Government confirms scope of Essex mental health inquiry

Department publishes terms of reference for statutory inquiry following deaths of NHS mental health inpatients in Essex

The Department for Health and Social Care has today published the Terms of Reference for the statutory inquiry following the deaths of mental health inpatients in Essex.

The inquiry – which is chaired by Baroness Lampard CBE – was set up to understand the events that led to the tragic deaths of mental health inpatients under the care of NHS trusts in Essex between 2000 and 2023.

The Terms of Reference will enable the Inquiry to continue the work of the former Essex Mental Health Independent Inquiry and will play an important role in identifying learnings from those events for the future. The Chair will be responsible for the progress of the Inquiry and will set out a series of recommendations to improve the provision of mental health inpatient care.

Health and Social Care Secretary, Victoria Atkins, said:

"Patients should feel confident, safe and supported – especially when receiving help for their mental health, which can be an incredibly vulnerable experience.

"This was not the case for mental health inpatients in Essex between 2000 and 2023, where so many patients ended up tragically and needlessly passing away – leaving their bereaved families with questions that need answering.

"We take this need seriously and through the Lampard Inquiry, we will ensure lessons are learned and patient safety is improved. We have today published the Terms of Reference, to allow the Inquiry to continue, and for families to get the answers they’re looking for."

The Terms of Reference are set by the Health and Social Care Secretary after consultation with the Chair, who has engaged with the families and other stakeholders.

When investigating the inpatient deaths, the inquiry will cover:

  • the serious failings related to the delivery of safe and therapeutic inpatient treatment and care
  • the actions, practices and behaviours of staff providing mental health inpatient care
  • the culture and governance of and at the Trusts and how that affected care and treatment
  • the quality of investigations and responses by and on behalf of the Trusts
  • the interaction between the Trusts and other public bodies including commissioners, coroners, professional regulators and the Care Quality Commission

The government confirmed on 28 June 2023 that the inquiry would be placed on a statutory footing and it was formally converted to a statutory inquiry on 27 October 2023. This gives the inquiry legal powers to compel evidence from relevant individuals and organisations. The Chair undertook a public consultation on the proposed Terms of Reference for the Inquiry in November 2023 and wrote to the Secretary of State with her recommendations in December 2023.

Baroness Lampard is a former barrister with experience in leading high-profile government reviews, including the NHS investigations into Jimmy Savile and investigations into the Borders, Immigration and Citizenship service. She took over as chair of the inquiry from Dr Geraldine Strathdee, who stepped down in 2023 for personal reasons.

The Chair will provide a final report as soon as practically possible.

For more detail, visit the Lampard Inquiry Website.

From: Department of Health and Social Care and The Rt Hon Victoria Atkins MP