A coroner has warned that more vulnerable people could die because of a shortage of dietitians at NHS psychiatric hospitals. The warning follows the death of Neeshat Dalal, 69, who died after a stay on a mental health ward at NHS Eastbourne District General Hospital.
Patient admitted under Mental Health Act
Neeshat Dalal was admitted to the Heathfield ward at the hospital on November 30, 2022, after being sectioned under the Mental Health Act for severe depression. She had struggled to eat and drink for around two months prior to her admission, and had attempted to take her own life three times, with the final attempt resulting in her being sectioned.
During her stay, Ms Dalal was not seen by a dietician, as is required for all mentally ill patients with nutritional needs, because Sussex Partnership NHS Foundation Trust (SPFT) could not afford to have one on the ward.
Death and coroner's findings
She collapsed while under anaesthetic during her third round of electroconvulsive therapy at the hospital on December 13, and was rushed to A&E. Ms Dalal died of a heart attack the next day.
A prevention of future deaths report sent to her family, NHS England and the Department of Health and Social Care this month found that "inadequate consideration was given" by hospital staff to the possibility Neeshat was unable to eat or drink due to vomiting, rather than her "refusing to eat in order to end her life".
The report by East Sussex Coroner Rachel Redman added: "Neeshat's nutritional needs were not appropriately met. She required support from a dietician and a more timely referral to the gastroenterology team."
Nationwide funding concern
The coroner warned there was a risk more people could die from a lack of specialist nutritional expertise on mental health wards unless funding was provided. "In my opinion there is a risk that future deaths could occur unless action is taken. In the circumstances it is my statutory duty to report to you," Ms Redman said.
The coroner also said there was evidence that a lack of funding for dieticians "extends to Trusts nationwide" and that this is "not a local problem" experienced in Sussex alone. Her report added: "My concern is that severely mentally unwell patients such as Neeshat who was sectioned under s2 Mental Health Act 1983 are not receiving dietary and nutritional support from a qualified dietician when experiencing difficulties in eating and drinking. Funding is required for the specific provision of appropriately qualified dieticians who can meet the nutritional needs of inpatients undergoing psychiatric care in SPFT and in other Trusts where such support does not already exist."
Responses from authorities
In its response to the report, NHS England acknowledged that access to dietitians was "highly variable" across different trusts, and said safer staffing standards for multi-disciplinary team members will be considered by the National Quality Board next month.
A Department of Health and Social Care spokesperson told the Mirror: "Our deepest sympathies are with the loved ones of Neeshat Dalal. Her case is a tragedy, and we are determined to learn the lessons from it. We have published new guidance for NHS mental health services to improve the culture of care, and ensure staff are properly equipped to support people with their physical health needs, and better understand when someone is at risk."
A spokesperson for Sussex Partnership NHS Foundation Trust said: "We offer our sincere condolences to the family of Neeshat Dalal. We acknowledge the response to the Prevention of Future Death (PFD) report from NHS England in which they highlight the variable inpatient provision of multi-disciplinary team members, which includes dietitians. We support the need to raise awareness of the essential roles of Allied Health Professionals (AHPs), which includes dietitians, to improve quality in inpatient mental health, learning disability and neurodevelopmental services and we welcome the development of safer staffing standards in relation to AHPs."
