Coroners have a statutory duty to make reports to a person, organisation, local authority or government department or agency where the coroner believes that action should be taken to prevent future deaths.
The Labour Party, who compiled the figures, has said the increase is due to the government’s austerity policies. Shadow health minister Justin Madders responded to the finding, saying: “This shocking rise in austerity-related deaths in the NHS shows yet again the devastating impact of Tory underfunding. Jeremy Hunt has claimed patient safety as his watchword, yet the truth is that more deaths are being blamed on a lack of resources in the NHS.
“If the government doesn’t provide the health service with the funding it needs there is a real danger that services just become unsafe for patients. Ministers must take action now and give the NHS the resources it needs to keep patients safe.”
There were 42 ‘prevention of future death’ reports (PFDs) relating to issues such as lack of beds, staff shortages and insufficiently trained agency staff in 2016 compared with 30 in 2013.
Within the 42 PFDs relating to lack of resources, eight were specifically concerned with resourcing of mental health services, double the number from 2013. Labour said the resourcing of mental health services was of particular concern, with deaths related to issues including the lack of mental health in-patient beds or shortages of trained staff.
In 2017, a damning PFD sent to the Department of Health after the death of Christopher Fairhurst in December 2016 said a shortage of GPs put patients at risk and placed unmanageable workloads upon those GPs who were in post.
At the inquest into Christopher’s death, the court heard that the GP practice where Christopher was a patient serves 14,000 to 15,000 patients, but has been operating for the past few years with four or five GPs. Coroner Lisa Hamshi recorded a conclusion of misadventure, but Fairhurst’s family claimed he was often ‘twentieth in the queue’ when he tried to book a GP appointment.
The coroner claimed the ‘knock-on effect’ of the NHS funding crisis is seen ‘day in and day out’ in courts like hers. Hamshi said that she was satisfied with the care provided by doctors at Edenfield Road Surgery, but said she was concerned about the strain on surgeries – and a critical shortage of GPs across the country.
A Guardian investigation published in March found that coroners in England and Wales served PFDs relating to 271 mental health patients between 2012 and 2017. The NHS ombudsman also warned that mental health patients are suffering serious harm, and in some cases dying, because of “serious failings” in their treatment.
In a report analysing more than 200 complaints about NHS mental health care, John Behrens – the ombudsman – highlighted “failings that have occurred, and continue to occur, in specialist mental health services in England, and the devastating toll this takes on patients and their families”.
His findings came just two weeks after the Guardian revealed that coroners had issued NHS providers of care with legal warning notices over 271 deaths of mental health patients that occurred in England and Wales between 2012 and 2017 following failings in the treatment they had provided.
The report identified five “common failings” by mental health trusts that can lead to patients suffering distress or harm or dying avoidably. They include inadequate assessment of the patient’s risk of suffering harm or committing suicide and poor communication between health professionals and the patient or their family.
The report is a dossier of detailed but anonymous cases which, in some cases, led the ombudsman to conclude that patients were subjected to care so poor that it was “injustice [that was] shocking and tragic”. The failings illustrate how far the NHS has to go if it is to improve care in the dramatic way that ministers and health service bosses have promised in recent years.
For example, a Ms J died after she had a life-threatening reaction, called neuroleptic malignant syndrome (NMS), to being prescribed an antipsychotic drug for a psychotic episode she was having. Doctors dismissed the physical symptoms of her condition.
“Had doctors identified NMS, it is likely that Ms J would have received the appropriate treatment and survived. As such, we concluded that Ms J’s death was avoidable,” the report said. Her death illustrated “the human cost of service failures”, Behrens said.
In another case, a mental health professional decided that a Mr O was suffering from an episode of psychosis for the first time. However, the worker breached National Institute of Health and Care Excellence guidelines by not assessing the patient for signs of post-traumatic stress disorder. The NHS trust’s risk assessment “was too brief and inadequate”, the report said.
Among the mental health-related deaths attributed to resource issues in 2016 was that of Wendy Telfer, 44, who died after taking an overdose. The PFD to Royal Devon and Exeter NHS foundation trust said: “It is accepted that the problem of psychiatric in-patient beds is a national one, but on this occasion, had a bed been available when needed for Wendy, her death is likely to have been avoided.”
A 2017 PFD sent to the Department of Health after the death of Christopher Fairhurst in December 2016 said a shortage of GPs put patients at risk and placed unmanageable workloads upon those GPs who were in post.
The peak month in 2016 for deaths identified by coroners as being linked to a lack of resources – whether mental health-related or otherwise – was December, with eight. The NHS is always most overstretched in winter, with staff shortages and high bed occupancy rates.
Regular winter crises are a consequence of increased demand for services without a corresponding increase in funding. In four weeks in the run-up to Christmas 2016, 50 of the 152 English trusts were at the highest or second-highest level of pressure, according to a Nuffield Trust analysis commissioned by the BBC.
A Department of Health and Social Care spokesman said every preventable death was a tragedy. He said: “When coroners recommend specific steps to prevent future tragedy we expect NHS bodies to act without delay.
“As well as making mental health services a personal priority, both the prime minister and the secretary of state have committed to a long-term plan with a sustainable multi-year settlement for the NHS, which will be agreed with NHS leaders, clinicians and health experts.”
That clearly isn’t adequate.
Mental health is an integral and essential component of health. Those groups with high rates of socioeconomic deprivation also tend to have the highest need for mental health care, but the lowest access to it.
People with mental illnesses are also vulnerable to abuse of their human rights. Scarcity of available resources and inequities in their distribution pose major obstacles to better mental health.
Research by the Royal College of Psychiatrists (RCP) found that the income of mental health trusts across the UK had fallen since 2011, after taking account of inflation.
In England, 62% of mental health trusts reported a lower income at the end of 2016-17 than they had in 2011-12. Only one trust saw their funding rise in all five financial years, according to official figures.
The RCP reports that the total amount of income that mental health trusts received in 2016-17 was £11.829bn – £105m less than in 2011-12 at today’s prices.
Parity of esteem – the requirement to treat mental and physical health equally – was enshrined in law in 2012 and became part of the NHS Constitution in 2015. Yet ddespite legislating for parity of esteem, the government has failed to adequately fund it. The lack of resources is exacerbated by the fact that mental health funding is not ring-fenced and can be diverted by the NHS to plug gaps in other areas.
“It is totally unacceptable that when more and more people are coming forward with mental health problems, trusts are receiving less investment than they did, in some cases, seven years ago,” said RCP president Professor Wendy Burn.
It’s totally unacceptable that a government which has contributed to a rise in mental ill health in the first place by designing policies that widen inequalities, implementing cuts to public services that are both avoidable and immoral, continues in failing to recognise the psychological costs of austerity for individuals, communities and wider society.
Careless cuts cost lives.
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