We Quit Our Jobs, Sold Our Home Twice And Spent 10 Years Fighting For The Truth

There didn't look to beryllium thing retired of nan mean erstwhile Jane Figueiredo said to her girl that nighttime connected nan phone.

"Alice asked maine to bring her immoderate snacks for nan adjacent clip we visited," Jane says. But that call, astatine 22:15 connected 6 July 2015, was nan past speech they ever had.

Around 3 hours later, Jane and her husband, Max, were being driven to infirmary successful a constabulary car astatine speed. They had been told their girl was gravely ill.

Alice had sewage into a communal toilet astatine Goodmayes Hospital, successful Ilford, eastbound London, wherever she was a intelligence wellness patient, and taken her ain life. She was conscionable months distant from her 23rd birthday.

On Monday, almost 10 years later, nan North East London NHS Foundation Trust (NELFT), which runs nan hospital, and Benjamin Aninakwa, nan head of nan ward Alice was on, were recovered blameworthy of wellness and information failings complete her death.

The assemblage decided not capable was done by NELFT, aliases Aninakwa, to forestall Alice from sidesplitting herself.

It's taken a decade of battling by Alice's parents to uncover nan truth astir really nan 22-year-old was capable to return her ain life successful a portion wherever she was meant to beryllium safe.

They doubly had to waste their home, discontinue their jobs and person worked full-time connected nan case.

The assemblage deliberated for 24 days to scope each nan verdicts, aft which clip nan Trust was cleared of nan much superior complaint of firm manslaughter, while Aninakwa, 53, of Grays, Essex, was cleared of gross negligence manslaughter.

During nan seven-month trial, we sat a fewer seats distant from nan family. They've sometimes been overwhelmed, leaving nan tribunal angry aliases successful tears, arsenic they felt their voices - and that of Alice - were not being heard.

Now, Jane hopes nan verdicts will bring awesome alteration to psychiatric attraction providers astir nan country. "You request to do far, acold amended to extremity failing those group who you person a work of attraction to," she said aft nan verdict.

Weeks earlier, successful mid-March this year, nan Figueiredos were surviving successful a edifice room successful cardinal London.

While folding their clothes, they said to nan BBC during a break successful nan trial, which was already moving months longer than expected.

They had been surviving retired of suitcases since nan extremity of October, erstwhile tribunal hearings began.

Even earlier nan symptom of proceeding grounds astir their daughter's death, they said simply existing for illustration this had been a immense challenge.

For nan couple, it was important to beryllium astatine nan Old Bailey each time successful personification - nary matter nan costs - because they felt this was their only chance to spot nan Trust held to relationship for their daughter's death.

Alice was calved successful 1992, nan 2nd of 3 daughters. She was a agleam and energetic child, and often nan centre of attention. She loved music, poetry, reference and, successful particular, art. Family and friends opportunity she had a large personality.

"She had a really profoundly thoughtful, sensitive, caring nature. She was really kind. She was really generous," remembers Jane.

As a child, Alice started to create what became an eating disorder, and by 15 she was showing symptoms of terrible slump and was admitted to a intelligence wellness unit.

In nan pursuing years she would beryllium hospitalised connected galore much occasions.

In 2012, past 19, she was admitted to nan Hepworth Ward, astatine Goodmayes Hospital, for nan first time. It is an inpatient intelligence wellness portion for women, tally by NELFT. She was admitted location a full of 7 times complete nan pursuing 3 years.

"She needed safety. She was a consequence to herself," says Jane.

"It was a mobility of, someway managing nan situation and trusting nan aesculapian occupation to make nan correct decisions," adds Max, Alice's stepfather.

Between admissions, Alice had agelong periods erstwhile infirmary curen wasn't needed. She had been applying to spell to assemblage and was readying a brighter future.

But connected 13 February 2015, arsenic her intelligence wellness took a superior move for nan worse, Alice was admitted to nan Hepworth Ward for what would beryllium to beryllium nan last time.

Three days later, Alice was detained connected nan portion nether conception 3 of nan Mental Health Act to acquisition curen for her ain information and could not time off without her consultant's permission.

Alice was put connected 1 of nan highest study levels, reserved for patients astatine astir consequence of harming themselves. It meant a personnel of unit had to enactment wrong arm's magnitude of her 24-hours-a-day.

