(13 years, 10 months ago)
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Anna Soubry (Broxtowe) (Con)
Before I begin the Adjournment debate I will let hon. Members leave, as I anticipate and understand they will, given the hour.
As you will know, Mr Deputy Speaker, I bring to the House’s attention a very serious and tragic matter. It is almost a year to the day since John McGrath was killed by his grandson, William Barnard. John McGrath’s wife, Mabel, was seriously injured in that unfortunate incident. William Barnard was sentenced last month and is now in Rampton secure hospital, where he will be, no doubt, for a considerable time, because at the time of the incident he was seriously ill, suffering from paranoia and schizophrenia. Those who were supposed to be in charge of his care in the mental health services team available to him have helpfully provided a report that goes into considerable detail about the events that led up to that dreadful incident.
I will not go into the detail of that report. It is available for anybody to read if they contact me or Nottinghamshire Healthcare. However, it is clear from the report that there was a significant and serious failing in the care and supervision that should have been enjoyed by William. That is deeply regrettable, because this incident happened without that care and supervision. Had he had it, this tragedy would not have occurred. I am grateful that the Minister has come along today, and I know that, if time allows, he will meet the family. On their behalf, may I extend to you, Mr Deputy Speaker, their thanks for allowing me to address the House in this way? In short, they are very keen to ensure that John McGrath did not die in vain.
The report contains many recommendations. The NHS trust in Nottinghamshire, Nottinghamshire Healthcare, assures me that it has learned many lessons and has said the failings identified that will not happen again, as a result of the recommendations that it is determined to implement. However, through this debate, I want on behalf of the family to ensure that everyone—every team, every trust, every authority—not only reads the report, but understands the failings that it identified and is made aware of the recommendations that it contains, in order to ensure that such a tragedy never occurs again anywhere else in the United Kingdom.
I will quote from the report in time, but I would like to begin by talking briefly about John McGrath. John earned the nickname Dr John, because of his kindness and his willingness to help anyone who came his way, in any way that he could. At the time of his death he was almost 82, and he and Mabel lived in Stapleford, a small town in my constituency. William was the son of their youngest daughter Kathleen. The couple had three other children, all of whom are in the Public Gallery today, as is Mabel. Her other grandchildren, and William’s sister and her boyfriend are also here.
As the report says, William Barnard is part of a large and supportive extended family, who played a significant role in providing care for him under extremely difficult circumstances. I have met the family and they are remarkable. They are an example to us all of the sort of love and support that we wish we could all enjoy. They are good people. Indeed, it is perhaps testimony to the sort of people the family are that they have come to this place today with a file containing other cases—cases that I know will cause the Minister great concern, as they concern us all—cases of other people who were meant to be in the care of mental health teams and workers, but who unfortunately did not receive the care and support that they should have had, and either killed or injured other people. I know that the Minister will take that dossier and read it.
It is because of the love and support within that family that they have always had great concern for William, to whom I want briefly to turn. In his late teens, he began to exhibit signs of a serious mental illness. He spoke to his mother, who at that time was training to be a nurse. She knew that there was a problem, and together they engaged with mental health services. Again, I will not go into all the detail—the appendix to the report makes clear some of their dealings with mental health services—but it is clear that, from 2002, he exhibited many of the symptoms of a serious mental illness. That, if I may say so, was clear for all to see.
I am no expert, but if I may say so, in 2007 William was exhibiting some of the stereotypical behaviours of somebody in need of serious help and assistance. There were a number of unfortunately very typical symptoms shown by people who experience such an illness, but the important features included a non-engagement with, and suspicion of, mental health care workers and their team. There was also a lot of evidence that William was at great risk of inflicting serious harm to himself through self-neglect. I would say that there were also features—I have read about them in the appendix—that should certainly have caused those responsible for his care to be alerted to a potential risk to other people.
Today I was shown a photograph of Will, as he was known by his family, from when he was well. He was described by his family to me as a gentle giant, and in the photograph—I am sure that the family and he will forgive me for saying this—one can see a rather chubby-faced young man, and he is smiling. He looks happy, and he is clearly well. That stands in sharp contrast to the photograph that has appeared in some of the local papers—understandably so—of William on his arrest. In that photograph, he is a gaunt, haunted young man. That just shows how his illness had affected him.
