Another beautiful soul failed by staff at Linden Centre

Part One….
Inquest John Beecroft
A very elightening afternoon was held at Chelmsford Coroners Court . The Chief Executive Officer was called as a witness to the sad death of patient John Beecroft February 2015.
He was questioned with regards trust policies. Cqc recommendations and warnings that had been issued to the trust. Staff training. Activities on the wards. Smoking policies and the searching of patients for lighters. And of course the subject of doors.
It appears Andrew Geldard joined the trust in 2002 as Financial Director. He began the role of CEO IN 2008 partially, then took over full responsibility as CEO IN 2009.
When questioned if he had any nursing or mental health training…he said,”NO”. He had never been involved in mental health prior to his role as CEO.
He spoke of regular reviews to ligature risks and said, “wardrobes may be an issue.”
“Doors are seen as being an inherent risk.”
and that “over the years the highlight has been on doors”……well why has he taken so long to sort this issue???????
He said, “replacing door hinges has not been an easy task”.
He said, ” all doors on inpatient areas have pressure sensors now and yes if they had been in use in Feb 2015 it would have prevented John’s death.”
He then went on to say that the door sensors are only on trial until Oct 20th 2015. What’s gonna happen after 20th October then ???
He said ,”we have recently replaced all our doors, but approx five mins later in his evidence…said..”there are still some door openings we need to apply ourselves to”.
Well either you’ve replaced them all or you haven’t? ????
He then went on to say…”generally the doors open out”. What’s generally mean???
In conclusion… “we continue to work on the issue of doors”.
“Work regarding alternative door handles ..is also programmed to be done.”
“Ligature risk is an ongoing issue….which is managed…ongoing”.
He said of Linden Centre. …”it’s a place where they should feel safe”.
“A therapeutic environment”.
The Coroner went on to policies and said to Geldard. ..
“You can have policies coming out of your ears. …but if they are not implemented at grass roots level…what’s the point???
Our thoughts exactly madam Coroner.!!!!