Bermuda is to send inmates with severe mental health challenges to St Andrews Healthcare, a UK charity which has been hit by scandals in recent years – including the deaths of four clients in their care over a seven month period in 2010.
Citing concerns about safety and leadership, Care Quality Commission which regulates hospitals across the UK has given it an overall grade of ‘requires improvement” for its level of care in its inspections reports for the last two years.
St Andrews Healthcare was also the subject of a critical investigative report earlier this month on Channel Four which found serious lapses in the care of several patients with learning disabilities.
Patient transfers from Bermuda are slated to begin pending successful contract negotiations.
The charity which operates specialist mental health care facilities in four sites across the UK was the first to go public with the news that it had won Bermuda’s favor, heralding its “first international partnership” on its website this month.
A review by Bermuda’s government led to us being invited to offer our support and we were successfully selected from a list of healthcare providers in December, and were given final approval in February. Contract negotiations are now starting,” the hospital stated on its website on Wednesday.
Dean Howells, Executive Director of Nursing and Quality said: “This is great news. It gives our potential service users a much improved opportunity of recovery, thanks to our personalised and holistic approach to care. The new partnership means that we can extend our reach and transform more lives.”
An earlier website posting – now edited – noted that the arrangement meant income from new sources and that three male inmates from Bermuda would be the first to be transferred to its Northampton facility and another nine would follow “in the coming months”.
That posting also announced that St Andrews had been selected from among “numerous healthcare providers” in December and was awarded the contract at the end of February.
St Andrews receives the bulk of its funding from the UK’s National Health Service and is the preferred destination for people who have been ordered detained under the country’s mental health laws.
CQC rates UK hospitals according to five categories – “safe”, “effective”, “caring”, “responsive” and “well-led”.
Its latest inspection report published on Tuesday rated St Andrews “good” in three of those categories but deemed it “requires improvement” in the “effective” and “responsive” categories, and gave it an overall rating of “requires improvement”.
Weak ratings for two of its services – Acute wards for adults of working age and psychiatric intensive care units and Forensic inpatient/secure wards – were largely responsible for its weak overall rating. Both services received a “requires improvement” rating in the safety category with the forensic inpatient/secure wards and acute wards for working age adults receiving “requires improvement” grades in the safe and effective categories respectively.
CQC’s February 2015 inspection also gave it an overall rating of “requires improvement” finding that both the “safe” and “Well-led” categories required improvement.
Last month, Channel four’s Dispatches programme broadcast an investigation into the facility which alleged poor levels of care of young learning disabled patients. St Andrews has rejected the programme as inaccurate and misleading.
We take the accusations extremely seriously but believe the programme portrays a very distorted view of the work we do here. We strongly refute the allegations as either inaccurate, misleading or taken out of context, it said in a press release on March 2.
Bill Johnson, one of the patients highlighted by the programme died while in St Andrews’ care – of severe constipation, a known side effect of anti-psychotic medication Clozapine, which had been missed by the staff. The Dispatches broadcast also reported that Johnson was one of four patients on the same ward who died within the space of seven months – all of whom had been prescribed the same drug.
St Andrews told the programme that it had made changes to its policies and practices around the use of Clozapine since the deaths which occurred between October 2010 and May 2011.
There are about a dozen inmates in Bermuda’s prison system with mental health challenges who cannot be accommodated at the MidAtlantic Wellness Institute.
Government committed to an arrangement with an overseas institution in the 2015 Throne Speech and in last month’s budget debate Health Minister Jeanne Atherden acknowledged that there were nine inmates who were not receiving the care they need.
A Bermuda Hospitals Board spokesperson said that the news had not been publicised because the process is not yet complete.
Much collaborative work has been undertaken between BHB, the Ministry of Health, the Ministry of National Security, the Ministry of Legal Affairs, Department of Court Services and Department of Corrections in finding a viable solution for the population of inmates who need mental health services.
“While work continues to determine the most appropriate long-term solution for Bermuda, an interim solution is needed. A competitive process was therefore initiated last year to find an overseas partner to ensure people in Bermuda’s correctional facilities today are not left at risk. St Andrew’s has just been selected as the preferred bidder and the contract negotiations are due to start this week.
