More than 1,000 patients died needlessly because of serious failings at Britain’s worst NHS Trust, it is claimed today.
The grim toll of “unexpected” deaths was allegedly recorded at the crisis-hit Norfolk and Suffolk NHS Foundation Trust (NSFT).
But campaigners fear the true figure is even higher.
Shocking failings laid bare by the Sunday Mirror reveal catastrophic and systematic shortcomings in the care of mental health patients.
NSFT has spent seven years in special measures and has been rated “inadequate” four times since 2017 – the worst record in the UK.
Campaigners claim preventable deaths have soared since mental health and learning disability care services in Norfolk and Suffolk merged in 2012, with a brief to save £40million.
There have been seven chief executives in that time.
NSFT disputes claims of 1,000-plus – but it refused to hand over its data on unexpected deaths. Campaigners now want the NSFT dissolved, with new mental health trusts for the two counties.
Mark Harrison, of the Campaign to Save Mental Health Services, said: “We are convinced there have been at least 1,000 avoidable deaths – maybe higher.
“How many times do you give this Trust a chance to protect patients and stop lives being lost?”
The Mirror can reveal:
- 2,536 mental heath patients died between 2017 and 2021.
- Campaigners claim Trust documents reveal 359 unexpected deaths from 2012-15, 184 in 2016-17, 137 in 2018-19 and 320 from 2020 to 2022.
- The Care Quality Commission reported 115 “unexpected or potentially avoidable deaths” bet-ween late 2019 and 2021 – thought to be within the figures above.
- 15 people were feared to have taken their own lives within three months of contact with the Trust.
- Coroners have issued 36 “prevention of future deaths” reports involving the trust since 2012.
The reports call for action to avoid further tragedies. Four have been issued this year, including one relating to a woman who took her life after there was no bed available and another involving a man who used a plastic bag to end his life.
Norwich South Labour MP Clive Lewis has told the House of Commons that failings, driven by cuts and poor leadership, “led to deaths, suffering and tragedy for over a decade”.
He told the Sunday Mirror: “We need to act urgently to stop more lives being lost. Everything else that has been tried has failed. We need a public inquiry to get to the bottom of it.” The scandal is being likened to Mid-Staffordshire, where up to 1,200 patients died in four years as a result of poor NHS trust care.
An unexpected death is classed as one where the cause cannot be anticipated, including suicide, an accident or natural causes.
It includes anyone who has been treated by the Trust in the six months before their death.
NSFT, which has a £305million budget and employs 4,227, was last month threatened with enforcement action by the CQC over its latest shambolic inspection.
It laid bare a cover-up culture and said bosses failed to ensure workers learn from incidents “to protect patients and staff”.
It revealed staffing levels were often unsafe, long waiting lists were not managed properly and patient records were inaccurate.
After its latest inspection, long-suffering families tied symbolic hearts to railings outside the NSFT headquarters in Norwich, each representing a life lost to failings.
Nick Fulcher, whose mum-in-law died in a hospital van on the hard shoulder of the M11, said: “They make promises to put things right and never do. They say they learn lessons and are sorry.
“It’s the same old story after every death. There needs to be an inquiry”. Whistleblowing nurse Emma Corlett said bosses at the NSFT were warned nearly a decade ago that lives were being lost.
Ms Corlett, 46, who left in 2016, said: “Cuts were the trigger for services falling apart. We lost 80 experienced community mental health nurses and social workers in central Norfolk alone.
“The assertive outreach team was visiting patients two or three times a week, keeping them well and keeping them out of hospital.
“Instead of seeing a patient several times a week they were only seen a couple of times a month. Without the previous level of care patients started to deteriorate and became a risk to themselves.”
Sheila Preston, 77, was a governor of the Trust when her son Leo Hillel Jacobs, 39, died in 2016 from a suspected accidental overdose. She quit her role in 2019 after becoming critical of the Trust’s leadership.
She said: “They have completely failed in their responsibility to the public. There doesn’t seem to be any accountability when things have been going really wrong. I think things have got worse in all respects. God knows how many more lives are going to be lost.”
Among those failed was Matty Arkle, 37, who was given an hour’s unescorted leave from a unit in Bury St Edmunds, Suffolk, in April 2017, against his family’s wishes. He killed himself. The Trust was criticised at his inquest for a delay in noticing Matty had gone missing.
Another patient, Joshua Sahota, took his life with a plastic bag.
Joshua, 25, died at the Wedgwood Unit in Bury St Edmunds, in September 2019. Suffolk coroner Nigel Parsley said Joshua’s relatives were not told the bag – used for clothing – was on a restricted list.
Mr Parsley said that “had the family known that was a restricted item, it would not have been taken to the hospital in the first instance”.
And after student Theo Brennan-Hulme, 21, took his life in Norwich in 2019, the NSFT said there were “missed opportunities” to help him.
Jacqueline Lake, senior coroner for Norfolk, said “a loss of compassion” led to staff believing “some suicides are inevitable”.
