Southern Health NHS Trust 'Failed' To Investigate Over 1000 Deaths

Lawyers Express Concern Over Lack Of Investigation Into Unexpected Deaths Of Mental Health Patients


Dave Grimshaw, Press Officer | 0114 274 4397

Specialist medical negligence lawyers at Irwin Mitchell say the reports that an NHS Trust has failed to investigate the unexpected deaths of more than 1,000 people since 2011 raises serious concerns regarding how the trust learns lessons to improve care in future.

A leaked report obtained by the BBC has revealed that Southern Health NHS Foundation Trust failed to properly investigate the deaths of many mental health and learning-disability patients.

The investigation was commissioned by NHS England found 2013 after disabled teenager Connor Sparrowhawk drowned in a bath at a Southern Health hospital in Oxford. An inquest jury found NHS failings had contributed to the 18-year-old's death.

The report looked into more than 10,000 deaths between April 2011 and March 2015, of which 1,454 were unexpected.

But just 195 were treated as a serious incident requiring investigation (SIRI) and whether the unexpected deaths were investigated depended on the type of patient involved.

Adults with mental health problems who died were the most likely to be examined (30% of cases investigated). But just 1% of patients with learning disabilities and less than 1% of over 65s with mental health problems had their deaths investigated.

Investigations were also found to be poor quality and often extremely late, while coroners repeated criticised the Trust in relation to the timing and usefulness of reports provided by the Trust for inquests.

Southern Health provides services to about 45,000 people across Hampshire, Dorset, Wiltshire, Oxfordshire and Buckinghamshire

Expert Opinion
“This report is simply shocking and highlights an alarming lack of investigation into unexpected deaths across the very wide regional footprint that Southern Health NHS Trust operates in.

“It seems to suggest that patients with learning difficulties and older patients with mental health issues were somehow less worthy of an investigation which is totally unacceptable as these patients are often extremely vulnerable.

“It is important that the Trust responds to this report as soon as possible to reassure the families of those affected in relation to the treatment that their loved ones received.

“The process of investigating unexpected deaths, as well as that of inquests and litigation in medical negligence cases, is crucial to learning lessons and improving care for future patients. By not investigating this amount of unexpected deaths the Trust could be missing vital information which would enable its medical staff to treat their vulnerable patients better.”
Alison Eddy, Partner

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