Charles Ndhlovu: NHS 'corrected mistakes' after son's suicide - mother

Charles Ndhlovu's mother said he "loved his family"

An NHS trust has been accused of adding to the records of a man the day after he took his own life to "correct their mistakes".

Charles Ndhlovu, 33, died under the care of Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) in 2017.

His mother, Angelina Pattison, said the way her son's case had been handled had "upset me so much".

The trust did not respond to the claim about the records being added to but said learning from deaths was "vital".

A former CPFT employee has said he raised with the trust his concerns of "possible criminal activity".

Mr Ndhlovu, who was diagnosed with paranoid schizophrenia and substance misuse, had been under CPFT's care two months when he died.

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He had been transferred from a neighbouring trust after moving to Ely and then been taken off a community treatment order.

His mother, Angelina Pattison, told the BBC that despite being heavily involved in her son's care, she was "shocked that they transferred him without even telling me".

Ms Pattison said she only found out about a new care coordinator the day before she was due to travel to Africa.

Her son died while she was out of the UK.

A trust serious untoward incident (SUI) review acknowledged that when he was transferred no-one from CPFT had asked about whether his family had been involved in his care.

Charles Ndhlovu took his own life in October 2017

Ms Pattison said: "They didn't have any address of [my home] in his care plan and the care plan was done when he died - when they were running around to correct their mistakes, which they have done.

"So it was really something which has upset me so much."

Ms Pattison, who worked for CPFT as a health care assistant at the time, made a formal complaint to the trust.

The BBC has separately spoken to consultant nurse and psychotherapist Des McVey, who was asked by the trust to investigate a complaint in July 2021, understood to be the one from Ms Pattison.

Mr McVey said: "I noticed that the deceased did have care plans, but they were written the day after his death and they were also evaluated the day after his death and I was concerned that this wasn't picked up by the SUI."

He said this "really alarmed me", adding: "Surprisingly, there was no care plan to address his suicidal ideation and he had... an extensive history of trying to kill himself."

Des McVey left Cambridgeshire and Peterborough NHS Foundation Trust last year

He was also concerned about the methodology used to investigate possible racism by comparing the death to two Caucasian suicides, which he said "demonstrated a poor understanding of the complexities of institutional racism".

'Remarkably wrong'

Mr McVey said he told a manager he believed the SUI "was not credible" and said he could not complete the complaint investigation.

He said he made them aware of his view "that the risk assessment was so remarkably wrong, that they hadn't answered to why they'd taken him off the [community treatment order] against the advice of his current team".

He said they "had made so many speculative conclusions without any evidence, in fact sometimes evidence to the contrary".

But Mr McVey said no-one contacted him for six or seven weeks, before finding out the investigation had been given to someone else.

Mr McVey left the trust in early 2022 but said in June he contacted the new chief executive, Anna Hills, to raise his concerns "that there was possibly criminal activity going on, falsification of documentation and that the SUI was un-credible".

Ms Hills said an investigation would be completed but he has not heard back, he claimed.

Mr Ndhlovu's mother, from Newmarket, Suffolk, said: "I believe that if everything worked well Charles' death was going to be preventable, because there were so many things... to avoid his death."

CPFT has previously been criticised by a coroner over a serious untoward incident concerning the death of James Nowshadi, that it was "not credible" and had taken matters on "face value".

James Nowshadi was described as an "exceptional young man" by the coroner

The co-author told the inquest that a reference to the method of Mr Nowshadi's suicide was removed after the review was "touched up" by others.

Mr McVey said CPFT needed have an external audit into their serious untoward incidents, stating: "How many un-credible SUIs have been done by the trust?"

In response to the allegations, a spokesman for CPFT said: "The death of Mr Ndhlovu was tragic, and our continued condolences are extended to his family.

"Patient safety and the learnings from all deaths are vital to us to enable improvements in care.

"While there was a delay in investigating a complaint made by Mr Ndhlovu's mother - for which we sincerely apologised - those concerns were rigorously investigated in 2022, and a further review was conducted by our director of nursing following concerns raised to the new CEO.

"Over the past year, we have strengthened our processes around complaints and incidents, and the learnings from the review have played an important role in that.

"While there was no evidence of any racial discrimination towards Mr Ndhlovu during his treatment, we take any accusation of prejudice in our practices extremely seriously and will always fully investigate concerns raised."