Below has been superseded by two databases kept up to day by the brilliant Liz.

All coverage/commentary on LB’s death can be found here.

Easy read and more accessible coverage can be found here.

If anyone wants to add anything to the archives or change something, please email




This page will collate comments/reflections/analysis/media coverage and so on about the investigation into LB’s death. The report, by independent investigators, Verita, was published on Sloven’s website on Monday 24 February.

Click here for easy read version

I’ll update this page regularly, so please keep writing.

Paul Scarrott’s reply to Katrina Percy’s letter Southern Health 2 [Easy read]

The Mental Capacity Act and families. “I remember feeling physically sick when G was around 16 and letters started arriving addressed to him rather than me. Partly this was because I didn’t really understand the Mental Capacity Act then and partly it was that as the mum of someone with his level of learning disability I was struggling to imagine that anyone could treat him as an adult.” A big missing 

Story Seven: Window “The manager interrupted him and ushered both Steven and I into the dining room and shut the door on us. We got on with discussing matters of life and death – Did Vince Clark go to Erasure before Depeche Mode? And why you must wear a T shirt in the car or else the seatbelt might scratch your nipples.” 107 stories from an assessment & treatment unit


Papers, policies, progress and people “The gap between the rhetoric and the reality – most notably when it comes to people with “challenging behaviour” and complex needs – is clear. Cast your eyes over these “then” and “now” juxtaposed extracts and comments.” The Social Issue

Empathy, pain and action “I’ve received mixed responses to my involvement so far, where people know I am involved. A few people have been intrigued, as have I if I’m completely honest, as to what is driving me.” George Blogs

Controversial Oxford mental health unit may never reopen. Oxford Mail

Gary Bourlet of People First England talking about Connor. 

Running as therapy “Read some more blogs about LB this morning.  Cried.  His penchant for swearing, tinkering with a Nissan engine, his ability to look good in a suit ……. very close to home, this.” Janeyouell

Southern Health Easy Read response to The Connor Report 

NHS cover up … Sunday Telegraph

A public accounting “Scattered throughout the annual report are indicators that all has not been well at Southern Health in terms of leadership, governance and challenge (pages 27-51). For example, during 2012/13 there was an extraordinary turnover of personnel at Board level, which sends danger signals to me about the extent to which the work of the Trust in 2012/13 was subject to proper scrutiny. Over the course of 2012/13, five out of eight Non-Executive Directors left the Board, to be replaced by only three Non-Executive Directors – two Board meetings in the year had only three or four Non-Executive Directors in attendance.” Chris Hatton’s blog

Letter to Paul Scarrott from Katrina Percy 

The need for care, candour and change  “Good assessment, appropriate treatment, genuine care and candour when things are going wrong. We should not expect anything less from health services. No one should. Yet CQC’s report on mental healthcare show that physical health is too often ignored in psychiatric wards, how can we have hospitals that don’t provide treatment? Physical health problems do not disappear as soon as a diagnosis relating to mental health or learning disability comes along.” The distance from should to is

Contrasting tales “A beautiful, vibrant, loving, caring young woman celebrates her 30th birthday soon. To give you an example of her thoughtfulness, on Christmas Day morning she took time out to phone me and wish me a Merry Christmas and to tell me I’d been missed as I had been away from work for a few months. She is a true gem.” Learning Disability Today

Justice for LB: a movement for change “There has been a lot of anger and incredulity expressed on social media over the past two weeks. A twitter account@JusticeforLB was established the day before the report into Connor’s death was published, in less than two weeks it has gained 885 followers. It has shared 3,929 tweets, averaging about 300 tweets a day. Analysis of the account using twitonomy suggests that 69% of content comes from others, shared as RTs, and 18% of content is direct replies – leaving only 13% of tweets being original dissemination of information.” Georgejulian

Justice for LB “Jess and I have wanted to start a blog on Artism for a short while now but we didn’t quite know where to start. We came across the story below last week and it felt right to start here. Sara Siobhan has been blogging about being LB’s mum since 2011. I’ve read the blog a few times before – Sara has a dry but positive tone that I’ve always enjoyed and LB and Jake’s diagnoses are similar. LB’s art is great and Sara describes him as ‘regularly smashing typical expectations and making visible constraints and rules around ‘acceptable’ behaviour.’ That’s kind of how I’ve always seen Jake.” Artism by Jake

Honesty, respect and valuing people: what ‘good’ can look like “It’s about honest, open and regular communication…only by this can you ever begin to build real trust and develop mutual respect. It’s about treating the people you support with dignity and respect (as you’d like to be treated yourself) It’s about seeing them in the same way as you see yourself and anyone else. It’s about valuing people! A bit missing 

Accepting the unacceptable “Bringing Us Together is family driven and we would publicly like to offer our support to LB’s family and supporters.   We will stand with you and we will not accept the unacceptable.” Bringing us together

