An analysis by mental health campaigners has found that more than 30 patients died over a decade, as the risks at an NHS mental health trust were not acted on following a ‘controversial redesign’.
The report carried out by Campaign to Save Mental Health Services in Norfolk and Suffolk also found that nearly 20 patients at Norfolk and Suffolk NHS Foundation Trust (NSFT) have died since 2013 after communication issues and the failure to listen to concerns raised by family members.
Issues were raised over poor care at NSFT after a report from the auditors Grant Thornton revealed there were 8,440 “unexpected deaths” of patients of the trust between April 2019 and October 2022. Meanwhile, the trust has been placed in special measures four times and had nine chief executives in 10 years.
The report carried out by Campaign to Save Mental Health Services in Norfolk and Suffolk analysed 86 deaths of NSFT patients that were reported by local or national media since the service redesign in 2013, as well as prevention of future deaths (PFD), notices written by coroners.
The report categorised the 86 deaths into different factors that were publicly reported, with “risk not acted on” appearing most frequently (31 cases), followed by “poor communication” (19 cases), and “expressions of suicide ignored” and “family concerns ignored” (15 cases each). Some cases had more than one factor.
The Guardian reports that in 2013 senior managers at NSFT implemented a “radical redesign” of services that cut beds, reduced the number of consultant psychiatrists, and replaced primary care mental health teams with new teams that proved harder to access. At the time, campaigners warned that the changes would lead to worse patient care.
Mark Harrison, chairman of the campaign, told the Observer:
“They closed the homelessness team, broke up the crisis team, took NSFT workers out of GP surgeries. They made many of their most experienced staff redundant. And they made the others reapply for their jobs, where they either downgraded them or they added extra responsibilities for the same money.
“This is what led to the increased rate of unnecessary deaths. The campaign predicted that all those measures would result in increased deaths, and they did – and NSFT has never recovered from it.”
Analysing the coroners’ PFD notices, the report identified six cases since 2020 where coroners raised concerns about staffing issues. Meanwhile, last week, two more PFD reports were issued following inquests into the deaths of NSFT patients, one warning of failures in risk assessments by the trust and the other detailing a string of concerns.
Following the concerning number of deaths and coroners’ PFD notices, the campaign is calling for a public inquiry and police investigation into failings at the trust and the high number of deaths.
One mum, whose son died following the changes, told The Guardian that he was diagnosed with paranoid schizophrenia in 1998, but his service provision went downhill after the 2013 service redesign. She said the workload of community nurses shot up, and family carers such as Preston were sidelined.
She explained that the change was implemented during the school half-term. Leo’s new nurse went on holiday and was ill when he came back. Leo should have been seen every fortnight, but instead, he wasn’t seen at all.
“Two months later, when they all got together, the old nurse asked the new nurse, ‘Have you been to see Leo?’ And he said no. And this was the Monday after he died from a drug overdose on the Sunday.”
An NSFT spokesperson said:
“We offer our sincere condolences to all families and carers of people who have lost loved ones. We can assure all families and carers that we are working hard to learn from these incidents and do our very best to ensure they are minimised in future.”
Mental health medical negligence claims
Mental health negligence is when a patient fails to receive treatment the acceptable standard of care mental health professionals are expected to provide.
Examples of mental health negligence include Inadequate supervision of a patient who poses a threat to themselves or others, failure to ensure appropriate supervision and checks on patients and prescribing or administering incorrect medication.
If yourself or a loved one has suffered harm due to mental health negligence, contact Oakwood Solicitors Ltd today.
Further reading
Hospital negligence claims – Oakwood Solicitors
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Jade Glover is a Solicitor in the Medical Negligence team. She has worked for the company for over 9 years and completed her training during that time. She has specialised in Personal Injury clai…
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