Tim Deeming, of Tees Law, who represented the Sahota and Arkle families, said: “For too long the Trust has been failing families, despite the fact we, and others, highlighted numerous concerns.”
As a result of the latest inspection, NSFT was served a warning notice tying it to a legally-binding timetable of improvements.
Norfolk and Suffolk NHS Foundation Trust said it was “fully focused on making improvements”.
It added: “One death is one death too many. We are deeply sorry for any pain and distress experienced by patients and families we have let down in the past.”
The Department for Health said patient safety was “our top priority”, adding: “It is vitally important we learn from any mistakes made.”
Python death email shame
A boss boasted the NSFT “got away” with it after a damning report was overshadowed by news Monty Python’s Terry Jones had died.
The Trust was criticised after great-gran Doreen Livermore, 89, was pushed over by a man at Amberley Hall care home, King’s Lynn.
Mrs Livermore had previously complained about the man attacking her. Mark Prentice, the NSFT’s communications manager, emailed colleagues: “We seem to have got away (again) with the Adult Safeguarding Review. I think we may have been saved by the death of Terry Jones... yet again... we emerged virtually unscathed.”
However, a local reporter was mistakenly copied in. Mrs Livermore’s son Roy said at the time: “It is absolutely disgusting.”
My lovely son died waiting
A mum says her “lovely” son took his life after failing to get the right help.
Caroline Aldridge, 60, said desperate Tim, 30, was waiting to be seen by the NSFT.
She said Tim turned to drink and drugs because he could not get help with his bipolar disorder.
Caroline, who wrote a book called He Died Waiting after the death of Tim in his Norwich flat, said: “The mental health service in our two counties is dysfunctional.
“Tim was a lovely young man but his dark moments were increasing as he continued to not get the help he needed. Tim only got medication, which he mistrusted, towards the very end. He had been waiting ages for an appointment. That is the familiar story of this Trust, people dying while they are waiting to be seen.”
Peg, 80, died in van on M11
A family was left devastated after an 80-year-old dementia sufferer died of a suspected heart attack on a motorway hard shoulder while in the care of NSFT.
Peggy Copeman had been ferried 250 miles from Norfolk to Somerset after no mental health beds were available locally.
Four days later, a bed nearer her home was found. But on the M11, close to the end of the return journey in a hospital van, she fell critically ill. Her daughter Maxine Fulcher, from North Lopham, Norfolk, never got a chance to say godbye.
She said: “Mum was very frail and really wasn’t up to the journey, but they insisted. We had no say.” Her husband Nick added: “The people who run NSFT are a disgrace.”
Peggy had schizophrenia and dementia and was taken in by the NSFT after lashing out at a care home nurse.
Son dies days after release
A grieving dad says his fashion student son died after NSFT discharged him “too soon”.
Henry Curtis-Williams, 21, was held under the Mental Health Act after he was found on Orwell Bridge, in Ipswich, on May 11, 2016.
His family was not informed and Henry was released from hospital after 24 hours – only to be found dead on May 17. His dad Stuart Curtis said: “They had hardly taken him into care before they were releasing him. He was clearly very unwell yet they held him fleetingly and never told his family.”
Henry’s mum suffers nightmares and says her life has been destroyed. She said: “I feel sick every day.”
Sailing star's cries for help
A Team GB sailor who represented her country killed herself after being “failed by weaknesses” at the Trust, an inquest heard.
Harriet Philo-Powell, 18, was found in a barn next to the family home in Colchester, Essex, by her father.
She had told specialists she had “black thoughts” and tried to kill herself two weeks earlier.
The 2016 inquest heard a lack of communication between NSFT mental health services meant her previous calls for help were not seen.
7 bosses over 10yr debacle
The troubled Trust has paid six-figure salaries to SEVEN chief executives since 2012.
Aidan Thomas quit his £140,000-a-year job in 2014 to move to a neighbouring hospital.
His replacement Michael Scott left after the trust was rated inadequate in 2017.
Finance director Julie Cave was appointed on an interim basis but the post eventually went to Antek Lejk.
He stayed less than a year before another shake-up in 2019. Jonathan Warren then took charge but only lasted 11 months. Trust director Mason Fitzgerald was due to become the next chief executive but withdrew after listing a bogus law degree. He was later sacked.
Current CEO Stuart Richardson was appointed on £175,000 last autumn after he and Adam Morris acted on an interim basis.
Timeline of inadequacy
- October 2014 The trust is rated inadequate and placed into special measures.
- July 2016 NSFT exits special measures after being branded as “requiring improvement”.
- July 2017 It plunges back into special measures after again being rated inadequate.
- September 2018 The Care Quality Commission says the trust is still inadequate with “widespread low morale across services”.
- November 2019 “Early improvement” within the trust sees it handed a “requires improvement” tag, though it remains in special measures.
- November 2021 The Trust is downgraded by the CQC to inadequate and remains in special measures.
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