The inquest found that 63-year-old Richard Laversuch was unlawfully killed at Parklands Hospital on 27 November 2021 after 18-year-old Owen Herbert was wrongly placed on a lower-security ward. Jurors cited multiple failings: no available PICU bed, an unsuitable ward admission arranged by an AMHP, understaffing, and an inadequate risk assessment that relied on the patient's calm presentation. Herbert pleaded guilty to manslaughter and received an indefinite hospital order; he is detained at Broadmoor. The coroner will issue a Prevention of Future Deaths report and the NHS trust has apologised and implemented changes.
Inquest Finds Patient Unlawfully Killed After Multiple Failures on Psychiatric Ward
Laversuch and Owen Herbert were both patients at Parklands Hospital [BBC]
An inquest jury has concluded that 63-year-old Richard Laversuch was unlawfully killed by a fellow patient after a series of failures by health staff at Parklands Hospital in Basingstoke. The attack occurred in the early hours of 27 November 2021, when 18-year-old Owen Herbert strangled Laversuch on a ward that jurors found to be an inappropriate placement for him.
Coroner's Findings
Winchester coroner Nicholas Walker said the case exposed "a chain of poor decisions" and that he would issue a Prevention of Future Deaths (PFD) report focused on admissions procedures and risk assessment practices. The jury concluded Herbert had been wrongly admitted to a lower-security ward because an approved mental health professional (AMHP) named a lower-risk unit when arranging his admission and no Psychiatric Intensive Care Unit (PICU) bed was available.
Staffing and Assessment Failures
Jurors found staff admitted Herbert to an understaffed ward despite being told the unit was unsuitable. The subsequent risk assessment was described as inappropriate: it relied on brief observations made while staff were under staffing constraints and placed an "over-reliance on the calm presentation of the patient." Minutes before killing Laversuch, Herbert had reportedly tried to strangle another patient; when staff investigated, they found Herbert in bed and, the jury concluded, doubted the earlier report of an attack.
Cathy Laversuch (left) and Bridget Ryan say their brother and his killer were both victims of care failures [BBC]
Background on the Attacker
Herbert had been detained under the Mental Health Act in November 2021 after telling authorities he was hearing voices, had left his home in Overton carrying weapons, and believed he was "in a game" and would be "tortured" unless he killed someone. He later pleaded guilty to manslaughter and, in 2023, was given an indefinite hospital order; he is currently detained at Broadmoor Hospital.
Responses and Changes
Hampshire and Isle of Wight Healthcare NHS Foundation Trust apologised: "Richard should have been safe on our ward and we failed him." Chief executive Ron Shields said the trust has strengthened communication and decision-making around bed allocation, increased senior nursing presence on wards, and improved clinicians' ability to assess and escalate risks.
The coroner said he could not imagine how difficult it would be for Laversuch's siblings, who described both their brother and his attacker as victims of "systemic failings" in psychiatric care. The Department of Health and Social Care offered condolences and highlighted recent investments in mental health services and an upcoming Mental Health Strategy aimed at earlier intervention and reduced waiting times. Hampshire County Council has been approached for comment.
"Poor decisions were made one after the other," Coroner Nicholas Walker said.
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