In both cases, the women were failed by the hospital employer that should have protected them.

After vulnerable patient Dawn Owen took her own life on 20 April 2021, aged 46, in a mental health unit operated by Betsi Cadwaladr University Health Board, the Health and Safety Executive (HSE) stepped in, investigated and prosecuted.

HSE found no risk assessment had been carried out when she was admitted. The hospital had wrongly relied on an assessment carried out for a previous admission a year earlier.

HSE inspector Sarah Baldwin-Jones, speaking after the health board was fined £200,000 and ordered to pay costs of £13,174 at Llandudno Magistrates’ Court on 18 December 2023, said: “This failure resulted in Dawn’s high risk of self-harm being tragically missed.” She added: “Importantly, the health board should have trained staff in managing this risk in patients considering self-harm.”

A statement from Dawn’s family said: “Betsi Cadwaladr must now act on the findings of this investigation and keep vulnerable patients safe at the unit.” The statement added: “We as a family would like to thank the Coroner and HSE for their diligence in ensuring there was a thorough investigation into Dawn’s untimely death.”

It was a different story after the suicide of Dr Vaish Kumar aged 35, on 22 June 2022.

The junior doctor had been wrongly told she needed to do a further six months of training before starting a new role.  It meant she was forced to stay at Queen Elizabeth Hospital (QE) in Birmingham, where an inquest into her suicide heard she had been belittled by managers (Hazards 164). In February 2024, the doctor in charge of medical training for NHS England apologised unreservedly to Vaish’s family.

Vaish left a suicide note blaming her death entirely on the hospital where she worked.

Mistakes can be fatal

In a letter to her family, Dr Navina Evans, chief workforce and training education officer for England, admitted Vaish did not need to do the extra training. “I wish to unreservedly apologise for these mistakes and for the impact they would have had,” the letter said. “As an organisation we are determined to learn... not only across the Midlands but across England as a whole.”

Vaish had been chosen as chief registrar at Sandwell and West Birmingham Hospitals, where she worked through the Covid-19 pandemic. But Birmingham and Solihull Coroner's Court heard at a November 2022 inquest that she began to struggle around December 2021 when she realised her training at the QE was being extended (Hazards 160).

An independent review into workplace practices at the Trust, published in September 2023, found “an adverse working environment had become normalised,” with staff “often not feeling safe at work.”  It added: “Many staff at the Trust often felt unsupported, disrespected, and pushed beyond their capacity… This is clearly having an impact on psychological wellbeing, with many staff expressing a significant impact on their health and wellbeing.”

The Trust responsible for the hospital where Vaish worked apologised for its “unacceptable behaviours.” NHS England apologised for the mistakes it made that had an “impact” on Vaish’s mental health.

But the Health and Safety Executive, which was commended for its investigation and prosecution following Dawn’s suicide, said when it came to the death of a worker, it chose to do nothing.

HSE was familiar with the workplace. But a December 2023 response to a Hazards freedom of information request revealed in five visits to the hospital in the four years prior to Vaish’s suicide in 2022 HSE found “no breach” of safety law and reported “no further action.”

A foreseeable risk was going unseen by HSE, at this and other hospitals.

SPEAK OUT Send a message to HSE using our e-postcard. www.hazards.org/hsesuicide.

A January 2024 Care Quality Commission (CQC) report on deteriorating standards at Newcastle Hospitals NHS Foundation Trust found staff felt encouraged to “turn a blind eye” to bullying.  In the cardiothoracic surgery department at one hospital in the trust, where whistleblowers complained of bullying, harassment and safety concerns, the watchdog said trainees felt the atmosphere in theatres was “toxic.”

A Bournemouth University case study at an NHS Trust following several suspected staff suicides, published in the journal Medical Humanities in January 2024, noted: “Given the frontline work required by healthcare professionals, they must have the support of their profession and healthcare organisation to maximise their ability to care for themselves and their patients.”

It added: “Overall, existing research points to a lack of training around suicide awareness for healthcare staff suggest that organisations provide staff with suicide awareness training that provides guidance on suicide prevention and helps to reduce stigma and developing to compassion about suicide.”