In 2007 going into 2008, William was sectioned, which was largely due to the efforts of his mother. Again, it was clear that he had a problem, with a lack of engagement with, and a great suspicion of, those charged with his care. Indeed, he escaped from hospital in Derby. He was, in effect, captured—again, it is thanks to the family that he was detained—and he returned to hospital, before being discharged in due course from that Mental Health Act order and returning to Stapleford, into his loving and caring family.
Because of the nature of William’s illness, he should have been looked after by the assertive outreach team. In my work as a criminal barrister, I have represented a number of people who have suffered from mental illness. I have come into contact with some of the people who work with people with mental health difficulties and serious mental illnesses, and I have not met one who did not have the most remarkable skills, and a commitment to the person in their charge. They perform a difficult job, and often struggle to resolve huge conflicts. The outreach team in this case was well staffed and well equipped. According to the report, its members were trained. So this was not one of those cases involving a pitiful lack of funding or staff, or any other such deficiency. There were enough people; that was not the problem. The problem was a lack of care and supervision. No one took responsibility for William’s care. According to the dossier that the family has handed to me, that is all too common a feature of these terrible tragedies.
In December 2008, William refused to take his medication. That is typical of people with these conditions. He did not take his medication for some seven months before the incident, and those charged with his care knew about that. There were 30 attempts to make contact, but they resulted in only four face-to-face meetings, some of which were only fleeting. For four months before the incident, he was not seen by any professional health team workers at all. There were, however, 11 recorded occasions on which the family contacted the assertive outreach team, and 13 other instances in which other people and agencies, including the pharmacist and even the police, contacted the team to express their genuine, well-founded concerns.
The report talks about an “excessive passivity” in the management of William’s case, and a lack of information and detailed knowledge. It describes a breakdown in the assertive outreach team’s function. Concern was expressed by some workers, and I do not seek in any way to go behind that. No doubt there were people who were there to look after William and who had concerns about him, but the lack of communication and the systemic failings meant that no positive action was taken. There was no proper analysis of the signs of William’s deterioration. According to the report, there was “confusion” and “inaction”, as well as ineffective leadership and absent leadership. The report is a damning indictment of what happened in this case. It reveals a systemic failure.
I want to give the House an example, which makes profoundly sad reading. On 20 April, a meeting was called to consider the information that had been placed before the team. It was decided that Will would be monitored for six weeks, after which time a further meeting would be held to reassess his case and to decide whether he should be sectioned under the Mental Health Act. No one made a proper note of what was to happen, however; certainly, no one carried out any work. No review date was set, and there is no record of any action being taken. Worse still, perhaps, was the fact that no attempt was made to see Will for a month.
On 15 June, reports were received from the police and from the pharmacist, who, according to the report, did a remarkably good job of trying to get this young man the help he needed. There were also reports from the family. All kinds of alarm bells should have been ringing loudly at this point, but again, nothing was done or planned. On 24 July, Will was deemed to be an acute risk, not only to others but—most importantly, it could be said—to himself. There was another failed visit. Those who attended his flat saw blood on a door handle, and strange writings and other things on his door. All that clearly indicated that this young man was in desperate need of assistance. Again, his family was spoken to, and his grandfather spoke of his grave concern for the grandson he loved so much. And that grandson loved him and saw him very much as a father figure. A request for a Mental Health Act assessment to be carried out that very day, as it should have been, was turned down, and a decision was made to wait until the following Monday. By then, of course, it was too late, for it was on that very day that this dreadful incident took place.
The real question to be asked is, “What is to be done, and why are we in the House of Commons raising this matter?” We know that there is to be a report from the strategic health authority, and we look forward to reading its comments and recommendations. We believe that there will also be a coroner’s inquest report, as well as the report to which I have referred.
