Fatal NHS negligence about mental health
Rush to get dangerous paranoids out of hospital and back into the community
A year to the day after her world fell apart, Kath Barnard is sitting on the sofa of her comfortable home in Stapleford, Nottingham, clutching a cup of coffee and struggling to comprehend how it could have come to this.
Her son, William, had been a peaceful and affectionate child. But the first sign of problems came at primary school when he struggled to keep up and couldn’t read properly. Aged seven, a psychologist diagnosed severe dyslexia. At 19, having left school three years earlier and drifted from job to job, he sat his mother down and said he was hearing voices and that the neighbours were bugging his flat.
William was prescribed the antipsychotic medication Risperidone, and seemed to improve.
But, by 2006, he stopped taking his medication, withdrew from his family and, paranoid and distressed, spent hours locked in his flat, refusing to answer the door. The family asked for him to be sectioned, to no avail. No one knew quite how bad things were until Kath went to his flat in March 2007 and looked through a window where the curtain had fallen down.
The scene will stay with her forever. DVDs and CDs were hanging from the ceiling and walls. William had blocked sockets and removed light bulbs, believing electricity was wicked. The television was smashed, the fridge upturned and filled with rotting food. Bottles full of liquid, plants, flour and other substances were all over the floor and tables.
“It was soul destroying,” says Kath, 48, an oncology nurse. “You wouldn’t let a dog live like that.”
The authorities “finally listened” to Kath, and William was admitted to Derby City hospital. Six months later, he was released from secure accommodation, under the supervision of Nottinghamshire Healthcare’s Assertive Outreach (AO) team. For a while he seemed to cope but he stopped taking his medication in December 2008, and his condition began to slip alarmingly.
Seven months later, on July 24, 2009, William picked up a kitchen knife, left his flat and walked the short distance to his grandparents, John and Mabel McGrath.
John opened the door. William, without saying a word, took one step into the house and plunged the knife into his grandfather. In the space of a few seconds, he stabbed him 56 times and severely injured Mabel.
William, suffering from paranoid schizophrenia, believed the 81-year-old was part of a cult out to terrorise him.
Amid the grief, Kath feels a burning resentment that had the mental health professionals done their jobs, her father would still be alive. Kath’s father, John, had helped bring up her son when her marriage to William’s father, Christopher, a Grenadier Guard, had ended. He played with William and helped him with his passion for taekwondo. Most of all he was a rock of support as William struggled at school.
“Neither deserves what has happened to them, and no one blames Will,” says Kath. “From the moment he first got involved with the NHS mental health teams, they let him down. I blame them for what has happened.”
Kath’s ire might be dismissed as a grieving parent’s determination to apportion blame, were it not for a highly critical report by Nottinghamshire Healthcare NHS Trust. It exposes a catalogue of failings in the system. Central to the case is the work of the AO team; these teams were set up by the Labour government in 1999 in a drive for patients to be treated in the community.
As asylums were closed down, the number of adult beds shrunk from around 67,000 in 1990 to current levels of 26,500.
The role of AO is to provide intensive support for severely mentally ill people who would traditionally have been sectioned. Their role was to see William Barnard fortnightly, to keep him out of hospital and to help him integrate into society.
Despite 30 warnings from his family that his condition was deteriorating, they last gave him his fortnightly injection of Depixol an anti-psychosis drug in December 2008, before he refused to attend appointments and take his medication. In the end, they saw him just four times in six months.
A medical team even visited his flat on that fateful Friday morning, saw blood stains on the handle and bizarre scrawling on the door that “the magic eye is watching”, yet a decision was taken to leave any action until the following week.
The report highlights an “ineffective and predominantly absent leadership” and a “relative breakdown in the AO team’s function”. The team’s approach to care was beset by “malaise and passivity”. The report also raises the wider issues of whether those who are seriously mentally ill should be continually cared for in the community.
Marjorie Wallace, chief executive of the mental health charity SANE, says there are problems within the system.
In an analysis, carried out by SANE, of 69 homicide cases, Wallace said the “common fault lines” were similar – a failure to listen to the families’ concerns or to the patients, communications failures between agencies and an over-reliance on allowing patients to determine their own course of action.
“Driving this agenda is a diktat that everybody should be kept in the community at all costs,” she says. “These AO teams are judged on the number of hours they keep people out of hospital, regardless of whether it is detrimental to their wellbeing.”
Inevitably when discussing system failures, the issue of funding arises. Prof Til Wykes, Professor of Clinical Psychology and Rehabilitation, based at the Institute of Psychiatry at Kings College, London, argues that a major overhaul of the way mental health research is funded is required to improve services that cost the country £77 billion a year in loss to the economy and NHS and council spending.
“Poor mental health affects 16.7 million people in the UK,” she says. Her research points to twice as much money being spent on heart disease and five times as much on cancer research, conditions which see far fewer sufferers.
In June, William Barnard was sentenced to indefinite detention in secure accommodation, having admitted manslaughter on the grounds of diminished responsibility. Kath says he is so tortured by what he has done he wants to die. Lessons must be learnt, she says. “If the authorities had done their jobs, William would have received help and medication, and my father would be alive.”