“This means it is not possible to provide concrete dates such as when people will transfer and how much it will cost at this time, but we will share this information when the contract is agreed and signed. Currently, there are three inmates who would be candidates for this service, but in addition to executing the contract, there are complex legal considerations that still need to be addressed before they can be transferred. Having a solution in place for this vulnerable population will help improve care, and improve recovery and management of mental illness.”
The lack of a secure hospital for severely mentally ill offenders has led to suspects and convicts being incarcerated without proper care for lengthy periods before trial and indefinite sentences after trial.
And in recent years several inmates have been released only to reoffend shortly after.
In 2012, Alan Robinson, who suffers from paranoid schizophrenia, attacked two persons with a knife just three months after a stint in prison. He was found unfit for trial due to his mental health and spent two years in prison before being brought back before the courts. Robinson, 57, is now back in prison after being found guilty of attempted murder despite expert evidence that he was ill at the time of the attack.
And in 2008 Lorenzo Robinson took his own life by hanging in a Westgate prison cell. Robinson, 28, had been found not guilty of attempted murder by reason of insanity but incarcerated indefinitely at the West end prison because Bermuda’s only mental hospital was unable to accommodate him securely. His prison cell was designated as a “hospital cell” for the purpose but a court ruled that that decision was ultra vires the constitution and ordered Government to revisit the situation. Months later Robinson was dead.
More recently, controversy erupted when sex offender Malcolm “Chalkie” White was released from prison after serving 12 years of an 18 year prison sentence. It emerged that he had not taken part in any rehabilitation programmes and that other sex offenders may have to be released in the next few months.
Successive governments have so far failed to deliver an on-island forensic unit or an arrangement with an overseas facility.
Two years after Lorenzo Robinson’s death, then Health Minister Walter Roban announced that he had signed a statement of intent with Birmingham and Solihull Mental Health NHS Foundation Trust. We asked Government and the BHB for an update on that arrangement but no reply has been received.
Birmingham and Solihull Mental Health NHS Foundation received an overall grade of “good” in the latest available CQC inspection report issued in September 2014, although it deemed that it “requires improvement” in the safety category.
Former Health Minister Walter Roban, now in Opposition, referred us to the current government for an update on the arrangement with the Birmingham facility. He told us he found it “disturbing” that Bermuda will not be pursuing a relationship with Birmingham and Solihull Mental Health and that his party will look into the concerns around St Andrews.
Government and the BHB has not responded to a series of questions about the former arrangement and concerns about St Andrews.
We also sent a series of questions to St Andrews last night but no response has been received.
Costs for overseas mental health care in a high security hospital in the UK have been estimated at around $1 million per person per year, according to insiders in Bermuda’s mental health care community.
Citing information from the parent of a young St Andrews’ patient with a learning disability, a spokesperson for UK campaign group #JusticeforLB told Politica that a week’s stay at the facility costs £11,600.
UK sociologist and researcher Sara Siobhan founded #JusticeforLB after the 2014 death of her son Connor Sparrowhawk in a treatment center unrelated to St Andrews in Oxford – a death later ruled preventable by an independent inquiry.
A CQC inspection two months after Connor’s death found that facility to be “inadequate” in all ten of its performance measures.
The thought of flying ppl from Bermuda to Northampton makes my skin crawl, said Ms Siobhan in a tweet to Politica.
UPDATE: A BHB spokesperson sent this comment after posting this story
We are reviewing all quality and safety reports as we move into contract negotiations. The negotiations are only just starting and we anticipate the process will take many weeks of deliberation and discussion. If negotiations are successful, a final contract would include performance and accountability measures and these will be shared along with financial costs with the community.
The process is being overseen by a multi-agency Steering Committee including staff from BHB and Government and clinical staff, such as our local psychiatrists. St Andrew’s are best placed to talk though the improvements and actions they have taken to address the issues raised in the report to date, if the media is looking for detailed and immediate responses to the report.
With regards to the Birmingham & Solihull Mental Health NHS Foundation Statement of Intent, at the time it was not financially viable so a contract was not agreed.
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