An NHS trust has been fined more than £2.5 million over safety failings that lead to the deaths of two patients, the highest fine handed to a trust following a prosecution by the health watchdog.
The Dudley Group NHS Foundation Trust was prosecuted by the Care Quality Commission (CQC) following two separate incidents in which a mother-of-six and a 14-year-old girl, who were both suffering from sepsis, died after being “exposed to significant risk of avoidable harm”.
Natalie Billingham, 33, died at Dudley’s Russells Hall Hospital from multiple organ failure caused by a severe infection in March 2018. Kaysie-Jane Robinson, who had cerebral palsy, died in the same month after an inaccurate “early warning score” meant a sepsis screening tool was not triggered, Wolverhampton magistrates’ court was told.
The CQC said the care both patients received was undermined by the Trust’s failure to address known safety failings, which had been repeatedly raised in the months before the deaths.
The Trust admitted two breaches of the 2008 Health and Social Care Act.
Passing sentence on the Trust, District Judge Graham Wilkinson fined it £2,533,332 and ordered it to pay a £38,000 contribution to the costs of the prosecution.
‘Had the Trust reacted in a timely fashion, this double tragedy may not have unfolded’
Mr Wilkinson, who conceded that improvements in care had been made since the “dark days” of 2018, said: “One of the most significant features of the case when considering culpability was that the Trust had been inspected by the CQC in a series of unannounced visits during the months preceding this tragedy.
“What was found on each occasion clearly shocked the inspecting team of healthcare professionals.
“It was against this backdrop that Natalie and Kaysie-Jane were failed by the Trust.
“It is clear that had the Trust reacted to the concerns of the CQC in a timely fashion, then this double tragedy may not have unfolded.”
In a statement issued after Friday’s hearing, Diane Wake, the Trust’s chief executive, said: “We are deeply sorry that our care did not meet the standards Kaysie-Jane, Natalie and their families had a right to expect.
“Today’s hearing was an important step for the families in a long process. We want to apologise and offer our sincere condolences again to Kaysie-Jane and Natalie’s families.
“Although it will offer the families little comfort, we have learned from the failings that led to Kaysie-Jane and Natalie’s tragic deaths and made fundamental changes in the way our care is provided.”