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NHS Trust fined £300,000 due to "fundamentally unsafe" practices: A lesson to healthcare providers over identifying and addressing risks.

18 February 2019
Oxleas NHS Foundation Trust has been fined £300,000 after a patient stabbed two healthcare workers, causing significant injuries.

It was found that the patient, who was housed at Dartford's Bracton Centre, a medium secure forensic unit, had gained access to the kitchen area where he seized a knife and began his attack on the two healthcare workers. After the attack the patient also obtained a lighter which he used to start a fire. 

Given the seriousness of the incident, the attention of the Health and Safety Executive ("HSE") turned to the Trust; the crux of the case being that the Trust had failed to assess the risks and had also failed to take straightforward steps that could have prevented the incident from happening altogether. 

The HSE identified the following as features being relevant to the incident:

  • No patient specific risk assessments had been carried out despite it being routine to accept high-risk patients
  • The use of knives on the acute ward was "fundamentally unsafe" 
  • The patient had a history of schizoaffective disorder and violence 
  • There was no proper training in search techniques 
  • There was a previous incident where a nurse was doused with boiling water in an unprovoked attack in a therapy session 

At Woolwich Crown Court, the Trust pleaded guilty to two breaches of the Health and Safety at Work etc. Act 1974 for failing to manage the risk of inpatients and failing to provide all necessary health and safety information to a third party. It was fined £300,000 on the 20 December 2018 and ordered to pay £28,000 costs. 

This is at the heart of this case: missed opportunities to consider and manage risks and to take straightforward steps to reduce them. On the facts, it required carrying out patient specific risk assessments prior to admission, providing search technique training and the removal of knives from the acute admission wards. 

The lessons derived from this case are relevant to all healthcare providers. Healthcare providers should ensure that they have a paper trail that demonstrates when concerns are raised (whether that be concerns about a patient, employee or any other individual) and that they are properly followed up so that the provider has satisfied itself of the safety of patients, employees and members of the public. This is now more important than ever as the Care Quality Commission are clamping down on unsafe practices within the Healthcare Industry at an alarming rate. This is in addition to Public Bodies being on the receiving end of all-time high fines for similar breaches.

The HSE's continuing prosecution against The Priory, a private mental healthcare group, magnifies this message. They face a multimillion pound fine after a 14 year old girl died at their East Sussex facility. She was deemed high risk due to her history of suicide attempts yet she was left unsupervised with access and means to carry out another attempt. The Prosecutor has proposed a starting point of £2.4million for the failure to discharge its duty to ensure that people were not exposed to risk. It is thought that this is the first prosecution of its kind and serves as a stark reminder that risks should be properly identified and addressed. The Magistrates' Court heard that the company would be pleading guilty to the offence and sentencing is expected to take place at Lewes Crown Court on the 6 February 2019. DWF will consider the sentencing in our next issue of Insights.

You can read about the Oxleas NHS Foundation Trust sentencing here.