An inquest into the death of a teenager being treated at a mental health unit in Prestwich will be delayed "several months" after the NHS trust in charge was ordered to produce a report into the incident.
Charlie Millers, 17, died five days after he was found unresponsive in his room at Prestwich Hospital on December 2, 2020 - just weeks after 18-year-old Rowan Thompson died whilst being treated at the same hospital. A few months later, Ania Sohail, 21, also died at the hospital, making her the third young person to die after being treated at Prestwich Hospital in nine months.
Now, Greater Manchester Mental Health NHS Foundation Trust (GMMH), who run the site, have been ordered to commission an "external report" about all three deaths by NHS England. A pre-inquest review held at Rochdale Coroner's Court today, March 8, heard that the inquest into Charlie's death could be delayed by "several months" due to this report.
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Assistant coroner Lisa Judge told the court: "The hearing was aborted as a result of NHS England's indication they wanted to conduct an inquiry. I'm afraid I'm not in a position in regards to any identification for a prospected date for the report to be completed."
The court heard a notification of Charlie's death was sent to the CQC, NHS England, and the care commissioners at the time, but it has taken until now for the report to be ordered as NHS England made the decision to investigate the incidents after a letter from his mum Sam and her legal representatives requested an independent review. Paul Spencer, representing GMMH, explained he did not know how long the report would take, but anticipated it would be "a number of months" before it was completed.
At the hearing, several statements and medical records were requested from the healthcare providers involved in Charlie's care before his death, whilst he was living with him mum in Old Trafford, with the coroner requesting those be submitted to the court and the family by April. The full inquiry into Charlie's death should have started last week, February 28, in front of a jury.
Postponing the inquiry until further notice, Ms Judge stated she would be unable to hear the full inquiry between May and August due to personal commitments, but felt it was "highly unlikely" that NHS England would finish the report prior to her return. The report will cover three cases at Prestwich Hospital, believed to be the deaths of Rowan, Charlie, and Ania.
An inquest into Rowan's death is scheduled to take place at Rochdale Coroner's Court in June this year, but the hearing may need to be delayed to allow for the report to be completed if it is not finished by then. A watchdog previously said it was "very concerned" about the safety of people using the services at GMMH after a damning report by inspectors found there was not always enough nursing staff and that bank or agencies workers used at the site did not always have enough training.
The charity INQUEST, who campaign with the families of people who have died in the custody or care of the state, wrote to the CQC's Chief Inspector of Hospital, Professor Ted Baker, in September to demand further action, after working with both Rowan and Charlie's families about their care.
Rebecca Titus-Cobb, a lawyer representing both Rowan and Charlie's families at their respective inquests, had previously told a hearing into Rowan's death that there were "systemic issues regarding observation of patients on the unit" - a concern shared by both families.
Speaking after the hearing, Charlie's mum Sam Millers said: "I'm glad it's been delayed because it gives us more time to gather the evidence and have more time to get everything together. If it had gone ahead I think it would have been half-hearted with statements missing.
"I'm ok with it being delayed because it's for the right reasons. I wish it was all done and over with but if I've got to wait 15 years for justice for Charlie then I've got to wait."
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