Not for US

HSE insists it has no role in investigated, recording or prosecuting work-related suicides, telling Hazards repeatedly they are outside its remit because they are not reportable under the RIDDOR regulations (Hazards 155).

The regulator’s single suicide webpage stresses in bold “Suicides in the workplace are not RIDDOR reportable.” But the suicide webpage also notes: “Use the event as an opportunity to review your risk assessment for work-related stress and mental health.”

It was this precise shortcoming that led HSE to prosecute after the suicide death of NHS patient Dawn Owens.

HSE is being inconsistent and disingenuous. It has concocted a legal defence for its inaction that cannot survive even cursory examination. The regulator’s argument that because work-related suicide is not reportable under RIDDOR leaves it outside of HSE’s investigation and enforcement remit is particularly indefensible.

Many conditions not on HSE’s RIDDOR list do have dedicated HSE operational guidelines, spelling out the required investigation, inspection and enforcement processes. And work-related conditions not covered by RIDDOR, including pneumoconioses – the lung diseases like silicosis caused by inhaling dust at work – and chronic obstructive pulmonary disease (COPD), are the subject of explicit and repeated HSE enforcement campaigns and prosecutions.

The HSE approach contrasts starkly with that taken by the US safety regulator, OSHA, which does require reporting of work-related suicides for inclusion in Bureau of Labor Statistics (BLS) figures.

In a 19 December 2023 news release marking the publication of the BLS Census of Fatal Occupational Injuries Summary, 2022, which recorded 267 work suicides, OSHA head Doug Parker commented: “The BLS census also finds work-related overdoses and suicides continue to be causes of great concern, and they are another call to action for the Occupational Safety and Health Administration, employers and other stakeholders to address these very serious issues.”

HSE maintains suicide is a ‘complex’ issue (Hazards 163). It is. But so is asthma and COPD. Both, like many other conditions HSE treats as mission appropriate, are common in the general population but can also be caused or exacerbated by work.

Desperate workers need protection from unbearable pressures at work.

They are crying out for HSE to help.

Ofsted told to reform suicide-inducing inspections

The government should stop the use of single-word judgments such as “inadequate” or “outstanding” in Ofsted’s headline grades of schools in England, a committee of MPs has urged.

The 29 January 2024 report from the House of Commons education committee said relations between Ofsted and teachers had become “extremely strained”, with trust in the watchdog “worryingly low” in the wake of headteacher Ruth Perry’s suicide in January 2023 after a traumatic inspection (Hazards 161).

Prof Julia Waters, Perry’s sister, described the committee’s findings as a call to action to address the “toxic impacts” of an inspection regime that had damaged many teachers and headteachers.

Responding to the coroner’s Prevention of Future Deaths report following the December 2023 inquest into Ruth Perry’s death (Hazards 164), Ofsted apologised fully for the first time for its role in the suicide and promised a review of lessons to be learned.

Sir Martyn Oliver, who became Ofsted chief inspector on 1 January 2024, said “such tragedies should never happen again – and no-one should feel as Ruth did.” His 19 January 2024 statement added: “As his majesty's chief inspector (HMCI), I would like to express my deepest condolences to Ruth's family and friends and apologise sincerely for the part our inspection of her school played in her death.”

The Ofsted apology reinforces the coroner’s finding that work-related pressures were a contributory factor in Ruth Perry’s death.

However the Health and Safety Executive (HSE), the regulator responsible for investigating work-related deaths, told Hazards it has no intention undertaking an investigation as “suicide is not reportable under RIDDOR.”

Hazards has warned that a failure by HSE to investigate work-related suicides will inevitably lead to missed opportunities to ensure preventive interventions and justice for the dead and bereaved (Hazards 163).

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HOSPITAL CASES

A suicide in a hospital. The Health and Safety Executive (HSE) prosecutes a health board on criminal charges under health and safety law. So, asks Rory O’Neill, why does the workplace safety regulator see a crime by the employer when a patient dies, but not when the same safety mismanagement leads to a hospital worker taking her own life?

ACTION!

Use the Hazards e-postcard to tell the HSE to recognise, record and take action to prevent work-related suicides.