Please note, Hampshire and Isle of Wight Healthcare NHS Foundation Trust was formed in 2024 when Southern Health NHS Foundation Trust, Solent NHS Trust and some services from Isle of Wight NHS Trust and Sussex Partnership NHS Foundation Trust merged to form a new organisation.
We are required by our regulators to publish some reports and investigations into our services. You can view these below, including any relating to relevant services from our legacy Trusts. If you cannot find what you are looking for please contact our legal services team who will be able to advise further.
Firstly, and most importantly, our thoughts and our condolences are with the families and all those who were affected by this tragic incident.
In 2017, the Trust commissioned Caring Solutions, an external independent investigation company to undertake an investigation into the care and treatment provided to P1 (a patient of the Trust) who was the perpetrator of a homicide earlier that year. The executive summary from this external investigation report can be found here.
In 2019, as part of its role to oversee and support the investigation process following mental health related homicide, NHS England commissioned Niche to undertake a review of the Trust’s action plan arising from this investigation, our duty of candour responsibilities in this case, as well as the CCG’s oversight processes. This report can be viewed on the NHS England website.
All the 11 recommendations from the Caring Solutions investigation were signed off as having been addressed following presentation of evidence at a series of commissioner-led panels. The action plan was closed at a commissioner-led panel held in July 2021 following sign-off of the last outstanding action.
The additional recommendations suggested by Niche in relation to Duty of Candour and action planning have also been addressed through the development of the family liaison officer role and the strengthening of our ‘evidence of improvement’ processes following serious incidents. Action planning and duty of candour were themes that formed part of the subsequent Pascoe independent review in 2021 and actions taken by the Trust in these areas were subject to significant additional scrutiny and assurance processes led by NHS England. These concluded in 2022.
Furthermore, the Trust worked through the serious incident review accreditation network programme from the Royal College of Psychiatrist accreditation programme during 2020 and 2021 and received accreditation in October 2021.
The Trust remains committed to constant and ongoing learning and development of its systems, processes and practice to make services as safe and effective as possible.
In February 2020, NHS Improvement published an investigation report after Nigel Pascoe QC independently reviewed the historical cases of five people who died in Southern Health’s care between 2011 and 2015. The report recommended a second stage process to look at how the Trust has improved in the intervening years and the further developments we have planned.
This second stage took the form of a series of virtual public hearings which were held in March and April 2021. Staff from our Trust provided evidence and responded to questions from a panel of experts. Patients and carers were also invited to share their experiences of care at Southern Health.
The second stage report has been published along with an action plan from Southern Health addressing the recommendations.
Ron Shields, Chief Executive of Southern Health said:
“This second report brings important recommendations to help us provide the best possible care to patients, carers and families. I thank the panel and everyone who contributed.
“On behalf of the Trust, I apologise again unreservedly to the families affected by the tragedies of 2011-15 highlighted in Mr Pascoe’s first report. While we focus on improving services now and in the future, we do not forget or diminish the failings of the past.
“As the report acknowledges, the Trust has made significant improvements since then - but we know there is much more for us to do, in partnership with service users and their families, to get things right first time, every time.
“Making these changes remains our absolute priority and we will now produce a detailed plan to reflect the report’s recommendations, showing where we have already made changes and how we will make the further improvements necessary.”
Futher information
- View the Action Plan from Southern Health
- View the full stage two report from Mr Pascoe QC, extracts of the stage two report featuring the Executive Summary, Recommendations and Conclusions and and easy read version of the stage two report on NHS Englands website here.
A serious incident investigation report has been published by NHS England following the deaths of Chris Stone-Houghton who was accessing our services, and his wife Ruth Stone-Houghton, in 2022. The purpose of the report was to help understand what happened and what opportunities there are for learning for all agencies involved.
Firstly, our thoughts and deepest condolences remain with Chris and Ruth's children Oliver and Abbie and everyone impacted by what happened.
The Trust fully accepts the findings of the review which will further inform our efforts to strengthen the services we offer.
Having reflected on the learning from the investigation, we have continued our work to improve the way we support those who care and love our patients, as well as the care we provide directly to the patient themselves.
For example, we have:
• approached colleagues in the Early Intervention in Psychosis (EIP) National Network to understand how other services use patients’ age to determine access to care. We have updated our standard operating procedure for EIP, to ensure that care teams’ clinical judgement is used, based on individual patient need, when considering whether people over the age of 65 should be eligible to enter EIP.
• reviewed our pathways to ensure people's care is streamlined and managed by the clinicians leading their care. If a patient is admitted on to a ward we provide in-reach from other teams when required to provide specialist and expert support but the care is managed by the ward team.
• recruited a psychologist to strengthen the level of psychological input on the ward.
We are immensely grateful to the family who continue to work proactively with us to ensure the lessons are learnt and change is meaningful, so that our care continues to improve. Chris' son Oliver is open and willing to discuss any planned changes directly. Contact can be made via the Trust.
The full investigation report is available on the NHS England website.