Families: How visiting bans led to poor care

It comes after several coroners and national bodies have raised concerns over the impact of visiting restrictions, which have been in place in various forms for the last 18 months.

Azra Hussain, 40, took her life in May 2020 within a psychiatric intensive care unit run by Birmingham and Solihull Mental Health Foundation Trust.

Two days before her death, her mother and daughter had contacted a nurse to say Ms Hussain had messaged them to say she had attempted suicide. However, the family’s concerns were not escalated to the multidisciplinary team, which then held a digital meeting without involving the family, preventing them from being able to raise their concerns directly.

Ms Hussain’s daughter Mari, who had visited her mother up to five days a week before the pandemic, said the trust had turned down requests to meet with her mother at a nearby park at social distance.

Ms Hussain’s family were able to make some video calls, but Mari said: “It was just a face on a screen. Seeing us in person would have given her the push that she needed.

“People need to see their families. We need to see them because that makes the difference between life and death. If mum saw us, even at social distance, she would still be alive.”

Ms Hussain was due to begin electroconvulsive therapy treatment two months before her death but this was not carried out due to covid disruption. An inquest jury concluded her death would have been prevented if she had undergone this treatment. Ms Hussain was also on 15-minute observations when she took her life. Her family wants a public inquiry into her case.

Mary Smith, a lawyer at Novum Law who is representing the family, said: “In mental health settings, in particular, a family’s knowledge of the patient and their usual presentation when they are well, forms an integral part of the clinical assessment and treatment planning.”

In a report on the case, coroner Emma Brown said the trust now invites family members to fill out a form before such meetings, where they can raise concerns.

But she added: “There is the potential that information will not be recorded accurately or will not be understood in written form. It also doesn’t afford family the opportunity to hear the plan arising from the meeting and provide their views.”

She said there was “no reason” families could not attend meetings remotely.

The trust said it has worked to ensure “families’ views are central to the care planning process prior to, and during, the MDT”. It said there is a clear feedback process after MDT meetings, to ensure families’ views are considered.

Anne Harper was taken to the emergency department at Oxford University Hospitals Foundation Trust in September 2020, after a fall in her home.

Following a lengthy wait, she developed respiratory failure and died that night.

A report sent to the trust by the coroner noted that, due to the covid-19 pandemic, Ms Harper had nobody to accompany her while she waited. However, due to the severity of her fall, it was found it was unlikely she would have survived her injuries.

The trust responded in April, but did not address the issue of Ms Harper having nobody to wait with her.

Ruth Jones died at Tameside and Glossop Integrated Care FT in June 2020, after suffering an unobserved fall while isolating in her care home room.

The cause of death was identified as bronchopneumonia, exacerbated by a bone fracture.

In a report sent to the trust and national bodies, coroner Alison Mutch noted how Ms Jones had been sent to hospital alone, and suggested this presented significant problems to clinicians in terms of effective communication and understanding her health needs.

In a response, care minister Helen Whately acknowledged the concerns, but said at the time of the admission, NHS England’s guidance limited bedside visitors to one person, with a second visitor allowed in certain circumstances.

Joseph Hargreaves died at Stockport FT in April 2020 after suffering complications from underlying swallowing difficulties.

A coroner’s report sent to the Department of Health and Social Care found lockdown measures meant his family had not been able to visit him regularly in his care home, and were not allowed to see him in hospital.

It added: “The provision of information about the events leading up to his admission, his baseline and underlying health issues, to treating clinicians was reduced.

“In his case it did not impact the outcome, however it was clear from the evidence that it could in other circumstances cause significant challenges in delivering effective treatment quickly to vulnerable patients.”

In a response sent in February, ministers said guidance had been updated since Mr Hargreaves’ death and allowed for more visitors where social distancing could be maintained.

The family of Keeley Norman, who has been in a coma at Nottingham University Hospitals Trust since a car crash in April 2021, say the mum-of-one would have died had they not inadvertently been allowed to visit her more regularly.

Initially, the 27-year-old’s family was only allowed one hour-long visit per day, and on 30 July, against the family’s wishes, she was put on an end-of-life pathway and all her treatment withdrawn, including for a known pulmonary emoblism.

Because visiting restrictions were more relaxed for end-of-life patients, this meant more family members could visit, which Ms Norman’s mother, Tammy Campbell, said made her more responsive.

Following a legal challenge, the hospital reversed its end-of-life decision and reinstated Ms Norman’s medical treatment. The family are now able to visit her for longer during the day.

Ms Campbell told HSJ: “She had more movement, eye opening, when certain people came in the room she could hear their voices. She’s doing a lot more than what she had been doing for the first three months.”

The family is also represented by Novum Law, and lawyer Ms Smith said: “The stimulation provided by family and close friends is often an integral part of a patient’s recovery, particularly those with brain injury. Keeley’s family saw her begin to respond once additional visitors were permitted. It should not have taken her being placed on an end-of-life care pathway for this to happen — her need for stimulation came well before this.”

Michelle Rhodes, the trust’s chief nurse, said: “We are really sorry that the situation has caused the family so much distress, we are working hard to try and accommodate the individual needs of all our patients and their families while maintaining safety for other patients and staff. It is very difficult to always get the right balance.”

HSJ also made efforts to contact the families of Ms Harper, Ms Jones, and Mr Hargreaves.