Families of patients who lost their lives while under the care of an NHS trust after a "catalogue of failures" have written an open letter to the Prime Minister in a desperate plea to hold a public inquiry.
Fifty-seven-year-old Pamela Brown, from Redcar, died in September 2019. She took her own life at Saltburn cliffs after absconding from the psychiatric hospital whilst on ten minutes of unescorted leave.
Now, her daughter Rebecca Brown is calling for a statutory public inquiry into the hospital trust that she believes is responsible for her mum’s tragic death.
Pamela, from Redcar, was struggling with depression, anxiety, and intrusive thoughts when she was sectioned under the Mental Health Act and was detained at Roseberry Park Hospital in Middlesbrough.
The hospital, run by Tees, Esk and Wear Valley NHS Trust (TEWV) “inadequately” assessed her risk, meaning she was able to take an unescorted walk. Pamela’s body was found at the bottom of Huntcliff, in Saltburn, around five hours after she left the hospital.
Rebecca, Pamela’s only child, believed that the trust “let down” her friendly, kind mum.
After her death, an investigation carried out by the trust found that there were “11 care and service delivery” problems and an inquest into her death ruled that 'the overall formulation of risk' was inadequate and that contributed to her taking her own life.
At the inquest, TEWV confirmed several steps have been taken to address the issues found in their review.
Rebecca said: “When mum was admitted to Roseberry Park in 2019, she told me she was just waiting to die. The signs were there – I don’t understand why her risk level wasn’t higher. She was clearly a danger to herself.”
“An inquiry is absolutely needed because otherwise, so many people are going to continue to suffer. They just keep making the same mistakes.
“My mum’s care was horrendous - I don’t understand how you can be so ill but be given leave and not tell the families."
Rebecca believes that the same issues identified in her mother’s care still persist in the trust. She said: “It’s the lack of listening – TEWV didn’t listen to any of the families. They weren’t taking us seriously about anything we knew about my mum.
“I tried to tell them this wasn’t like her but they never listened. They kept saying the best place for her was at home – but she was a danger to herself at home, and they kept her risk level too low.”
Rebecca is keen “not to blame low-level staff”, but believes that the “whole trust needs an overhaul”.
She added: “You have all the coroners, and all the inquests saying that something needs to be done, but it never seems to happen. How many crises do you need to have, how many people have to lose their mums, to get any change?”
At an inquest into Pamela’s death, when giving their verdict, the jury told Assistant Coroner Jo Wharton: "At the time of her death Pamela Brown was a formal patient at Roseberry Park Hospital.
“The overall formulation of risk was inadequate and resulted in Pamela taking her own life."
Rebecca added: “People need to know about the campaign for an inquiry - I wasn’t aware of the issues at TEWV before her. They were supposed to look after her, but they just didn’t."
Read more:
- Bereaved North East families call on PM for health trust inquiry
- North East families write letter to PM calling for inquiry into trust
- Middlesbrough mum calls for inquiry after son's death
Rebecca paid tribute to her beloved mum, who had worked as a civil servant in the Department of Work and Pensions, saying: “She had lots of friends, there was nothing she wouldn’t do. She was bubbly and happy – you wouldn’t know she was unwell at all.”
A spokesperson at the Trust, said: “Our thoughts go out to those who have lost a loved one.
“As an NHS trust, we have no role or influence on public inquiries. These are a matter for government. We fully accept the need for accountability and that currently comes in many forms, including regular inspections from the Care Quality Commission.”
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