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13 October 2017, 08:14
Southern Health NHS Trust has been fined £125,000 after a vulnerable patient fell off a roof at a unit in Winchester.
The trust admitted failing to provide safe care after the man suffered serious neck injuries at Melbury Lodge in 2015.
The judge reduced the fine to lessen the impact on patient care. Southern Health was also ordered to pay £36,000 in court costs and a £170 victim surcharge.
The Care Quality Commission (CQC), which regulates all NHS trusts, brought the case against the Trust which has repeatedly hit the headlines over its failure to investigate the deaths of hundreds of patients in its care.
Paul Greaney QC, prosecuting for the CQC, said Southern Health failed to take action to prevent patients from gaining access to the low rooftop between 2010 and 2016 on at least seven occasions despite warnings from its own health and safety officer.
The case comes after a patient, referred to only as Mr AB, aged in his 60s and who has "a distinguished history of public service", fell from the rooftop in December 2015 and suffered serious neck injuries.
District Judge Loraine Morgan said:
"It's a significant concern that even this tragic incident involving AB did not result in immediate steps to prevent any further incident.
"Works were not carried out because money was not available. If £300,000 had been spent in a timely manner by the Trust, not only could this prosecution have been avoided as would the loss to AB and his family."
Judge Morgan said in deciding the level of the fine she took into consideration the Trust's financial situation, its guilty plea and improvements to its management procedures.
Mr Greaney explained Mr AB's fall came after the patient previously climbed on to the rooftop during a paranoid episode when he believed the KGB was attempting to kill him and his wife had advised staff the previous day he was at risk of attempting to escape again. He said:
"She reminded them that he had escaped from the ward before and explained that he was very good at being deceptive as his past career had taught him how to escape.
"It follows that not only was a person responsible for health and safety at the Trust plainly aware of the problem by April 2012, he was proposing that steps be taken to remedy it.
"Those steps were not taken until well after the events concerning Mr AB in late 2015. Rather, a dangerous state of affairs was allowed to persist."
Describing the incident, he added:
"It seems that staff attempted to talk him down, but Mr AB then plummeted from the roof.
"In the result, Mr AB sustained serious injuries which have had a major impact upon his quality of life."
Mr Greaney said that despite Mr AB's fall, the Trust failed to take action and three patients gained access to the rooftop 11 weeks later with one suffering an arm injury and another managing to escape to France.
Mr Greaney said works to prevent access to the rooftop had now been carried out.
Paul Spencer, defending, said the public spending "squeeze" contributed to its failures to assess the risk and carry out essential works at the hospital which is one of its 150 sites. He said:
"It's without doubt one of the factors was the desire to save money. It is in a critical financial position.
"The Trust faces what all trusts up and down the country are facing, particularly what is acutely facing the issue of mental health care.
"There has been a balancing of budgets issue against a very significant public sector purse squeeze which has been well documented.
"It's not possible to open a newspaper without reading, day after day, the pressures that the NHS is under and the mental health service has definitely been the poor cousin of the NHS.
"It's against that backdrop that the Trust has had to manage an ever-increasing burden."
He said the Trust faces a daily cost of £810,000 to keep its services running with daily NHS interest payments of £20,000.
He added that the Trust, which is operating in deficit, was required to make £10.2 million efficiency savings last year and £12.8 million in the current financial year.
Mr Spencer said an additional cost was £2.7 million needed to meet its requirements to pay for its patients who have requested to be cared for by other trusts.
He explained that if the Trust failed to meet the efficiency savings, it would not be eligible for a Sustainability and Transformation Fund "bonus" of £2.9 million. He said:
"The Trust is going to struggle to meet its financial obligations this year and as a result of that, its concern is it won't meet its target and will lose its sustainability fund.
"The Trust has sold off sites, it's attempting to identify those sites it no longer needs for redevelopment.
"It has exhausted the area to identify further sites that wouldn't directly impact on patient services."
Mr Spencer said the cost of running Melbury Lodge was £3.6 million per year and the cost of recent refurbishment to provide improved safety features at the centre was £1.5 million including £300,000 to prevent access to the rooftop carried out in May 2016.
Mr Spencer said there had been no further rooftop incidents and added: "These failures were not picked up by board level, there is now a reporting procedure so if there was a repeat, it would be picked up by the board and actioned."
The Trust's interim chief executive Julie Dawes and finance director Paula Anderson were in court to hear the ruling.
Professor Ted Baker, CQC chief inspector of hospitals, said after the hearing:
"There can be no excuse for this failure by Southern Health to protect their patients from harm.
"Unfortunately this was not an isolated incident - but part of a wider failure to deal with concerns over safety as they arose.
"The Trust had failed to make basic improvements to protect the people in its care, despite having been aware of the dangers for years.
"There had been at least seven incidents before this - yet they ignored clear evidence from their own reports on safety and did little to prevent this dreadful accident.
"Even after this event, the Trust was slow to take action. It was a false economy which has now cost the Trust dearly - and with awful consequences for one man.
"In the circumstances, we had no choice but to prosecute in the criminal courts.
"I hope this case will serve as a warning to any other provider that imagines they can cut corners on safety at the expense of their patients."