HSC "stands by" report into vulnerable woman's death

Monday 29 January 2018

The Committee for Health and Social Care says it extends its deepest condolences to Mary Machon's family, who have criticised the former HSSD for "failing" the vulnerable woman - but HSC says it stands by a report produced at the time of her death.

Mrs Machon committed suicide in October 2014, despite having had contact with both Guernsey Police and Mental Health authorities during the time leading up to her death.

The circumstances leading up to her death were outlined at Guernsey's Royal Court on Friday afternoon, during an inquest to determine her cause of death. A verdict of suicide was recorded which her family told Express they were expecting.

However, Mrs Machon's next of kin told Express they remain unhappy with reports produced into her death. 

She was 44 when she took her own life and had had involvement with both Guernsey Police and the island's Mental Health team, under the then Health and Social Services Department, in the days leading up to her death.

Her family claim Mrs Machon (née Davies) asked for help from staff on the then Albecq ward at the former Castel Hospital, and the CDAT, in the days before she died.

A statement read to the court during the inquest into her death, said "there were no suspicious circumstances" and that a Mental Health review after her death concluded "there were no lessons to be learned and recommended no changes to current practice following the tragic but unpredictable death of Mrs Machon."

Her family continue to dispute that and also said in their own statement which was read to the court that they were unhappy with reports written on her death: "we remain concerned that the later-dated report of the HSSD contains inaccuracies and omissions which are unacknowledged by HSSD". 

Mrs Machon's family say they feel there was a "lack of care in the production of the (HSSD) report, and perhaps a lack of care of Mary". The family statement said they feel there is "much HSSD could have done differently". They say they are also unhappy with the-then HSSD and now HSC's complaints procedure and communication policies. However, the family say they are satisfied with the work of Guernsey Police, saying "the police processes were professional". 

The Committee for Health and Social Care has told Express it takes patient care and support "incredibly seriously" and it has reviewed what happened in Mrs Machon's case. HSC says, as HSSD did before it, that it stands by the reports into Mrs Machon's care and death.

The full statement from HSC is below:

"Health & Social Care takes the support it offers patients incredibly seriously. In fact, it is our sole focus. This is a sad and complex case and HSC extends its deepest condolences to Mrs Machon’s family and friends.

"While Mrs Machon was not in the then-Health and Social Services Department’s direct care at the time of her death in 2014, HSSD carried out a review of the support and care it had provided. The report explored events leading to Mrs Machon’s death, her contact with mental health services, contributory factors and lessons learned. It was shared with Mrs Machon’s family in England in April 2016. HSC stands by the report HSSD produced, which was subject to strict governance controls at the time, and supports its findings and recommendations."