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The Independent
18 hours ago
- Health
- The Independent
UK's largest children's brain injury unit cut frontline staff over ‘financial crisis' before child deaths
Frontline staff were cut at a flagship rehabilitation unit weeks before a child died when nurses failed to monitor her properly, The Independent can reveal. The Children's Trust (TCT), a care home for disabled children in Tadworth, Surrey, has been criticised by coroners after three young patients, who had brain injuries and complex conditions and required either around-the-clock care or regular monitoring, died while under its care. One of those children, Raihana Oluwadamilola Awolaja, 12, who was meant to be receiving one-to-one care, died in hospital after her breathing tube became blocked when she was left unattended for 15 minutes. A coroner later found her death had been contributed to by neglect and ruled that, 'on the balance of probabilities, she would not have died at this time' had she been 'appropriately observed' when the breathing tube became blocked. Now, The Independent can reveal that the centre, which is the UK's largest brain injury rehabilitation centre for children, made staff redundant in the weeks before Raihana's death in June 2023 amid financial concerns. According to accounts analysed by The Independent, the trust had 'significant concerns' over its finances in 2022 and 2023. A report said that redundancies had been 'unavoidable', with a restructure which reduced overall staff numbers by 15 per cent completed by May 2023. At Raihana's inquest, coroner Fiona Wilcox found there was 'simply insufficient staff to provide constant one-to-one care' and that the nurses' gross failure to observe her was 'compounded by the lack of sufficient staff on the unit where Raihana lived to provide proper 1:1 care'. She found that, in practice, the one-to-one care provided for the young girl by the trust was one nurse to two patients, when parts of the daily work routine, such as breaks, meetings and handovers, were taken into account. The coroner's prevention of future deaths report said: 'There were simply insufficient staff to provide constant one-to-one care, as understood it should have been provided and commissioned by the local authority. 'There was confusion as to what one-to-one meant at the time of Raihana's death and how it is practised now by carers and nurses who gave evidence.' The coroner added: 'There will still be occasions when vulnerable residents such as Raihana will be left one to two, with eyes on only observation, despite an apparent increase in numbers of staff on duty at any one time, albeit it should happen less often.' Evidence to the inquest also revealed Raihana's mother repeatedly raised concerns that, contrary to the agreed levels of 'around-the-clock one-to-one care', she had found her daughter to be left with no supervising carer. The inquest heard this issue was discussed at meetings at TCT, but it continued to happen. Staffing levels were not explicitly mentioned in the coroners' prevention of future deaths (PFD) reports for two other children who died at the unit, Mia Gauci-Lamport, 16, and five-year-old Connor Wellsted. But an inquest into Connor's death heard he had likely been dead for hours by the time staff found him. The young boy was found dead in his cot at TCT on 17 May 2017 after he became trapped under a cot bumper. A key concern was that he had 'no regular or direct supervision overnight', other than staff opening the door or watching him through a glass window. Mia, who required 24-hour care, died of natural causes after she was found unresponsive in her bed. She should have had in-person checks every 15 minutes, but it was 'common practice among' some staff to use a video camera to check on her, the PFD report said. Concluding Mia's inquest, coroner Karen Henderson, who also investigated Connor's death, said the lack of a 'robust and adhered-to care plan for night observations' mirrored the same concerns she raised about Connor's death. The Independent has found that TCT reported a 'serious incident' to the Charity Commission in August 2022 over its finances. The Charity Commission describes serious incidents as events or issues that could harm the charity's beneficiaries, staff or volunteers or result in a loss of the charity's money or assets, damage its property or harm an organisation's reputation. Leaders later approved a financial recovery plan which aimed to reduce staffing costs at the charity, which has multiple executives earning six-figure salaries. Its annual report for 2022-23 said the trust had made 'significant headway' on two key objectives – reducing expenditure and increasing income, adding: 'Regrettably, with staff costs representing 80 per cent of total expenditure, we had to undertake an organisational restructuring which was completed in May 2023.' Raihana died in June 2023, and Mia died three months later, in September. The report added that overall staff numbers were cut by 15 per cent, which reduced the total staffing budget by £3.7m. It added that it would remain focused on 'minimising staff costs (including temporary agency workers and recruitment fees) and maintaining a leaner workforce going forward.' TCT told The Independent it had 'stabilised' its finances 'following a financial crisis in 2022', and that it was a different organisation now compared to the years in which Connor, Mia and Raihana died. It admitted that, at that time, financial pressures had 'threatened the future' of TCT. It added that, following Raihana's death, it had made significant changes to its monitoring and observation policy and has introduced a flexible 'floating' staff role available 24 hours a day, which ensures additional support can be provided. It added: 'The lack of sufficient staff on the unit where Raihana lived was not due to cuts in staffing levels to aid financial recovery. 'Staffing levels were in place, which allowed us to be compliant with our policy and meet our contractual agreements around 1:1 care at that time.' TCT said it has also since changed its policy on monitoring patients, which it says ensures practices are clear, consistent and personalised to meet each child's needs. It said the organisation now requires every staff member allocated to provide one-to-one care to formally sign a document at the start of their shift to confirm their understanding of the individual's care, monitoring and observation needs. Responding to the coroner's concerns over Raihana's death, the trust said it was in the process of creating a new staffing model aligned with national standards. Mike Thiedke, chief executive of TCT, said: 'The board and my executive team remain committed to ensuring the highest standards of care for all children and young people at The Children's Trust. 'Through collaboration with our NHS and wider system partners, continuous engagement with stakeholders, children and families, and a strong focus on improving clinical governance, we are confident that the changes we have made are resulting in tangible improvements to the care we provide.'
