St Michaels Hospice, St Leonards, fined over fatal fire

A hospice where three residents were killed by a fire has been fined £250,000 for its "woefully inadequate" safety measures.

The blaze at St Michael's Hospice in St Leonards, East Sussex, led to the evacuation of 23 people.

But, Hove Crown Court heard, staff were ill-trained to deal with such an event, and the main fire exit was locked.

Judge Christine Henson, who slammed the hospice's safety measures, also ordered it to pay £165,000 in costs.

Managers at the hospice admitted two fire safety breaches, and its denial of 11 other indictments was accepted by the court.

'State of panic'

Pearl Spencer, 78, Jill Moon, 62, and David Denness, 81, died in hospital after suffering smoke inhalation.

Patient Rodney Smith, 67, was charged with arson after the fire on 11 July 2015 but died in jail before his trial.

In pre-sentence reports for the prosecution, Mr Sailesh Mehta said it was clear that staff had "no appropriate training for the evacuation of residents, holes in the ceilings allowed smoke to spread, locked exit doors could not be readily opened".

He said the main fire exit was locked, and there was no proper evacuation training for staff.

"Nurses were in a state of panic - they tried to stop it [the fire] with towels to no avail.

"Some patients had to be put on a small filing cabinet to wheel them along as there were not enough wheelchairs available," he said.

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In its defence, the hospice said it was unaware of the defects "ruthlessly exposed" by the fire, and it accepted "blameworthiness for failing to make the premises as safe as it should have been".

Court proceedings were brought by East Sussex Fire Authority in May last year.

Image captionTwenty-three elderly patients, some of whom were terminally ill, and nine members of staff were in the hospice

The hospice said the fine would be paid from reserves and costs from elsewhere.

It was reduced by 30% due to St Michael's charitable status.

Mr Smith was a terminally ill patient at the hospice when the blaze broke out.

Twenty-three elderly patients, some of whom were terminally ill, and nine members of staff were forced to leave the building.

Ten residents had to be taken to hospital for treatment.

In a statement on Wednesday, chair of the hospice Irene Dibben, and chief executive Karen Clarke said: "We remain truly sorry for the pain and anguish caused by the fire.

"We also share the pain of our own staff and volunteers, many of whom are still coming to terms with the full devastation of the fire.

"We need to decide as an organisation the best way to settle the fine. In light of this, there will be no further comment at this stage."

CQC to decrease fees for small community care providers.

Following a public consultation last year, the CQC have outlined the fees that providers of health and adult social care in England will pay from April 2018 to cover the costs of their regulation. They made proposals that affected NHS trusts, NHS GPs and community social care providers.

CQC’s regulatory functions are funded both by fees paid by providers and by grant-in-aid from the Department of Health. Government policy requires CQC to fully recover the chargeable costs of regulating health and adult social care in England.

Examples of the fee changes that community social care providers, NHS trusts and NHS GPs can expect include:

  • A community social care provider with 1 location and 15 service users will see their fee decrease from £2,192 to £926
  • A community social care provider with 3 locations and 50, 100 and 45 service users at each of the locations will see their fee increase from £6,093 to £9,643
  • An NHS trust with a turnover of £120 million will see their fee decrease from £158,902 to £85,200
  • An NHS trust with a turnover of £681 million will see their fee increase from £322,249 to £483,510
  • An NHS GP provider with 1 location and a patient list size of 5,200 will see their fee decrease from £4,526 to £3,473
  • An NHS GP provider with 2 locations and patient list sizes of 10,000 and 8,300 at each of the locations will see their fee increase from £8,371 to £11,449.

For all other sectors the fee scheme remains unchanged, which means a provider’s fee will remain the same as that for 2017/18, providing their registration remains unchanged.

You can find the annual fee for your service for 2018/19 using the fees calculator published on the CQC website.

Wide variation uncovered in how NHS and local authorities work together when applying the Mental Health Act

People might not be getting the specialist mental healthcare they need and when they need it most because of disparity in how approved mental health professional services are provided across the country.

Approved mental health professionals (AMHPs) are typically social workers who work on behalf of local authorities to – amongst delivering other responsibilities – assess people to decide whether or not applications should be made to detain them under the Mental Health Act following medical recommendation.

AMHPs play a vital role in ensuring that people are detained in hospital only when there is no other option. Where possible, they help to identify alternatives to people being legally detained under the Act so that people do not receive healthcare that is unnecessarily restrictive.

In the ten year period between 2005/06 and 2015/16, the number of detentions under the Mental Health Act increased by 40% – from 45,484 to 63,622. AMHP services would have been involved in considering the majority of these applications.

Today (Tuesday 27 March), the CQC have published a briefing paper that sets out their key findings around what is working well and what the barriers are to these services running as well as they should be.

In it, they have concluded that while there are examples of good practice, further work is needed support local AMHP services to deliver their roles effectively. In particular; AMHPs told them that:

  • There are difficulties with recruiting and retaining AMHPs.
  • In some parts of the country, there are often delays in admitting patients to hospital because mental health beds are fully occupied.
  • There is variation in the extent to which health and social care services are integrated and work together.
  • They were concerned about limited access to low level prevention resources (e.g. in the community) and limited funding across adult social care commissioned services that might have supported people so that they did not need to be detained or admitted to hospital.

The CQC have shared their paper with the Department of Health and Social Care so that it can inform the ongoing independent review of the Mental Health Act, led by Prof Sir Simon Wessley.

Dr Paul Lelliott, deputy chief inspector of hospitals (lead for mental health) at the Care Quality Commission, said:

“Local authorities, through their approved mental health professional services, have a crucial role to play in working with the NHS to ensure that people with serious mental health problems get the care and support they need. Although this includes ensuring that every attempt is made to find less restrictive alternatives to detaining people in hospital under the Mental Health Act, it also means being able to admit a person promptly when that is in their best interests.
“We have found that where AMHP services work well, they are underpinned by good leadership, that their role and contribution is recognised locally, and that there is solid partnership working across the system which allows innovative practice to be shared.
“Also, AMHPs we spoke to told us that particular forms of community provision can sometimes prevent the need to detain a person in hospital under the Mental Health Act. These alternatives to admission include intensive support to the person in their own home, or in another safe place, and in crisis cafes.
“However, not all parts of the country achieve this vision of integrated care that minimises the restrictions placed on people with severe mental health problems, while ensuring they can be admitted to hospital promptly when this is unavoidable. The barriers include reduced bed capacity in specialist services, difficulties in recruiting and retaining AMHPs, variation in how health and social care providers and commissioners integrate across areas and the unavailability of services that might provide an alternative to admission.
“The Government’s independent review of mental health legislation that is being led by Prof Simon Wessley is a ‘once in a generation’ opportunity to get to the bottom of the concerns we have raised about the use of the Mental Health Act and in particular, the ongoing rise in detentions. The role of AMHPs will be very important in understanding and addressing this.”