The tragedy of Southern Health NHS Trust continues to unfold. There has been a litany of failure and obfuscation by the Trust over the past four years, including over a thousand unexpected deaths which have not been properly investigated. This Trust, which covers Hampshire, Dorset, Oxfordshire and Buckinghamshire, provides specialist mental health and learning disability services to some of the most vulnerable people in those communities. It is one of the largest providers of these types of services in the UK.
In 2013 Connor Sparrowhawk drowned in the bath in an inpatient unit run by Southern Health following an epileptic fit. The same bath where another patient had died in 2006. Angela Smith, took her own life after a number of missed opportunities by the Trust. David West died in their care. His father was ignored after he repeatedly tried to raise concerns. Connor, Angela and David, and many more, were denied the support they so desperately needed. Report after report, inquest after inquest, show systemic failures, and a marked reluctance on the part of the management to release information and take responsibility.
The latest chapter in this catalogue of failure is yet another report by the Care Quality Commission (CQC), published last Friday, following a short-notice focussed inspection of the Trust. It makes for shocking reading. It warns that too little has been done to improve patient safety since their last report in December. The CQC found that the Trust had not put in place the right governance arrangements to investigate incidents, including deaths. Opportunities had been missed to learn from mistakes and to reduce the chances of them happening again. Inspectors had serious concerns about the safety of patients. Despite being warned about ligature risks in inpatient mental health and learning disabilities services in January 2014, October 2014 and August 2015, the CQC found that the Trust had still failed to address these risks. Twelve patients have jumped off the roof of one of the Trust's hospitals over the past five years. This is a scandal, and it's happening on the watch of a government which has made great play of patient safety, without taking the action needed to make it a reality.
Yesterday, Labour was granted an 'urgent question' to hold ministers to account. As the Minister blustered, it was clear that not enough is being done. Jeremy Hunt did not speak, and left the Chamber before the end of the questions. I asked three specific questions of the Minister. The first was whether the Government could guarantee the safety of the 45,000 patients currently under the care of Southern Health. The Minister said that, on the advice of the CQC, he was persuaded patients are safe. I remain unconvinced, but I sincerely hope he's right.
My second question was about where responsibility lies. It is clear that there have been failings across the organisation for a number of years, but ultimately the buck stops with the chief executive. The Trust has only had one chief executive during the whole period under review. It is not something I said lightly in the Chamber, but I believe her position is now untenable and she should be replaced.
Third, I demanded a full public inquiry into this Trust, and the wider treatment of people with mental illness and learning disabilities within the NHS. Here, the Minister opened the door to the future possibility of an inquiry, but such equivocation will provide little comfort to the families of the victims who are rightly demanding accountability.
I have had the privilege to meet Connor Sparrowhawk's family, and they have behaved with great dignity and tenacity in pursuit of information and accountability. Yet today it was revealed that Connor's mother, Sara Ryan, has had to face abuse and vitriol in her quest for the truth. Despite this, I know the family will keep going until they are successful. But it shouldn't be left to the families and campaigners alone to fight this fight.
It is beyond the pale that despite countless warnings there are still serious deficiencies at this Trust. We need those in charge to take responsibility. We need full disclosure of the facts. We need services which adequately looks after all people with complex mental health conditions and learning disabilities, and we need justice for them and their families when the system lets them down. Ministers have been sleeping on the job. We must keep up the pressure and carry on the struggle on behalf of all those failed by Southern Health, and all those currently in their care.
Luciana Berger is the shadow minister for mental health, and Labour MP for Liverpool Wavertree