Ridouts LLP The importance of risk assessing patients before admission to care homes: an NHS Trust and care home owner found guilty of health and safety breaches

In July 2012, Hertfordshire Partnership NHS Trust was fined £150,000 and ordered to pay costs of £326,345 for placing a male patient suffering from bipolar disorder in a care home where, tragically, he stabbed to death a female care worker.

The sentence followed an eight week jury trial at Luton Crown Court that resulted in the Trust being found guilty of contravening a health and safety regulation by failing to undertake a suitable assessment of the risk the patient posed. In addition, the Trust was convicted of a second charge of failing to discharge a duty to ensure persons not in its employment (in this case the staff and residents in the care home) were not exposed to risks to their health and safety.  The patient could be aggressive and violent and in the past had carried offensive weapons. He had also been known to exhibit sexually inappropriate behaviour to women. The NHS Trust had never sent anyone to the care home before. The carers at the care home (which has since closed) were not competent in dealing with patients suffering from bi-polar disorder.  Judge Michael Baker QC indicated the blame at the Trust went “to senior management level.”

As well as the Trust, the former owner of the care home was fined £75,000 and ordered to pay costs of £338,996, having been found guilty of contravening a health and safety regulation by failing to carry out a risk assessment of the patient prior to admission. The owner was also convicted of two charges of failing to ensure the safety of staff and residents at the care home.  On sentencing the owner, the Judge criticised him for not being candid with the Trust when it enquired whether the home could cater for someone with the patient’s condition and allowed “financial gain to guide him rather than a prudent approach to issues of safety.”

This tragic case highlights the importance on the part of public sector purchasers and independent sector care providers of carrying out proper risk assessments prior to admission. Significantly, the case indicates the importance of a purchaser of care (in this case a mental health Trust) fulfilling its duty to adequately assess the risks that might be posed to staff and residents in a care setting prior to the placement happening. Furthermore, it reinforces the fact that care providers have a duty not only to protect the safety of their residents but their staff as well.

The Health and Safety Executive inspector stated after the sentencing, that:

“I hope this will make all NHS Trusts and care facilities carefully consider the procedures that they have in place during patient placement.”       

There is a real pressure on some care home providers to accept service users with presenting conditions they are not geared up to care for when faced with reduced occupancy levels owing to local market conditions. However, this case should stand as a warning that care providers should always carry out a proper risk assessment in advance of a placement to ensure that their care staff have the competence to look after the person in question. A service should not feel pressurised to accept someone who presents with needs beyond the skill set of the home. The provider should also have due regard to any CQC conditions of registration around categories of client since there is an additional risk of contravening a condition which is a criminal offence.  Due regard should also be had to the CQC essential standards in the admissions process.

At Ridouts, we have experience of advising providers on their admission procedures. Please feel free to contact us for advice if you have any concerns about your admission procedures or any particular placements. We’re here to help.

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