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Why the NHS


and they’re not getting it.”
Oliver died in November 2016
after suffering partial seizures. As
well as leaving behind parents Paula

must change
and Tom, he left a sister, Heather,
23, and a brother, Adam, 26.
His death from neuroleptic
malignant syndrome (NMS) is one
of a number of high-profile NHS
tragedies involving people with
learning disabilities.
When autistic teenager Oliver McGowan was
All died in NHS care
admitted to hospital, he and his family told As well as Oliver, Josanne
Wadsworth, 31, Richard Handley,
doctors not to give him an antipsychotic. 33, Connor Sparrowhawk, 18, and
Judith Benn, 54, all had learning
But they went ahead anyway and Oliver died. disabilities and all died in NHS care.

Now, his mum Paula tells Darren Devine of


The deaths all resulted in
investigations and left serious

her campaign to ensure all NHS staff receive question marks over the quality of
their care.

training in autism and learning disability And earlier this year the
Learning Disability Mortality Review
(LeDeR) highlighted how those with
Paula and Tom McGowan watched learning disabilities die 15-20 years
son Oliver go from being a
paralympian hopeful to lying intubated
and clinging to life in hospital. Until people like
He was suffering from a severe Oliver and
allergic reaction to olanzapine, an
antipsychotic medication. Connor are seen as
Southmead Hospital in Bristol gave fully human, health
him the drug against his own
wishes and those of his family. This care is not going to
followed Oliver being trialled on an improve, sadly”
antipsychotic a year earlier and
reacting badly.
As Oliver was lying in his earlier than the general population.
hospital bed on a life support Dr Sara Ryan, Connor
machine, doctors told his parents Sparrowhawk’s mother, fought a
he would never walk again, be lengthy battle after her son
blind and have no memories or Oliver McGowan was “just a nice drowned in a bath when he was
language. They took the young lad”, below left. After he left unsupervised in an NHS care
heartbreaking decision that their disability and autism training was admitted to hospital and given unit. She says: “Until people like
18-year-old son’s life support could mandatory for all NHS staff. It had olanzapine his appearance changed Oliver and Connor are seen as fully
be withdrawn. gathered more than 44,000 rapidly. His father says he developed human, health care is not going to
signatures by the time this issue of a blue pallor around his eyes and improve, sadly.”
Lasting NHS change Autism Eye Magazine went to press. mouth, but doctors said “it was the
But the family is now working to Paula, a primary school teacher, lights”. Then, two days later, when Hospital passport ignored
ensure that Oliver’s death sparks and Tom, a senior RAF officer, say the family said his appearance Paula says she gave staff Oliver’s
lasting NHS change. they have been “overwhelmed” by looked swollen they were told “it was hospital passport, describing how
As well as being impacted by support, especially from medics. probably water retention”. The inset his autism and learning disability
autism in a relatively minor way, Paula says: “I’ve been approached picture, right, shows Oliver’s right affected him and detailing
Oliver had epilepsy, a mild learning by many, many doctors and hand, where a cannula was removed reasonable adjustments needed.
disability and cerebral palsy. Paula nurses now, all saying the same and the wound became infected. His However, she says it was “placed
believes that if Southmead Hospital thing – that they support father says that Oliver contracted in a drawer without a glance”.
had made reasonable adjustments the petition, they Methicillin Sensitive Staphylococcus Among the problems Oliver
it would have saved his life. believe that they Aureus (MSSA), a bacterium on the encountered during his hospital
In the wake of the tragedy, want the skin, “for no reason” and thinks the stay was having several doctors
Paula and husband Tom started a training and wound was the source. speaking to him at once while
petition to prevent avoidable they need using complex language. Also,
deaths by making learning the training Paula says when her son wanted to

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Happier days:
Oliver with
brother Adam
and sister his behaviour when he the drug was “one of the
Heather, above, woke. However, the contributing factors” in Oliver’s
and having family, who live death. She told Paula she “might
fun with mum between Bristol and have been right” to warn her about
Paula, right. New South Wales in the drug.
A World of Possibilites Top right: a
young Oliver
Australia, say Oliver did
not have challenging
The doctor is reported as
saying: “I take responsibility. I
surfing in 2008 behaviours. prescribed olanzapine, but I don’t
He never woke from the know that I’m responsible for
SpaceKraft design and Oliver was just a sedation as he developed the NMS anything else that happened.”
that saw his brain swell after the The Department for Health and
install a full range of nice young lad. antipsychotic. Social Care (DHSC) say they want
He played for the
sensory environments.
Paula adds: “Oliver was just a staff trained to support people with
nice young lad. He played for the learning disabilities and autism.
cerebral palsy England cerebral palsy England football
football squad and squad and was training to be a Consistent approach
To find out more or to was training to be
paralympian.
“He was the president of the
The DHSC commissioned both
Skills for Health and Health
receive a free catalogue a paralympian” school council at college. He was
a school prefect.”
Education England, which oversee
the training of NHS staff, to
please call us on: walk around, a normal part of his Gravely concerned
develop core skills and a
consistent approach to people with
seizure activity, he was restrained The mother is “gravely concerned” learning disabilities. This saw a

Tel: 01274 581007


and this heightened his anxiety. for any autistic youngster who framework published in 2016,
The family say while in an displays challenging behaviour if setting out essential skills. The
ambulance Oliver made it very doctors are so quick to reach for DHSC has also commissioned a
clear he did not want antipsychotic antipsychotics when dealing with core skills framework for autism.
medication. When trialled on an someone as placid as Oliver. In a statement, the DHSC said
antipsychotic a year earlier Oliver Paula stresses her son was the framework should equip staff
endured hallucinations, an increase assessed by two different senior “for roles that have regular contact
in seizures and tore his skin. consultant psychiatrists as not with autistic people”.
Paula says A&E doctors wrote having a mental health disorder. A North Bristol NHS Trust
‘antipsychotic medication’ in red in At an inquest into Oliver’s death, spokesperson said their staff “had
the allergies box on all of Oliver’s assistant coroner Dr Peter to make some very difficult
intensive care unit 24-hour care Harrowing ruled olanzapine was a treatment decisions” while caring
charts. Oliver was eventually “significant contributory factor”. But for Oliver and “did their very best
sedated, but a few days later he also ruled the drug was properly at every stage”.
doctors used olanzapine to control prescribed and that the NMS could The spokesperson added: “We
not have been predicted. remain committed to continue
According to a BBC report of improving the way we care for
Or visit our website Visit this page to see and sign Oliver’s petition:
https://petition.parliament.uk/petitions/221033
the inquest, Dr Monica Mohan, the
consultant neuropsychiatrist who
people with autism and learning
disabilities, making reasonable
www.spacekraft.co.uk prescribed olanzapine, admitted adjustments for each individual.”

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