Taking stock and fisking Southern Health’s CEO “Anyway, below is a fisking of the CEO’s interview this morning. (By the way, Phil Gayle of BBC Oxford should be congratulated on not just a brilliant job putting key questions to the CEO, but also continuing to focus on this story long before most other media outlets have considered it.) Before you read the full thing, there is one major point to note: having listened to this very carefully and transcribed it, I cannot find one occasion on which Southern Health’s CEO says “sorry” or apologises in any way at all. I’ve said before that Southern Health can sink to depths to which even we thought they could never sink, and they’ve only gone and done it again.” arbitrary constant

He should never have died “A host of very adept, passionate bloggers and campaigners have been demanding not only answers, but action after the death last year of Connor Sparrowhawk. Connor, 18, died while “being cared for” at a Southern Health Trust in-patient unit in Oxfordshire for people with learning disabilities.” The Social Issue 

What would justice for LB look like? “They [assessment/treatment units] are also often ill-equipped to deal with autistic people and make little attempt to improve their standards in this area. They are phenomenally expensive, costing much more than some very comprehensive home and respite care packages. They are led by psychiatrists, but very often the patients have no psychiatric reason for being there; they are there because a crisis in their life situation has prompted challenging behaviour as a result of a pre-existing learning disability.” Indigo Jo Blogs

An open letter to Katrina Percy from Paul Scarrott “It is time for Southern Health and the local Commissioners to stop talking about user-involvement and… start giving self-advocates and family carers the power to shape services.” MyLifeMyChoice

“Never do anything by halves if you want to get away with it” ““He wouldn’t,” Matilda said. “And the reason is obvious. Your story would sound too ridiculous to be believed. And that is the Trunchbull’s great secret… Never do anything by halves if you want to get away with it. Be outrageous. Go the whole hog. Make sure everything you do is so completely crazy it’s unbelievable. No parent is going to believe this pigtail story, not in a million years. Mine wouldn’t. They’d call me a liar.” Arbitrary constant

Say nothing “And where are the major charities? Planning their next conferences? Checking their funding applications? Who knows? They’re not supporting the JusticeforLB campaign in any meaningful way. This echoes my experience whilst Steven was held in the Unit. I couldn’t get any of them interested when I needed them. But after the Court judgement, you couldn’t move for them putting their twopennyworth in. Image over humanity.” Love, belief and balls

The Connor Report; ‘preventable’ deaths and the wrong lessons “This failure to acknowledge and use the experience and knowledge of family members is nothing new when it comes to service responses to young people with learning difficulties.  The experience described by Connor’s mother is only one recent example of many which echo Ann Shearer’s comment over 30 years ago: “There is even evidence that the patterns of official help actually make life harder for families….” (Ann Shearer, 1981, Disability: Whose Handicap?).” Jenny Morris

Mama lions, pain, privilege and justice “Where is the voice of social care? Where is the NHS? The CCG? I believe that the voices missing are those most needed. Where is the comment from the social care commissioners who somehow decided an Assessment and Treatment Unit was worth commissioning? Where is the CEO of the Trust that was responsible for LB’s preventable death? If we’re really talking about privilege, these are the people we should be levelling that at. These are the people who are on large salaries to make these decisions, where are they when they need to show some accountability?” George Blogs

The sad death of Connor Sparrowhawk: some reflections “I was struck, when reading through Sara’s blog, by the part she wrote about LB wanting a girlfriend (tears are welling up now) and this being a possible contributory factor to his decline. The poor lad just wanted what we all want….and why wouldn’t he? We all need to be connected to others, to feel valued and loved…and not just by our family who are going to love us unconditionally.” whatever.

Connor Sparrowhawk easy read version “The official report into Connor’s death is difficult to read and full of jargon.” People First England

Statement on the death of Connor Sparrowhawk “At People First England we believe that all adults have the right to a safe, independent life, lived in a manner of their own choosing. The astronomical sums of money paid for places in ATU’s shows that this is not a problem of lack of overall funding, but a lack of care, dignity, choice and respect..” People First England

A statement from Change “Shaun, worker with learning disabilities says “I think this was a criminal offence. Staff should have been there for Connor. He should have had the support when he needed it – not 15 minutes later, when it was too late. This feels like we are back in the 19th Century again..” Change

Why? #JusticeforLB  “Why? Do we as parents, patients, families, campaigners, interested people have no option but to be fluent in and use the jargon of Health & Social Care NON Language..” You don’t look sick!

