Today, the Care Quality Commission has published a rapid review of Nottinghamshire Healthcare NHS Trust and it touches in its final part on the specific healthcare received by Valdo Calocane between May 2020 and September 2022. The BBC headlines it as “a series of errors” found by the CQC who, we must remember, are themselves under the cosh from the new UK Government whose Secretary of State for Health thinks they are “not fit for purpose“.
None of this inspires much trust and confidence, does it?!
The full document is there to be read, if you have the appetite but for here, it’s worth noting various problems –
SUMMARY FINDINGS
- It is clear he was acutely unwell throughout the period under review.
- He was inappropriate discharged from the Trust’s care at the end of the period, without follow up.
- He first presented in psychosis and appeared to have little understanding or acceptance of his condition, attributing it over time to intelligence agencies and the police conspiring against him and his family.
- He was diagnosed after his first admission with paranoid schizophrenia and there were issues with him taking his prescribed medication from early on.
- The review found that if the decision had been taken on his fourth admission to treat him under s3 MHA, it would have afforded wider opportunities to stabilise him, treat his condition and future proof his care arrangements.
- Instead, he was admitted under s2 MHA (for assessment) despite the fact his second and third admissions had been under s3 MHA (for treatment).
- Patients admitted under s3 MHA are eligible for statutory aftercare (under s117 MHA) and they can be discharged on Community Treatment Orders, neither of which applies to s2 patients.
- By the time of his fourth admission, there was a documented history of crisis, admission, intervention, discharge and then disengagement from community services – only for the cycle to begin again and for each subsequent intervention to come after the commission of an offence.
- Detention under s3 MHA would have afforded opportunity to treat Mr Calocane via “depot” injections (longer lasting anti-psychotics, sometimes preferred for complex patients with crisis cycles like this).
- The review found a serious of “errors, omissions, and misjudgements in his care.”
Key among these were:
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Inconsistent approaches to risk assessment
Risk assessments minimised or omitted key details and did not make explicit the serious nature of the risk Mr Calocane posed to himself and others based on previous behaviour.
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Poor care planning and engagement
Valdo Calocane’s family contacted NHFT to raise concerns on a number of occasions but the information they provided was not consistently acted on.
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The decision to discharge Valdo Calocane back to his GP in September 2022
The evidence over the course of Valdo Calocane’s illness and contact with services and police indicated beyond any real doubt he would relapse into distressing symptoms and potentially aggressive behaviour.
Discharging Valdo Calocane back to his GP – due to his lack of engagement with mental health services – did not adequately consider or mitigate the risks of relapse.
CQC’s RECOMMENDATIONS FOR NHFT
- Review treatment plans for people with schizophrenia regularly to ensure treatment is in line with national guidelines.
- Ensure clinical supervision of decisions to detain people under section 2 and 3 of the Mental Health Act and regularly carry out audits of these people’s records and report these to the NHFT board.
- Ensure that, in line with national guidance and best practice, staff are aware of the importance of involving and engaging patients’ families and carers in all aspects of care and treatment.
- Ensure robust discharge policy and processes that consider the circumstances surrounding discharge and whether discharge is appropriate.
CQCs RECOMMENDATIONS FOR NHS ENGLAND
- Providing, within the next 12 months, evidence-based guidance setting out the national standards for high quality, safe care for people with complex psychosis and paranoid schizophrenia.
- Ensuring that within 3 months of the publication of the national standards for high quality, safe care for people with complex psychosis and paranoid schizophrenia, every provider and commissioner develops and delivers an action plan to achieve these.
- Ensuring, through provider boards, the delivery of the actions within 12 months of the standards being
WHAT’S IT ALL MEAN?
It’s a mess – if that isn’t obvious. He spent very little time in hospital when admitted, he was discharged to the community without adequate risk assessment or care planning, when he disengaged he wasn’t followed-up and both his own family and some professionals were ignored when they raised concerns. It means when he was admitted under s3 MHA full opportunity to ensure his revolving door was prevented were not seized – whatever the arguments about Community Treatment Orders and their effectiveness, the fact is we didn’t hear about them during court proceedings or the BBC Panorama programme last night. The whole point of them is meant to be to ensure a mechanism to more effectively and more easily manage patients who disengage from medication and / or services, after discharge.
None of the explanation of his healthcare, above, seems to consider the healthcare side of the interconnection with the justice system – bearing in mind he broken in to rooms, people were jumping from first-floor windows a somewhat terrified of him because he placed them in headlocks and tried to hold them hostage in their kitchen. Would prosecution for offences have helped with situation? – well, maybe not. There’s an argument it rarely helps the patient for them to be criminalised, but there is the argument that people who break in to other people’s rooms, as if to suggest they will be attacked are sent to court because the biggest issue is not the defendant’s wellbeing, but the broader risk to the public. I know there is a separate review of the policing decisions in this case, but I’ve made the point already: the healthcare decisions cannot be divorced from the policing decisions, and yet there are for review purposes.
Finally, we have the decision to discharge Valdo in September 2022, just as the courts are issuing an arrest warrant for failing to appear at court, charged with assaulting a police officer whilst being ‘sectioned’ in September 2021. The NHS Trust attempted to defend his discharge shortly after criminal sentencing in January 2024 stating patients with capacity have the right to disengage from care.
That’s only right to an extent, because the MHA is not about ‘capacity’, strictly speaking. And here’s a big question: if someone has disengaged from care in any circumstance, how do you know it’s a lawful, autonomous decision with capacity or a sign of serious relapse and illness, unless you follow them up and assess them again.
We now know hands were wiped here, no doubt at all.
NB: this is the latest in post about the terrible events in Nottingham, June 2023. You can find all the others collated on a specific Nottingham resources page along with other materials, inc reports and legal documents.
Winner of the President’s Medal, the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation. (c) Michael Brown, 2024
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – www.legislation.gov.uk
Mental Health Cop 