As I have said, lessons must be learnt, not just by Nottinghamshire Healthcare NHS Trust—which has given me an assurance, for whose assistance I am grateful, and to whose representatives I have spoken at length—but throughout the country. We are keen to ensure that when reports such as this are produced, whatever tragedy they concern, it is not one of those cases in which all that happens is that someone says, “Yes, we will carry out all the recommendations.” Perhaps that is done for a short period, but there is no long-term, regular audit to ensure that everything that should have been put right has indeed been put right for the future.
The other thing that everyone wants is for families to be far more involved in the care of people like Will who mean so much to them. According to the report, there was a lack of interaction, and we want that to change. Of course there are some cases in which the family does not need to be involved, and of course there are real conflicts over the autonomy of a patient; but in this case, as in so many others, the people involved should have been listened to, and should have been involved to a greater extent. It could be said that William’s grandparents, Mabel and John, were themselves vulnerable people to whom a duty of care was owed. They should have been listened to, and they should have been involved.
As a result of an Act introduced by the last Administration, those who work with people who suffer from the sort of illness from which William Barnard suffered, and still suffers, have powers to enter homes. They also have powers to ensure that someone who should be taking medication and is not doing so can be “recalled”—a criminal barristers’ term—to hospital. I ask the Minister to ensure that everyone involved in local health services is aware of those powers and willing to use them, and that the assertive outreach teams that exist throughout the country do exactly what it says on the tin, and are assertive in their care and support.
The Minister of State, Department of Health (Mr Paul Burstow)
I congratulate my hon. Friend the Member for Broxtowe (Anna Soubry) on securing what I think is her first Adjournment debate. Adjournment debates provide an opportunity for issues such as this to be debated in the House, and for the Government to account for what they are responsible for and ensure that others do the same. It is entirely appropriate for such a tragic and distressing case to be raised in an Adjournment debate.
Our thoughts must go first to the family whose lives have been turned upside down by this devastating incident. I offer them my deepest sympathies. As my hon. Friend said, members of the family are in the Gallery listening to the debate, and I look forward to meeting them afterwards and discussing the case with them directly. I fully understand their desire to ensure that something positive comes out of this terrible tragedy. As my hon. Friend said, our priority now is to ensure that the NHS learns from the incident, at a local and also, where appropriate, at a national level. I have asked my officials to look carefully at the issues raised by the case as they consider the future direction of mental health policy.
I shall say a little more about the national context later, but let me begin by focusing on the local issues. As my hon. Friend explained, Nottinghamshire Healthcare NHS Trust launched an internal investigation, which reported in April. It is a frank and honest account of what went wrong, and it gives the local NHS a good basis on which to improve the safety and effectiveness of its mental health teams. All that precedes the full external and independent investigation that the strategic health authority will commission in the near future. The trust has assured me that since the internal report came out it has taken active steps to address the weaknesses identified. It tells me that it is improving records management, strengthening communication between teams and reviewing its policy and procedures for assertive outreach. It is also addressing the way that mental health teams assess and manage risk, as well as looking at leadership issues and how they manage a patient's condition over the long term.
In addition, the trust has reviewed the cases of every patient using assertive outreach services to ensure that their care is not being compromised by the same failings. It has commissioned an external review of its assertive outreach teams, which is due to report in a fortnight. I have been reassured that the trust's board will examine the findings and respond swiftly and diligently to them. My hon. Friend and I would agree that all that work must feed directly through into better and safer practice on the ground. Crafting objectives and principles is one thing; achieving tangible improvements to practice is quite another.
My hon. Friend is absolutely right to emphasise the issues of strong leadership and clear lines of responsibility in assertive outreach teams. I can tell her that what should happen is that every assertive outreach patient has a named care co-ordinator. The co-ordinator takes overall responsibility for the appropriate assessment, care and review of the patient. There is no nationally prescribed model for who must take on that responsibility. I do not think that it is sensible to start prescribing how local teams are structured or run through a mandatory code. After all, patients’ needs will differ, and so will local circumstances.
