| SPOTLIGHT |
A multi-academy trust has been fined £30,000 after a 19-year-old student died as a result of a “series of management failures” at his special educational needs school.
Owen Garnett, who had been diagnosed with Pica - where sufferers have a compulsion to eat things which have no nutritional value – died after choking on a paper towel in 2023 at Welcombe Hills School in Stratford-upon-Avon, which is part of the Unity Multi Academy Trust.
An investigation by the HSE found that none of the staff in the teenager’s class team had received any specific training on the management of safety risks associated with Pica, and that despite a “near miss” incident just days earlier, the school “failed to take action” to ensure it didn’t happen again.
The regulator also found that students at the school have individual risk assessments which detail any specific health and safety risks, and the control measures that need to be in place. The risk of choking associated with Pica was identified on the teenager’s risk assessment and a “named person” was supposed to supervise him to make sure he did not eat anything that could cause him harm.
However, the HSE found that the school failed to ensure that all the safety risks associated with Pica hazards were correctly identified and that the preventive and protective measures including supervision, were organised in such a way as to protect Owen Garnett.
The school also failed to effectively investigate and respond to the concerns raised by his family, the watchdog noted.
As a result of the investigation’s findings, Unity Multi Academy Trust was fined £300,000 and ordered to pay £10,750 in costs at Coventry Magistrates Court on 18 December 2024.
HSE inspector Rebecca Whiley said: “This tragic incident could have easily been avoided if Owen was being closely supervised, as he should have been.
“The near miss incident a few days before should have raised the alarm with the school and triggered an investigation into how Owen had been able to access the paper towel, and steps could have been taken to prevent it happening again.
“His death resulted from a series of management failures throughout Owen’s time at the Hub, and a failure by the school to act on the concerns raised by his family.
“Our thoughts today are with Owen’s family. He was a young man with a happy life ahead of him. He should have returned home safely to his family after a day at school, but because of the failings by Welcombe Hills School and Unity MAT, he did not.”
In a statement, Unity Multi Academy Trust said: "It is with profound sadness that the Trust extends its deepest condolences and sincere apology for the desperately sad death of Owen. Our hearts go out to Owen's family and friends during this incredibly difficult time.
“In the aftermath of this tragic event, we have striven to ensure that lessons are learned and the learning implemented to guarantee the safest environment for young vulnerable people like Owen to live, learn, and thrive. Our commitment is to ensure a better, safer future for all our students.
“To prevent such a tragic outcome from happening again, The Trust fully and unreservedly accepts that more could and should have been done. With this in mind, a number of measures have been put in place to ensure that no other family goes through what Owen’s family has endured. These measures include:
“We are dedicated to making our schools a safe haven for all children and will continue to work tirelessly to uphold this commitment.”
Lottie Winson