In a missive to unit conscionable complete a period into her admission, Max and Jane wrote: "She cannot incorporate nan consciousness of sheer torment, aggravated slump and overwhelming despair she is experiencing."

The head for Hepworth Ward astatine nan clip was Benjamin Aninakwa. The now 53-year-old had been moving connected nan portion since it opened, successful 2011. He was successful complaint of nan portion during each of Alice's erstwhile admissions, truthful knew her well.

But different things connected nan ward had changed. The caregiver and nan consultant, who had antecedently cared for Alice, had some moved connected and location was a precocious level of impermanent agency unit filling long-standing gaps successful nan rota. Her parents opportunity Alice felt unsettled.

"I deliberation it became clear that location was an constituent of chaos successful nan ward," says Max.

Jane, who was a chaplain to nan intelligence wellness trust, would sojourn Alice each day; Max, who worked for nan NHS arsenic an accountant, would extremity by a fewer times a week, often pinch food.

Alice told her parents that unit weren't carrying retired observations properly. On 1 occasion, wrong nan first fortnight of her admission, she said an agency wellness attraction adjunct who was expected to beryllium staying adjacent to her, was alternatively making a telephone call.

The family later saw an soul email saying Alice had been near unsocial while nan attraction worker continued this conversation. In that time, Alice attempted to harm herself utilizing her bedding.

The aforesaid email said that erstwhile nan attraction adjunct returned and recovered Alice she slapped her. "Nothing was done astir that. There was nary safeguarding," says Jane.

During nan trial, nan tribunal heard that Alice had attempted to harm herself connected astatine slightest 39 occasions during her admittance - galore of these progressive integrative bags aliases bin liners.

Even though they were successful nan acheronian astir galore of these incidents, her parents became truthful concerned they started raising it pinch unit astatine nan hospital, successful personification and successful respective emails.

On 16 May, 3 months into Alice's stay, Jane emailed nan advisor for Hepworth Ward, Dr Anju Soni, astir an incident of self-harm pinch a integrative container successful which Alice mislaid consciousness.

"If it had been a fewer minutes longer earlier she was found, nan result could person been very different - she could person died," she wrote.

The tribunal heard that galore of these incidents were not recorded decently by staff, nor communicated to nan family.

After respective months, Alice's slump began to ease. In June, her study levels were lowered to bespeak her progress, and they were yet reduced to hourly checks.

She was capable to time off nan portion for short periods, moreover going to a Fleetwood Mac performance pinch her fellow Andrew.

But her eating upset remained a superior challenge, and she was still nether section. She asked to beryllium moved to a master portion to thief her recovery.

On 30 June, Alice complained of thorax symptom and was transferred to adjacent King George Hospital. When she came backmost to Hepworth Ward a mates of days later, nan tribunal heard she was told she was excessively frail to spell connected planned leave.

Her family retrieve aggravated fluctuations successful her temper astir this time. They opportunity she was disappointment that her eating upset wasn't improving, small advancement was being made connected her moving to different portion and she was getting bullied by different patients connected nan ward.

On 4 July, 3 days earlier Alice died, Jane and Max went to sojourn her. The eating upset was taking its toll. They could spot their girl was struggling.

"She sat location almost successful silence, tears were rolling down her face," remembers Jane.

Late connected nan nighttime of 6 July, Alice and her fellow exchanged messages pinch each other, talking astir their emotion of Bob Dylan's music. At 23:30 he wrote: "I can't extremity reasoning astir you, x."

The tribunal heard that astir that clip Alice had asked to speak to a attraction adjunct she sewage connected with.

The attraction adjunct was called distant to an emergency elsewhere successful nan hospital. When she returned to Hepworth Ward she looked for Alice. She yet recovered her slumped successful nan communal toilet.

Errors by 2 nurses connected work connected Hepworth Ward slowed nan presence of an on-call expert and paramedics. Alice was yet taken to different infirmary wherever she died.

"It's a infinitesimal wherever your full life has changed and will ne'er beryllium nan same. That's what we person had to study to unrecorded with," says Jane.

Still dealing pinch nan devastating daze of losing their daughter, nan Figueiredos group astir piecing together what had happened to her.

The Trust produced a Serious Incident (SI) report. These investigations are meant to thief forestall akin incidents happening.

But nan Figueiredos felt it was incomplete and nan Trust was avoiding accepting work for Alice's death.

Whatever their concerns, nan study contained accusation that was caller and troubling. It mentioned 13 incidents successful which Alice had utilized a integrative container aliases bin container to self-harm.

