Five-year-old Lila Marsland’s death was contributed to by neglect, jury finds

The inquest into five year-old Lila Marsland’s death was concluded just after 1pm on Thursday the 5th of June.

An inquest jury has concluded that the death of five-year-old Lila Marsland from Hyde was contributed to by neglect, following a nine-day long hearing at Stockport Coroner’s Court. Lila died on 28th of December 2023, just weeks before her sixth birthday, after being discharged from Tameside Hospital with tonsillitis.

Throughout the inquest, a photograph of Lila, placed on the coroner’s desk by her mother, Rachael Mincherton, served as a painful reminder of the young life lost. Rachael described Lila as “a joy to parent” and gave an emotional testimony about her daughter’s final hours, reliving what she called “a living nightmare.”

Lila had fallen ill during a family walk at Dovestones on the 27th of December 2023. She vomited on the way home, became lethargic and complained of neck pain. Concerned, Rachael took her to Tameside Hospital later that evening. Medical records showed she had a high fever and an elevated heart rate of 135 beats per minute. Lila was not seen by a doctor for six hours.

Despite these symptoms, a full examination was not carried out by a doctor, with one of them telling the court that they didn’t want to disturb Lila as she was sleeping. One of the attending doctors, Dr Noor, told the jury she conducted two tests for meningitis and both returned negative results. However, Rachael disputed this, stating only one test was carried out — when the doctor moved Lila’s legs apart, causing the little girl to scream in pain. Rachael also claimed Dr Noor spent no more than five minutes with her daughter.

At approximately 2:40am on the 28th of December, and following limited assessment, Lila was discharged with a diagnosis of tonsillitis and a prescription for amoxicillin.

Lila was then found unresponsive at home at around 9am that morning by her mum. Despite attempts at resuscitation by her mother and paramedics, she was pronounced dead minutes later at 9:19am

The inquest jury was tasked with determining whether Lila’s death involved a gross failure to provide basic medical care and was therefore contributed to by neglect. After hours of deliberations, the jury said in their conclusion that Lila’s death could have been prevented if she had received appropriate treatment and antibiotics for meningitis the night before.

Coroner Chris Morris emphasised the gravity of the inquest process, carefully spelling out key words as the jury recorded their findings, underlining the importance of accuracy when documenting conclusions.

The jury ultimately determined that Lila died from undiagnosed and untreated pneumococcal meningitis Streptococcus pneumoniae, hours after being discharged from hospital and that therefore, Lila’s death was contributed to by neglect.

Following the verdict, Rachael Mincherton delivered a deeply emotional statement outside court: “Today, after a traumatic day reliving Lila’s death, we welcome the jury’s decision of natural causes caused by meningitis as contributed to by neglect,” she said. 

“We’ve got the outcome today that we believe we should have, but hearing the word ‘neglect’ is something a parent should never have to hear. We are now left with the devastating loss of our daughter for the rest of our lives.”

Rachael thanked the jury for confirming what she said she had known for 17 months. She also expressed her gratitude to Coroner Morris and her legal team, including Irwin Mitchell and barrister Sarah Edwards from 7BR Chambers, for their tireless work.

Rachael told the press: “I cannot put into words the pain our family has been left to feel because of the failings that Lila encountered.

“Throughout this inquest, we believe there has been limited remorse and compassion shown by the hospital trust. To sit in a court and listen to statements around the loss of our five year old little girl has been a living nightmare. The failings in care that have led to Lila losing her life is something that must be looked at, and we believe serious changes need to be implemented, because children should not be being neglected when taken to hospital by a concerned parent.

“I sincerely hope that Tameside Hospital can now make serious changes so that another child does not die and another family does not have to go through this horrifying experience.”

Rachael also called for urgent changes at Tameside Hospital: “It is not only the training on recognising a life-threatening illness that needs to be improved, but also the support from upper management,” she said. “Lila was a person — a beautiful little girl with the rest of her life ahead of her. It’s now essential that standards of care are drastically improved.”

Coroner Chris Morris has called for changes to the way that hospitals are run to prevent future deaths. His two main recommendations were that systems are updated making them easier and more efficient to use, and that communication improvements were made between staff throughout the hospitals.

A spokesperson for Tameside and Glossop Integrated Care NHS Foundation Trust said: "We want to express our sincere condolences to Lila's family for their heartbreaking loss. 

“It is clear from the independent investigation that there were missed opportunities in Lila's care. We accept the coroner's findings and apologise unreservedly for this. 

“As a Trust, we have made, and will continue to make, improvements to ensure we learn from this case." 

Lila’s family outside of court.