The Independent
22-06-2025
- Health
- The Independent
Four nurses investigated over death of boy, 5, at flagship children's care home
Four nurses are facing a fitness to practise probe after the death of a 5-year-old boy at a flagship care home for disabled children, The Independent can reveal. The Nursing and Midwifery Council (NMC), the UK's nursing watchdog, initially found there was no case to answer over the death of Connor Wellsted, who suffocated in his cot in 2017 while being cared for at The Children's Trust (TCT) in Tadworth, Surrey. The nurses were referred to the NMC in May 2022, but the watchdog later closed the investigations. It reopened the probe in November 2023 and, this month, after a 19-month-long investigation, decided all four nurses should face fitness to practise tribunals. No interim conditions have been placed on the nurses, meaning they can continue to work while awaiting the outcome. If the committee finds the nurses are unfit to practise, they could be struck off or suspended. However, the committee can also decide that the nurses' fitness to practise is not impaired and give no sanction. It comes after The Independent revealed that Surrey police had reopened a probe into the handling of Connor's death following a litany of failings over the little boy's care. Connor died at TCT, the UK's largest brain injury rehabilitation centre for children, which can care for up to 66 young people, having suffocated when a cot bumper became lodged under his chin. He had been there for six weeks, receiving care for neuro-rehabilitation. He was the first of three disabled children to die while in the care of TCT. Raihana Oluwadamilola Awolaja and Mia Gauci-Lamport died in June and September 2023, respectively. Multiple failings have been identified in all three of the children's care, including a failure to appropriately monitor them. In 2022, coroner Karen Henderson found Connor died after the cot bumper, which was not properly secured, came loose and obstructed his airway. The inquest found TCT 'failed to keep Connor safe in his cot.' Among concerns highlighted by the inquest was the fact Connor had 'no regular or direct supervision during the night'. The inquest also revealed staff did not fully inform the police and coroner's services as to the circumstances of his death. Police were not told of the position Connor was found in, and that he had been dead for some time. They were also not told that the padded cot bumper was initially found across his neck, the inquest heard. The prevention of future deaths report states TCT's chief nurse and medical director were concerned about the role the bumper played in his death, but they did not keep a copy of his medical records or inform the relevant statutory bodies and 'arguably misled' the CQC. The pathologist was also not informed of the circumstances of his death, which prevented a post-mortem examination from taking place to establish whether the cot bumper played a part in how he died, the report said. 'An innocent individual' Last month, Coroner Fiona Wilcox issued a prevention of future deaths report following the death of Raihana. The report found there was a 'gross failure in care by nursing staff' after they failed to adequately observe her. It is not known whether any of the same staff cared for both Connor and Raihana. The inquest also revealed: 'Following Raihana's death, TCT undertook an investigation which failed to uncover what had happened or to understand the cause of her death. This meant that a nurse, to whom Raihana's care had been handed to by the allocated carer was blamed by the TCT and was referred to the NMC erroneously.' TCT said the initial investigation had been carried out by an external organisation. The inquest also found 'issues with the credibility of another nurse (nurse two) who should have been caring for Raihana'. Ms Wilcox warned: 'There may be a culture of cover-up at the TCT, in that they carried out a flawed investigation after this incident, pushing blame onto an innocent individual and thereby avoiding highlighting systemic failures and learning and thus risking lessons that should be learned are lost that could prevent future deaths.' In response to the coroner's allegations about the erroneous referral to the NMC, TCT said: 'We accept that the initial external investigation was inadequate and did not sufficiently explore systemic factors. 'We later identified these issues and undertook further work to strengthen our organisational learning. The extensive evidence presented to the coroner during the inquest helped clarify the events that led to Raihana's death and enabled us to improve the way we manage and investigate incidents. 'Raihana's death has prompted significant reflection, change, and action across our organisation. We are working hard to build a no-blame culture and support our specialist staff to meet our high standards of care. We've made significant changes to how we review and respond to concerns - focusing on learning, not blame.' It said it has implemented the Patient Safety Incident Response Framework (PSIRF), 'which shifts the emphasis from individual fault to understanding wider systemic issues'. The NMC was sent a copy of Raihana's prevention of future deaths report. In a response to The Independent, it said: 'We are aware of the tragic deaths of Connor, Raihana and Mia and our thoughts are with their loved ones. 'We can confirm that we have received the prevention of future deaths report in relation to Raihana's sad death and are considering the appropriate next steps. 'We are only able to confirm whether an individual is under investigation in certain circumstances, which is generally if we have completed an investigation and case examiners decide there is a case to answer.' The NMC confirmed that, in the case of Connor, its case examiners have decided there is a case to answer concerning four registrants and have recommended they proceed to a fitness to practise committee. The NMC has faced criticism over the screening and decision-making of referrals.
