An NHS trust has apologised to the families of two psychiatric patients after multiple failures led to one patient strangling the other to death on a low-risk ward. Richard Laversuch, 63, was killed by Owen Herbert at Parklands Hospital in Basingstoke, Hampshire, in the early hours of 27 November 2021.
Herbert, then aged 18, believed he was "in a game" and would be "tortured" if he did not kill someone, a jury inquest heard. Hampshire and Isle of Wight Healthcare NHS Foundation Trust told the court it accepted responsibility for failures in care and had made changes as a result.
What apology did the trust give?
Giving evidence at the hearing in Winchester, the trust's director of quality and professions, Donna Greenwood, apologised for "gaps in our care". She told the Laversuch family:
Richard should have been safe on our wards and he wasn't.
Turning to Owen Herbert's parents, she added:
Owen should have been safe in our care... In terms of the impact it's had on him and your family's future, I and the trust are very sorry.
Parklands Hospital was run at the time of the killing by Southern Health. The trust accepted five failures, the inquest jury was told.
What failures did the trust admit?
Greenwood said Herbert, from Overton, should have been admitted to a Psychiatric Intensive Care Unit (PICU), for higher-risk patients, in accordance with national standards. She accepted there was a failure by staff to carry out a risk assessment when he was admitted, the ward was insufficiently staffed, his patient record prior to admission was not properly written up and there were communication failures over his admission.
When asked by the coroner if the failures "caused or contributed" to the death of Laversuch, the director replied
yes.
Previously, the inquest heard when Herbert arrived "unexpectedly", the PICU was full, so staff on a lower-risk ward felt they had to accept him instead, despite being told at the beginning of their shift that he was "too high-risk". The staff admitted him without alerting on-call managers to the situation they faced.
The jury was also told Herbert tried to strangle another patient minutes before killing Laversuch, from Andover, but when staff investigated the patient's report, they found Herbert in bed and did not suspect him.
Herbert was given an indefinite hospital order in 2023, after pleading guilty to manslaughter on the grounds of diminished responsibility.
What changes have been made since the death?
Parklands Hospital was run by Southern Health NHS Foundation Trust until 2024, when an amalgamation of services took over under the new name of Hampshire and Isle of Wight Healthcare NHS Foundation Trust. As a result of Laversuch's death, the new trust has put up flow charts to remind staff about the patient admissions processes, the inquest heard.
Procedures have been tightened, there is better access to senior staff, and mirrors to monitor patients in corridors have been installed, Greenwood said.
What concerns did the family raise?
Laversuch's sisters - a retired hospital consultant and a retired nurse - told the court they were concerned about the clarity of the trust's written policies on admissions and other practices. Greenwood said the comment was fair and invited the pair to review the documents, to which they nodded enthusiastically.
The coroner thanked the NHS trust for its openness.
Key Facts
- Richard Laversuch, 63, was killed by Owen Herbert at Parklands Hospital in Basingstoke on 27 November 2021.
- Hampshire and Isle of Wight Healthcare NHS Foundation Trust accepted five failures in care.
- Donna Greenwood said Herbert should have been admitted to a Psychiatric Intensive Care Unit.
- Herbert pleaded guilty to manslaughter on the grounds of diminished responsibility and received an indefinite hospital order in 2023.
- The trust said it has since tightened procedures and improved staff access and monitoring.
