 7/10/70. Signed, 12 June 2017, Melanie Shaw [signature].
Brian, please thank the listeners for their letters. I have stamps and paper but no envelopes. If a stamp is STUCK to a self-addressed envelope, I will be given it and can write back. I don’t need or want money, all I want is to talk to people by letter.
Please help me to stop this abuse. I have no knickers either. It’s unbelievable and God only knows what they are doing in private to other inmates. I’m scared to sleep and often put my chair behind my door. Do you understand me?
I don’t deserve this at all.
This is NOT rehabilitation.
I’ve not been diagnosed as mentally ill but normal; the [HM Prison Service] area psychologist for Yorkshire has refused to finish her report by not coming back to prison. People who are decent are traumatised by my maltreatment and neglect.
[letter ends]
* If calling from Ireland or Europe, this number is 00 44 115 711 7666. From North America, it is 011 44 115 711 7666.
Originally posted on mydaftlife: I want to write this post as close as possible to giving evidence at the General Medical Council (GMC) tribunal investigating Dr Murphy’s fitness to practice. To capture the essence and rawness of the experience. The…
For the last few years at my nearest Tesco (aka Stress-co) store they have held a “locked in for autism” event – and it has always, for want of a better word, freaked me out, why would anyone chose to be locked in a glass box in public for all the shopping world look at you ?
As an autistic woman and parent to wonderfully neurodiverse children, we earned stares over the years, and maybe, just maybe it is meant to represent that, we are locked in by others perceptions of what Autism is, this “fundraising event” it’s just so skin-crawlingly awful a concept, and as a consequence, I give the store a wide berth until it is over.
This petition has nailed why I hate it so much, the representation that you are locked in highlights institutional abuse of some of the most vulnerable people within our society and that Cauldwell are exploiting the goodwill of the people who do not know that our children and loved ones are imprisoned and locked away from community and family.
