Valdo Calocane: NHS England Report

Question

Asked by

To ask His Majesty’s Government whether they plan to publish a full version of NHS England’s report regarding Valdo Calocane.

My Lords, I offer my sincere condolences and, I am sure, those of all in your Lordships’ House, to the bereaved families of Barnaby Webber, Grace O’Malley-Kumar and Ian Coates. Our thoughts are also with the three survivors who sustained serious injuries in the horrendous attacks that took place in Nottingham. Yesterday, NHS England published in full the report of the independent investigation into the care and treatment provided to Valdo Calocane.

I thank the Minister for her reply and associate myself with her condolences to the families and the other injured persons. This is a thorough report of 300 pages. Short of naming any names, I do not think there is anything more to be said. However, I have three points. First, the report indicates the difference in the balance between patient rights and community safety, and I would like the department to take that point firmly on board. Secondly, it appears that some of the treatment decisions were taken by individuals but could probably have been better taken by multidisciplinary teams to test the individual judgment against a wider group of experts. Thirdly, the report mentions equality, diversity and inclusion factors and the extent to which they cut across medical decisions. Will the Minister come back to this House, perhaps in six months’ time, having asked her services to look at these three points and any others because there are far too many lessons-to-be-learned reports from which lessons never seem to be learned?

I assure the noble Lord that officials are working with NHS England and partners to set out the next steps regarding how future mental health homicide reports should be published and to ensure that we act as transparently as possible in line with our legal obligations and with engagement for families. That is very important for the future. The three points the noble Lord raises are very relevant and are being dealt with thoroughly in Committee as we take the Mental Health Bill through this House. I am confident that your Lordships’ House is on top of this matter, as are the department and all concerned. There has already been progress on the CQC report published previously, and all the recommendations in this report have been accepted in full.

My Lords, these Benches share in the condolences to all those affected by this tragedy. This is a watershed moment, but I am not sure whether the culture of the NHS has changed, given that yesterday a senior official said,

“the system got it wrong”.

No. Individuals in the system got it wrong. What extra mechanisms will the Government put in place to ensure that every individual is held accountable for this and future tragedies in each ICB area?

I understand the seriousness of the points the noble Lord makes. As he is aware, the report to which we are referring is concerned with the care and treatment provided by health services to Valdo Calocane rather than questions of culpability. More broadly, I remind your Lordships’ House that the Prime Minister has committed to establishing a judge-led inquiry into these attacks. We absolutely understand the importance of an inquiry. Having met the families myself, it is crucial to provide families with answers and ensure that this cannot happen in the future.

My Lords, the Calocane report is a devastating mix of horror at state failures. It echoes everything from the grooming gangs to Southport, and you just think, “How could this have happened?”. The Minister said that we are dealing with this in Committee on the Mental Health Bill. I query that because the report has only just come out, and it seems to me that the Mental Health Bill will need to change to reflect the lessons learned, as the noble Lord, Lord Balfe, said. Otherwise, we are ignoring it. Will the Minister reflect on how that is happening?

Secondly, did she notice the worrying detail that staff were nervous about forcing treatment because debates here in Westminster on racism in the mental health system meant that they stayed back—they were silent—because this patient was black? Can the Minister assure us that those kinds of politicised issues should now be swept away from all service provision and that we will tell staff that the ethnicity of the patient does not matter and that they have to act according to procedures?

I thank the noble Baroness for the opportunity to clarify that my reference to the Mental Health Bill discussions was in relation to the three points raised by the noble Lord, Lord Balfe, rather than the detail of the report. As I said, the recommendations have been accepted in full, and there is a programme of work to take them forward and for full reporting back. In respect of the further comments the noble Baroness made, it is of course the care of the patient that matters and protection for both the patient—whoever they are—and the public.

My Lords, it is a tragedy that, on average, 120 people are killed every year in Britain by people suffering mental illness. As the noble Lord, Lord Hanson of Flint, flagged last night on a different but relevant topic, the risk of tragedy can never be zero, so mitigation of risk is key. I hope the Minister will commit, perhaps in the Mental Health Bill, that full and complete reports on crimes committed by those who have been treated under the Mental Health Act 1983 should always be published because that is the best way to decrease the likelihood of them happening again. I should flag that in 2006 the High Court refused a request to have a patient’s medical history deleted from a published report.

I am grateful for the reflections of the noble Earl. I said earlier and am happy to emphasise again that the department is working with NHS England and partners to set out the next steps regarding how we will do exactly what he is speaking of, which is how future independent mental health homicide reports should be published, because it is so important to be transparent. Transparency is key, not just for bereaved families but to ensure that it drives improvements to services to help prevent tragedies. I certainly share the intention of the points raised by the noble Earl.

The Minister will know from the Mental Health Bill discussions that there is quite a strong feeling about the abolition of community treatment orders, which were introduced into the 1983 Act by the 2007 amendments. I had reservations about them when I sat on that Bill in another place. I continue to have reservations about them, and this case is indicative of the difficulties and dangers of trying to administer strong medications to people in the community.

I am grateful to the noble Baroness and for all her contributions to the Mental Health Bill. Perhaps I could use this opportunity to say, in answer to her question but also to a previous question, that improving patient rights is not in conflict with public safety. That is something that I know we are very mindful of about the Bill. As the noble Baroness is well aware, and as we have debated many times in this Chamber, there is a case, when to protect people from themselves and to protect the public, action must be taken, and that should not be shied away from.

My Lords, as the terms of reference of the inquiry are developed, could the Minister outline whether they will cover the key questions that have been raised about the criminal justice system? Do we need to look, for instance, at renaming the offence “manslaughter on the grounds of diminished responsibility”, with the cry that he has got away with murder? Will it look at the sensitive issue of, when somebody is not culpable for getting as ill as he did, which is what the court found in the unduly lenient sentence judgment, whether we need to explain to the public why we do not send people to prison but only to hospital in those circumstances?

As the noble Baroness is aware and as I have already confirmed, the report is totally focused on the care and treatment of Valdo Calocane. The questions about sentencing are of course a matter for the courts, but I am sure that my colleagues in the Ministry of Justice will be interested in the noble Baroness’s comments.