Failures of inpatient care “My daughter Julie was held in a specialist ward for adolescents with mental health problems for twelve months from the age of 14. During this time we, her family, were physically excluded from the ward, sidelined in meetings, and openly criticised.”Juliesmum

A preventable death “If they had really been used too and skilled in person centred planning they would have known about “important to and Important for” ….the key person centred thinking skill.  They would have been able to balance the fact that “having long baths was reallyimportant to Connor but supervising him was important for him to keep him safe…” A bit missing

To think the NHS should know…”I think people don’t realize how easy it is for anyone to drown even in a shallow bit of water like a bath..” Mumsnet

I remember his jeans were wet “Katrin is gone. I can’t bring her back. LB is gone, his death can’t be undone. But the system needs to accept responsibility and make changes so that no other family trusts their child to people who fail to take the most basic precautions. Fail to keep them safe.” Making it up

Parents not spoken to enough “I sat in many many meetings with gritted teeth and red hot cheeks as I was referred to as “mum” and my daughter discussed as if she were more known to the complete stranger considering her needs. The stranger who had not even seen a photograph of her let alone the many albums and films and artefacts that made up a full and rounded and joyful picture of what was her life and the family who loved her.” All aboard the trauma train

A preventable death: Some questions “A great young man died. And a great young man’s family has been ripped apart. We owe it to LB and his family to do everything we can to turn the piss awful state of adult social care around.” Love, Belief and Balls

My personal plea “As a parent of a disabled child, Connor’s death has saddened me and made me very angry. I am so scared for the future of my own son. I already know that if I am not around, then he is in danger. I know that I cannot leave him alone when he is in hospital as they do not have the staff to monitor his epilepsy. I have to make sure someone I trust, who knows his seizure pattern and medications is with him at all times.” Living with

‘Let it not be about lessons learned’ “It is not the only place I am aware of where a person with autism is trapped in a unit not equipped for them; I have recently heard of another situation where someone with autism is trapped in a unit that mainly caters for people with less severe learning disablities, and which is ill-equipped to provide suitable activities which has in the past caused an upsurge in challenging behaviour.” Indigo Jo Blogs

A Glasgow kiss “However, the stark facts were: for reasons no-one can quite comprehend, Connor was left unsupervised in a bath, even though staff knew he was epileptic. He drowned. Trained clinical staff apparently didn’t even know how to perform CPR.” Blipfoto

Some thoughts on the LB report “This phrase first started being used by the disability rights movement in the 1970s. Disabled people were fed up of their lives being dominated by the medical professionals and other organisations. It is an empowering statement, one that is still around today. Going back to the report “they” are discussing LB in an abstract sense. It is written by professionals for professionals. It is not written for the average person in the street to understand. Whilst I understand reports like this have a place I feel it is important to reclaim the humanity of LB after this report is published. He wasn’t “a patient” or “a label” but a human being.” Allbigideasstartsmall

Connor Sparrowhawk: Death by indifference “And the report shows so much passing of bucks and refusal to accept responsibility, it’s unbelievable. No risk assessment of Connor’s bathing arrangements. No review of his epilepsy when he entered the unit, or after it was suspected he’d had a seizure. Not all relevant staff were trained in life support. No record of the agreed observation actually happening while Connor was bathing.” Funky Mango Musings

On Southern Health and Connor Sparrowhawk’s preventable death.. “Actually, Southern Health staff’s approach to the family was adversarial. Read in paragraphs 7.17-7.18 how S3 talked to the family about whether they could visit or not; read in paragraph 7.19 what S3 had to say when Connor’s younger brother wanted to visit the person he’d shared a room with for his whole life; read in paragraph 7.20 how a member of staff lied directly to Connor’s parents about whether Connor wanted them to visit; read also in paragraph 7.20 how S3 thought (a) it was reasonable to put am 18-year-old to bed at 7pm and (b) contradict their own unit’s visiting hours in order to deliberately prevent Connor’s parents from seeing their son; read in paragraph 7.31 how S3 reduced an experience Special Educational Needs teacher to a distressed state through their interrogations.” arbitrary constant

Congratulating Southern Health and (fisking them) and true leadership “Now, I’m no expert on leadership but I’m pretty sure it has something to do with personal accountability and responsibility, and being present when something bad has happened, as well as the good times.Am I alone in thinking that NHS Leadership Award standing on the mantelpiece at home is looking a bit hollow?” abitrary constant

Questioning Southern Health’s future fitness for purpose “I don’t think any assurances provided by Southern Health about what they will learn and do in the future can be trusted. It is for this reason, built on all of the details presented above, that I call to prompt relevant organisations – statutory, regulatory, legal or otherwise – to fundamentally question and consider Southern Health’s ability to provide care services to people in the future.”arbitrary constant

Preventable “LB was in the unit under no clear legal authority, possibly unlawfully deprived of his liberty, both clinical leads did not think he should have been there, and yet he was. He was stuck in an unsafe, impoverished environment, with nobody taking charge of helping to support him and his family with a return home with the appropriate services. And then he died.  All of this was preventable.” The Small Places

