Trust fined £330,000 for falls deaths

Shrewsbury and Telford Hospital NHS Trust received fines in respect of five breaches of the Health and Safety at Work Act.

Overview

On 28 November 2017 Shrewsbury and Telford Hospital NHS Trust received fines totalling £330,000 in respect of five breaches of Section 3 (1) of the Health and Safety at Work etc. Act 1974 (‘the 1974 Act’), following a prosecution brought by the Health and Safety Executive(‘HSE’). The charges were brought after five elderly patients died following falls at the Princess Royal Hospital in Telford or the Royal Shrewsbury Hospital between June 2011 and September 2012, although in one of the cases there was no established causal connection between the fall and the patient’s death.

In detail

The case was heard at Stafford Crown Court by Mr Justice Haddon-Cave, who also heard the cases brought against the Mid-Staffordshire NHS Foundation Trust in 2014 and 2015. He gave credit for the Trust’s timely guilty plea, which earned a reduction in sentence of one third, indicating that, had the offences been committed by a private company, rather than a public body, the starting point for the fine would have been £1 million.

The HSE’s post-hearing press release notes that: “…investigations found that fall prevention measures, including close supervision of those in a confused mental state, were not properly applied. This was made worse by poor consideration and communication surrounding measures to protect against falls arising from each patient’s particular frailties.”

The case illustrates the potentially serious financial repercussions for Trusts which fail to ensure compliance with basic duties under the 1974 Act; and the real risk of regulatory enforcement action faced by those failing to manage falls risks properly.

Section 3(1) imposes a duty on all employers to conduct their undertaking “…in such a way as to ensure, so far as is reasonably practicable, that persons not in his employment who may be affected thereby are not thereby exposed to risks to their health or safety”.

Self-evidently, this provision is not restricted to risks associated with falls and is potentially of much wider application, as evidenced by the wide range of situations in which the same provision has been used to prosecute other healthcare bodies over many years.

Conclusions and implications

It is widely appreciated that the management of falls risk is a challenging area for providers of health and social care. This case demonstrates the importance of having in place a culture, systems and procedures which ensure that risk assessment in the case of every patient is suitable, sufficient and properly acted upon in the care planning which follows.

In cases where a patient has died there will ordinarily be an inquest hearing before any decision by the enforcing authorities (normally the CQC, in respect of offences since 2015) as to what action should follow. Being properly prepared for the inquest, and avoiding a PFD report by volunteering convincing evidence of appropriate changes having been made to avoid the risk of a repetition of the circumstances presenting a risk of future deaths, will always be important.

Trusts and other health or social care providers should be familiar with the circumstances in which falls (whether or not resulting in fatality) need to be reported under RIDDOR and maintain positive relationships with their enforcing bodies. Failing to report a reportable event constitutes an additional offence, but also risks jeopardising the enforcing body’s confidence in the organisation’s transparency and candour.

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