Sammy, aged 13, died against a background of “inadequate support” from his local authority and NHS Trust

Catherine Wood, Assistant Coroner for North Kent, has found there were multiple failings in the support and care offered to Sammy Alban Stanley and his family before his death, aged 13.  She concluded that those failings were possibly, if not probably, contributory to his death.

Sammy was a much loved son and brother.  He loved sewing, carpentry and making things; he loved his special school and he was proud to appear in his school play.  He was also a child with Prader Willi Syndrome, Autism and Anxiety.  Prader Willi Syndrome is a rare condition which involves behavioural aspects.  It was known to both Kent County Council and North East London Foundation NHS Trust (“NELFT”) that during these behavioural episodes Sammy frequently took steps which were life threatening.  He died on 26 April following a fatal incident in Ramsgate on 22 April 2020.  

During 2018, 2019 and 2020, Sammy’s mother sought support from the local authority and NELFT.  The Coroner accepted it was known that the risk associated with behavioural aspects of Prader Willi Syndrome could increase in adolescence.  The Coroner identified multiple failings including delay in securing a special school place for Sammy and communication difficulties between Kent County Council and NELFT.  These failings included a refusal by Kent County Council’s Children with Disabilities Team to assess Sammy, having concluded that he would not meet their criteria. A Kent County Council witness accepted that Sammy may have met the criteria and he should have been assessed. Following Sammy’s death Kent County Council revised their eligibility criteria for specialist disability services to remove a requirement that children with an Autism diagnosis also have a severe learning disability.

Particular failings were identified once Sammy was unable to attend school as he was shielding from Covid. The family were offered no additional support at home.

Patricia Alban, Sammy’s mother, said:

“Although I did all I could to cope with Sammy’s episodes, we were in crisis and the very limited support that we were finally awarded simply was not sufficient. We were operating at crisis point continually and things continued to escalate after Sammy was unable to attend school during the national lockdown. Every incident that Sammy had was life threatening and it was only my attempts to try to keep him safe, using all my energy and reserves, that nothing more serious happened before the 22 April. The authorities were aware of the risks but, in my view, did not take this seriously.”

The Coroner concluded:  “it was possible if not probable that a failure to provide extra support contributed to Sammy’s death”.  She recorded a narrative verdict which recognised Sammy died against a background of “inadequate support” from both KCC and NELFT.

The Coroner has indicated that she intends to make a report for the prevention of future deaths.

Sammy’s mother, Patricia Alban, was represented by Angela Patrick instructed by Anna Moore of Leigh Day Solicitors. 

Read more in the press release from Leigh Day here.

Coverage of the Coroner’s findings can be found, including from the BBC, ITV and Kent Online

Live coverage of Sammy’s inquest was tweeted by Dr George Julian at @SammyInquest.