Mum fears NHS trust cover-up over Cambridgeshire suicides review

The mother of a woman who took her own life weeks after being discharged from a mental health ward fears a "culture of cover up" within the NHS trust.

Hannah Roberts, 22, died by suicide in 2018 and her mother Sally said there were "discrepancies" in the accounts of the talented musician's discharge.

She feels an ongoing internal review into all Cambridgeshire & Peterborough NHS Foundation Trust (CPFT) suicides since 2017 should be independent.

CPFT did not respond to her comments.

The trust's chief executive Anna Hills previously said the internal review into 63 suicides would "be an important piece of work".

Its announcement came after the trust was accused of adding to the records of Charles Ndhlovu, 33, the day after he took his own life to, in his mother's words, "correct their mistakes".

But Mrs Roberts, who believes her daughter's death fits the criteria of the review, has not been contacted by the trust.

"We've only got the assumption that Hannah is one of those 63 because we've had no communication from CPFT to notify us that they're actually doing this review.

"We found out about it [in the] media."

She contacted the BBC after seeing its coverage of the announcement, and was concerned about the way the review was being carried out.

"I feel strongly that an internal investigation isn't going to achieve anything that they're going to learn from," she said.

"It needs to be a fresh pair of eyes and somebody who is going to be more objective and take into account the views of the families involved."

Her daughter Hannah, from Landbeach, was a voluntary patient on Mulberry ward at Fulbourn Hospital in March 2018 after a suicide attempt.

Mrs Roberts said her daughter was discharged on 21 March 2018, but CPFT's report had a "completely different recollection" of events.

"Hannah told us she had been discharged because she had self-harmed," she said.

"My husband was told that she was discharged because she had self-harmed, yet [CPFT's] report to the coroner said that she had asked to be discharged."

She said her husband "was almost pleading with them not to discharge her because we felt she was very high risk".

Hannah took her own life on 9 April 2018.

Mrs Roberts said Hannah had a signed an agreement when she went into hospital that stated if she self-harmed she would be discharged.

But she was told at the inquest in 2019 that in practical terms CPFT did not always impose that.

Asked why she believed an internal review would not be suitable, Mrs Roberts said: "I think there is a culture of cover up within CPFT.

"People aren't willing to acknowledge their mistakes and I think it needs a fresh pair of eyes... somebody to come in and be more objective to look at what's happened and to review these deaths."

An inquest into the death of 23-year-old James Nowshadi heard a review into his suicide in 2020 was "touched up".

His mother Maria said she found it "quite surprising and maybe a bit concerning" that it was an internal review.

"In James' case, there were serious things to consider about the [review] they did," she said.

"I just wonder whether the trust has the wherewithal themselves to be able to be open and honest enough to look at 63 deaths and pick out the points of learning from them."

She said she was "more reassured" that it was someone new to the trust doing the review, but she would prefer it to be someone external.

CPFT declined to state whether the deaths of Mr Nowshadi or Ms Roberts would be included in the review.

It also did not confirm whether it would include the deaths of people who took their own lives where a coroner gave a narrative conclusion at inquest, rather than a suicide ruling.

Both the Cambridgeshire & Peterborough Integrated Care Board (CPICB) and the Care Quality Commission (CQC) have been informed of the review.

While the CPICB declined to comment, the CQC said: "We don't have a formal role in the review but are liaising with the trust to stay updated on its progress and conclusions.

"Our main priority is always the safety of people using health and social care services, and if we have concerns, we won't hesitate to take action in line with our regulatory powers."

Ms Hills previously said: "The review will examine patient deaths, how we provide families with the information they need, how we recognise crucial themes and how we embed the learnings into our future care.

"This will be an important piece of work and will include concerns which have been raised about serious incident investigations."

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