However, there must be clarity. Everyone should know who is responsible for what, and people should be properly qualified, skilled and supported to discharge their responsibilities. The trust accepts that point. It tells me that it has set out a clear process for responding to service users who have not adhered to the agreed level of contact. Team managers are now responsible for monitoring that. I also understand that a risk assessment expert has spent a week with the assertive outreach team and is now developing a risk training programme for all staff. That training will be delivered in October.
Building on that point, I have also asked the trust about its quality assurance procedures. Assertive outreach obviously depends on strong relationships across different teams. That can be hampered if people change jobs, or if the continuity is broken in some other way, so the right quality assurance process is vital. Change has to be embedded within the organisation through regular and robust assessment of the competency of assertive outreach teams. In this regard, the trust tells me that it has improved clinical and managerial supervision as well as its performance management arrangements. For instance, attendance at multidisciplinary team meetings is now compulsory for anyone involved in a patient's care. Team managers now carefully monitor attendance at these meetings, and ensure that all actions coming out of the meetings are properly followed up.
I am keen that lessons from this tragedy are shared and absorbed by the rest of the NHS. In our White Paper, we talk about an NHS freed from the endless succession of top-down mandates and departmental circulars. That is the right approach. We want to replace command and control with much stronger local accountability, with councils in particular taking a much stronger role in working with the NHS and holding it to account. We have also said that the NHS will focus much more on achieving better outcomes; there is a debate to be had about what those outcome measures will be. A consultation is happening over the summer, and outcomes for mental health patients will form part of those discussions.
However, cutting the Whitehall apron strings does not mean abandoning our duties to look at local incidents and consider national repercussions. I will not pre-judge the external investigation. My hon. Friend would not expect me to do that, but I can tell her that the external investigation will be sent to the National Confidential Inquiry into Suicides and Homicides by People with Mental Illness as a matter of course. The inquiry team will consider the findings as part of its regular reviews of homicide investigations. The National Patient Safety Authority would respond to any points of national concern raised by the independent investigation.
In addition, my hon. Friend may be aware that the NHS already flags patient safety incidents via the NPSA’s national reporting and learning service, and if a trend or pattern emerges the NRLS can issue an alert to all relevant providers. Those alerts would give advice to the NHS on how to prevent such events from occurring.
My officials have contacted the NPSA about the specifics of this incident and it says no similar problems affecting other assertive outreach teams have been reported to it. Therefore, I will be particularly interested to see the dossier of evidence and I will follow that through.
Mary Macleod (Brentford and Isleworth) (Con)
This incident was very movingly described by my hon. Friend the Member for Broxtowe (Anna Soubry), and I do not think it is an isolated incident—I think it has happened elsewhere around the country. Can the Minister give an assurance that the lessons from this case will be learned across the country and that it will change the way things are done in the future?
Mr Burstow
In terms of the systems as they work now, we will do all we can to make sure that that learning is embedded, but I am concerned that my inquiries today have shown that the NPSA was not aware of this dossier and I will therefore look into that, and look at the dossier itself in order to see what it can teach us.
However, I want to reassure both hon. Ladies—and other Members—that if the independent investigation were to make recommendations with national implications, we would look at them very closely and make sure they were translated into action and learning around the country.
Let me end by saying that mental health professionals have an extremely difficult and challenging role; the hon. Member for Broxtowe was right to acknowledge that. The judgments they make are often finely balanced, and the risks they shoulder are considerable. Most professionals are doing an excellent job, and we ought to acknowledge that while also being concerned where practice falls short, but sometimes there are failures in care that could and should have been avoided. Tragedies like the case of John McGrath demonstrate the need for constant vigilance, scrutiny and self-improvement.
When such tragedies do happen, it is vital that all responsible authorities, both local and national, are honest about the weaknesses and diligent about putting things right for the future. Like the hon. Lady, I will take a close personal interest in the independent investigation and the coroner’s report. I want to ensure that this incident leads to improvements, because that is probably the only consolation that can come from such a tragedy.
That is my message to the McGrath family and the hon. Lady who has secured the debate tonight. I look forward to meeting the family shortly to discuss these matters further and to working with colleagues across the House to make sure our mental health services protect and give good quality care for people with mental health needs.
Question put and agreed to.