"I was shocked and horrified erstwhile I saw that," says Jane. "I thought, [the Trust] knew this had happened, and [they] still fto her transportation connected doing this, and she died," she says.

The family felt nan consequence of integrative bags for patients connected an acute intelligence wellness ward, peculiarly Alice, should person been obvious.

During a erstwhile admittance to Hepworth Ward nan twelvemonth before, Alice tried to harm herself utilizing integrative bags connected astatine slightest 3 occasions.

In November 2015, sensing location was much to uncover, nan mates holed themselves up successful a edifice successful Lindisfarne, disconnected nan Northumbria coast, and started piecing together their suspicions.

"We went very quickly into really penning our ain study and sending it to each nan authorities that we knew of," says Max.

They utilized their insiders' knowledge from moving successful nan wellness service, to get their study successful beforehand of elder NHS group and regulators. They wrote to Sir Bernard Hogan-Howe, past caput of London's Metropolitan Police.

He wrote backmost and a constabulary investigation into what happened to Alice was launched. The Nursing and Midwifery Council launched inquiries into respective of nan nurses progressive successful Alice's care.

Even pinch nan constabulary involved, nan Figueiredos kept digging, getting clasp of arsenic overmuch archiving arsenic they perchance could. When they weren't capable to get documents done charismatic routes, they'd find different ways to get them, moving for illustration seasoned investigators.

Once they had them, they'd analyse them and nutrient elaborate reports that they sent to nan constabulary and regulators.

"If I could observe thing that would beryllium adjuvant to their investigation. I would effort to do that. We were a parallel investigation," says Jane.

All this digging came astatine a financial cost.

"We were successful our 50s, we some stopped moving and really sold our location and lived disconnected that to beryllium capable to do this," says Jane.

The affectional value was moreover higher. "You can't underestimate aliases moreover find nan words to say, nan toll that that takes connected you. It's profoundly re-traumatising," she says.

There were further shocks to travel successful Alice's aesculapian notes, which showed gaps successful nan hospital's charismatic SI report. They had been told Alice had attempted to self-harm pinch integrative bags connected 13 occasions, successful truth it happened astatine slightest 18 times.

Most of these incidents weren't recorded successful logs arsenic they should person been.

"It still shocks america to nan halfway today," says Max.

On nan unit, integrative bags were not utilized successful nan bins successful diligent bedrooms for information reasons, but they were successful a fewer communal locations, including a toilet that was often near unlocked. Alice utilized these bags to self-harm connected aggregate occasions, including nan incident that led to her death.

The proceedings heard location was small grounds that ward head Benjamin Aninakwa made immoderate effort to restrict entree to those bin bags, contempt nan rumor being raised pinch him, and it appearing successful Alice's attraction plan.

He did not look arsenic a witnesser successful tribunal but told constabulary nan toilet doorway was locked and he had been overruled erstwhile he tried to region nan bin bags. The tribunal heard location were nary emails aliases grounds successful Alice's objective notes and records to corroborate this.

A Care Quality Commission inspection successful April 2016, nan twelvemonth aft Alice's death, recovered bin bags still being utilized connected nan unit. The bags were yet removed.

The tribunal heard that astir nan clip Alice was admitted to nan infirmary for nan last time, nan Trust was carrying retired a "scoping exercise", which looked astatine removing each integrative bin bags from nan hospital's wards. It was revealed a bin which didn't request a integrative liner had been considered – it would person costs conscionable £1.26.

"NELFT placed much worth connected their rubbish bins than they did connected my daughter's life," says Jane.

In a statement, nan Trust said: "Our thoughts are pinch Alice's family and loved ones, who mislaid her astatine specified a young age. We widen our deepest sympathy for nan symptom and heartbreak they person suffered this past 10 years.

"We will bespeak connected nan verdict and its implications, some for nan spot and intelligence wellness proviso much broadly arsenic we proceed to activity to create services for nan communities we serve."

Jane and Max Figueiredo opportunity they wanted to clasp those astatine nan Trust to account, but that they besides wanted alteration for nan future. But location will beryllium nary ceremony astatine Monday's verdicts.

"Nothing will ever bring Alice backmost to america and we will ne'er extremity reasoning of her and missing her," says Jane. "There's ever 1 spot quiet astatine our table, 1 very typical sound silent that we agelong to perceive successful our conversations."