Discrepancies, blatant misses and gaping holes “*If a man with learning difficulties, autism and epilepsy shows you his bitten tongue, would you a) order bonjela and ignore it or b) consider it a warning of a seizure? *If a man with learning difficulties, autism and epilepsy shows you his bitten tongue AND his mother visits and raises urgent concerns that she thinks he has had a seizure, would you a) order bonjela and ignore it and ignore his mother or b) consider it a warning of a seizure?” George Julian 

Bystander apathy “The excerpts from the report ooze perhaps the central feature necessary to bystander apathy, diffusion of responsibility. Both within the unit but also crucially beyond it (how did LB end up in the position where the unit was the only option? What was the plan for what he was going to do after he left? Why were his family marginalised? Where were the Wizard of Ozian commissioners in all this?) no-one stood up and took responsibility for ensuring that LB could work towards the life he and his family wanted.” Chris Hatton’s blog

The death of Connor Sparrowhawk and liability of public authorities “The issue is not damages. The quantum awarded for actions taken under the Human Rights Act are typically small, and pragmatic legal advice on any borderline case would be to suggest the authority apologise and settle an action as early as possible to avoid legal costs and the costs of staff time involved in giving evidence. A bigger issue is reputational harm.” Mental Health and Mental Capacity Law

Teenager’s death was institutional disablism Disability News Service

Charities continue to fight for justice The Challenging Behaviour Foundation

Death of 18 year old Connor Sparrowhawk... Bindmans 

Independent investigation finds Connor Sparrowhawk’s… INQUES

Tragic death of Connor Sparrowhawk… Learning Disability Today

Teen’s death a tragedy Oxford Mail

Slade House patient Connor Sparrowhawk’s.. BBC Oxford News

Teen’s death at health unit.. Oxford Mail

Death of 18 year old in failing NHS learning disability unit Community Care

Inspection report Slade House CQC

11 thoughts on “Media/commentary

  1. Wow! Not a lot of point in Twitter trying to close @justiceforLB then! I have just retweeted the reply I got from @mencap_charity with the link to their response to the report. Stable Doors Twitter! Off to read the ones I haven’t seen! Love Jenny xx

  2. Pingback: Mama lions, pain, privilege and justice | George Blogs

  3. Pingback: “He should never have died” | The Social Issue

  4. Pingback: - JusticeforLB: A movement for change

  5. Pingback: The Connor Manifesto and 107 Days of Action | The Small Places

  6. Pingback: Day 47: Indignation and initiative vs ‘institutional inertia’ #107days | #107days

  7. Pingback: Indignation and initiative vs institutional inertia | The Social Issue

  8. is a contentious almost toxic website that tries to make the unthinkable thinkable at least. My second approach is to report in time on the ergonomic and other institutional frustrations that confront the patient designed into the surroundings. To precipitate an illness to better treat it is one thing, to cultivate trauma , to engineer dissent or compliance fits exactly into why monarch programming is a widespread abuse of all that could be better. I know I am on the right lines as within weeks of unpicking Antelope House one of the most toxic wards was closed down…a very last resort and I think I was the last straw, Beware the new shibboleths. I have read Will Filer and his Psyops “Extreme Process” and must be one a very few aware subjects as this new imperative demands new sacrifices and modalities. The Staff have no idea, and did not understand why I said “they were a disgrace to their profession”, so be kind as you find blame is not going to work with unaware little things doing what they have is the price of slavery.

  9. might interest you..please read all 35,000 pages to see beyond the anyway hidden away huge comic example of being given something impossible to deal with and seeing how you deal with it ..Psyops wars now fought by civilians.

  10. Hello Sarah
    Great to hear about the Justice for LB campaign – I only heard about it on Mike’s website and have tried to find out what is going on. I am disabled woman and consultant for National People First self-advocacy – I worked for them as Campaigns Worker – oversaw the campaign to ensure that people with LDs are included in Disability Discrimination Act (Equality Act) and Direct Payments legislation about 20 years ago. I have worked for UKDPC and Alliance for Inclusive Education since then as campaigns worker. I am keen to pass on information to People First and see how we can get involved – at the moment I am finding it all confusing because important stuff seems to be on numerous websites – I understand there is a All Party Parliamentary Group meeting on the Bill next Tuesday – if so can you please let me know – be good to meet some of you face-to-face. Is there a bill or not – according to the easy read nothing has been produced – if so that’s good because people can get involved right from the start. However I have read some draft clauses and understand there is a draft bill ready to be discussed at a all party parliamentary group meeting next Tuesday – it be great if someone can please let me know asap – email is tel number is 0208 459 5717 –

  11. Why has the Equality and Human Rights Commission not been involved yet?
    Discrimination is so clear in healthcare for learning disabilities, compared with non-disabled people. How can deaths not be investigated, and those who are not dead get such poor care that they will die earlier, and possibly a slow drawn out death.

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