UK’s largest children’s brain injury unit cut frontline staff over ‘financial crisis’ before child deaths
Frontline staff were cut at a flagship rehabilitation unit weeks before a child died when nurses failed to monitor her properly, The Independent can reveal.
The Children’s Trust (TCT), a care home for disabled children in Tadworth, Surrey, has been criticised by coroners after three young patients, who had brain injuries and complex conditions and required either around-the-clock care or regular monitoring, died while under its care.
One of those children, Raihana Oluwadamilola Awolaja, 12, who was meant to be receiving one-to-one care, died in hospital after her breathing tube became blocked when she was left unattended for 15 minutes.
A coroner later found her death had been contributed to by neglect and ruled that, “on the balance of probabilities, she would not have died at this time” had she been “appropriately observed” when the breathing tube became blocked.
Now, The Independent can reveal that the centre, which is the UK’s largest brain injury rehabilitation centre for children, made staff redundant in the weeks before Raihana’s death in June 2023 amid financial concerns.
According to accounts analysed by The Independent, the trust had “significant concerns” over its finances in 2022 and 2023. A report said that redundancies had been “unavoidable”, with a restructure which reduced overall staff numbers by 15 per cent completed by May 2023.
At Raihana’s inquest, coroner Fiona Wilcox found there was “simply insufficient staff to provide constant one-to-one care” and that the nurses’ gross failure to observe her was “compounded by the lack of sufficient staff on the unit where Raihana lived to provide proper 1:1 care”.
She found that, in practice, the one-to-one care provided for the young girl by the trust was one nurse to two patients, when parts of the daily work routine, such as breaks, meetings and handovers, were taken into account.
The coroner’s prevention of future deaths report said: “There were simply insufficient staff to provide constant one-to-one care, as understood it should have been provided and commissioned by the local authority.
“There was confusion as to what one-to-one meant at the time of Raihana’s death and how it is practised now by carers and nurses who gave evidence.”
The coroner added: “There will still be occasions when vulnerable residents such as Raihana will be left one to two, with eyes on only observation, despite an apparent increase in numbers of staff on duty at any one time, albeit it should happen less often.”
Evidence to the inquest also revealed Raihana’s mother repeatedly raised concerns that, contrary to the agreed levels of “around-the-clock one-to-one care”, she had found her daughter to be left with no supervising carer. The inquest heard this issue was discussed at meetings at TCT, but it continued to happen.
Staffing levels were not explicitly mentioned in the coroners’ prevention of future deaths (PFD) reports for two other children who died at the unit, Mia Gauci-Lamport, 16, and five-year-old Connor Wellsted.
But an inquest into Connor’s death heard he had likely been dead for hours by the time staff found him. The young boy was found dead in his cot at TCT on 17 May 2017 after he became trapped under a cot bumper.
A key concern was that he had “no regular or direct supervision overnight”, other than staff opening the door or watching him through a glass window.
Mia, who required 24-hour care, died of natural causes after she was found unresponsive in her bed. She should have had in-person checks every 15 minutes, but it was “common practice among” some staff to use a video camera to check on her, the PFD report said.
Concluding Mia’s inquest, coroner Karen Henderson, who also investigated Connor’s death, said the lack of a “robust and adhered-to care plan for night observations” mirrored the same concerns she raised about Connor’s death.
The Independent has found that TCT reported a “serious incident” to the Charity Commission in August 2022 over its finances. The Charity Commission describes serious incidents as events or issues that could harm the charity’s beneficiaries, staff or volunteers or result in a loss of the charity’s money or assets, damage its property or harm an organisation’s reputation.
Leaders later approved a financial recovery plan which aimed to reduce staffing costs at the charity, which has multiple executives earning six-figure salaries.
Its annual report for 2022-23 said the trust had made “significant headway” on two key objectives – reducing expenditure and increasing income, adding: “Regrettably, with staff costs representing 80 per cent of total expenditure, we had to undertake an organisational restructuring which was completed in May 2023.”
Raihana died in June 2023, and Mia died three months later, in September.
The report added that overall staff numbers were cut by 15 per cent, which reduced the total staffing budget by £3.7m.
It added that it would remain focused on “minimising staff costs (including temporary agency workers and recruitment fees) and maintaining a leaner workforce going forward.”
TCT told The Independent it had “stabilised” its finances “following a financial crisis in 2022”, and that it was a different organisation now compared to the years in which Connor, Mia and Raihana died. It admitted that, at that time, financial pressures had “threatened the future” of TCT.
It added that, following Raihana’s death, it had made significant changes to its monitoring and observation policy and has introduced a flexible “floating” staff role available 24 hours a day, which ensures additional support can be provided.
It added: “The lack of sufficient staff on the unit where Raihana lived was not due to cuts in staffing levels to aid financial recovery.
“Staffing levels were in place, which allowed us to be compliant with our policy and meet our contractual agreements around 1:1 care at that time.”
TCT said it has also since changed its policy on monitoring patients, which it says ensures practices are clear, consistent and personalised to meet each child’s needs.
It said the organisation now requires every staff member allocated to provide one-to-one care to formally sign a document at the start of their shift to confirm their understanding of the individual’s care, monitoring and observation needs.
Responding to the coroner’s concerns over Raihana’s death, the trust said it was in the process of creating a new staffing model aligned with national standards.
Mike Thiedke, chief executive of TCT, said: “The board and my executive team remain committed to ensuring the highest standards of care for all children and young people at The Children’s Trust.
“Through collaboration with our NHS and wider system partners, continuous engagement with stakeholders, children and families, and a strong focus on improving clinical governance, we are confident that the changes we have made are resulting in tangible improvements to the care we provide.”