New hope for meningitis vaccine
DOCTORS discovered a possible breakthrough in finding a vaccine for the deadliest strain of meningitis. Sky News said research teams in London and Singapore have identified certain human genes behind the infection, which could lead to vital clues on how best to treat it.
Currently there is no vaccine for the Group B strain which each year claims thousands of lives around the world.
Scientists scoured the genetic codes of more than 6000 people for clues as to why certain individuals are more vulnerable to attacks by meningococcal meningitis than others. They found evidence that genetics plays a key role in the way the body responds to the infection.
Most people can carry the bacteria in their throat without ever succumbing to the disease. But occasionally, the infection strikes with devastating force, leading to death in up to 10 per cent of cases. Around 1500 cases of bacterial meningitis are recorded in the UK each year. Most victims are children under five and teenagers.
Although people can be immunised against some types of meningococcal bacteria, scientists have been unable to develop a vaccine against the Group B strain.
Consultant pediatrician Dr Simon Nadel, of Imperial College, London, told Sky News, “This is a significant breakthrough because for the first time we’ve identified genes that are important in determining how susceptible we are to infection with this bacteria.” “And it could mean that the proteins we’ve identified could be used to develop a vaccine to protect us against all the different types of meningitis bacteria.”
British university degrees to become a lifelong financial burden?
Middle-class professionals face being charged much more for their university degrees under plans for a new “graduate tax” system, according to research. GPs could pay some £70,500 to cover the cost of tuition fees while teachers are charged almost £50,000, it was claimed.
The findings came as David Willetts, the Universities Minister, insisted that graduates should make a “bigger contribution” towards higher education to keep universities strong during the economic downturn.
Speaking on Sunday, he appeared to endorse plans set out by Vince Cable, the Business Secretary, last month for student fees to be replaced with a levy based on earnings when graduates start working.
The Coalition claim this would end the current situation in which teachers, care workers and research scientists are expected to pay the same for their studies as top lawyers, surgeons and City analysts.
But the University and College Union warned that the changes risked escalating the cost of a degree for all students – and leaving millions of people in even more debt.
In a new report, the union, which represents lecturers, analysed a series of different financial models to test the consequences of a new-style tax on earnings. The UCU said a university-educated nurse on average wages would pay a total of £36,871 if the Government introduced a five per cent tax on graduates’ total earnings over 25 years.
By contrast, under the current system, the same nurse graduating from an English university this year would be charged £10,300 to pay off the £9,440 tuition fee loan for their three-year degree. Even a three per cent rate of graduate tax over 25 years would work out significantly more expensive, at £22,123 for a nurse earning the average full-time salary of £29,497.
The conclusions come as the Government prepares to publish the findings of an independent review of student tuition fees in the autumn. The review – led by Lord Browne, the former head of BP – is widely expected to lead to a rise in the existing £3,225-a-year cost of a degree. Lord Browne has been asked to consider the graduate tax plan as part of his review.
Sally Hunt, union general secretary, said: “Parents and students will judge proposed changes to student finance on whether they make university more expensive or not.
“Whatever scheme is proposed to replace fees, the Government must ensure that studying for key professions remains attractive and that the prospect of prohibitive costs over a lifetime will not put off the next generation of innovators and public servants. “We urge Vince Cable to look again at the idea of taxing big business for the substantial benefit it gains from a plentiful supply of graduates, rather than merely looking to penalise students further.”
But speaking on BBC1, Mr Willetts admitted the Coalition was looking at some “tough options”. This included forcing former students to make a “bigger contribution back towards the cost of the university education they have enjoyed”. “If you look at the overall position, we want to carry on providing finance for universities, but we think more of that finance should come from people after they have graduated, after they are in well paid jobs, and then making a contribution back,” he said.
Under a five per cent graduate tax on all earnings over 25 years, a secondary school teacher on average wages would pay £46,046, a social worker £37,550, a research scientist £46,418 and a doctor £70,526. According to UCU figures, if the rate was set at three per cent over 25 years, the same teacher would be charged £27,628, the social worker £22,530, the scientist £27,851 and the doctor £63,338.
Paying off a £9,440 tuition fee loan under the present system of funding for higher education costs the teacher £10,025, the social worker £10,272, the scientist £10,017 and the doctor £9,696.
The UCU said its research prompted fears that introducing a graduate tax could lead to shortages in teaching and social work, and would make “embarrassing reading” for Mr Cable. Mr Cable has admitted that some people were likely to end up paying more under a graduate tax system. But he said it was “unlikely” that those with degrees would have to make contributions for life.
He said: “It surely can’t be right that a teacher or care worker or research scientist is expected to pay the same graduate contribution as a top commercial lawyer or surgeon or City analyst whose graduate premium is so much bigger.”
But the UCU’s conclusions have been criticised by the National Union of Students which has advocated a graduate tax system as an alternative to up-front fees. Aaron Porter, NUS president, said: “It would be quite wrong to make sensationalist and simplistic judgements before we have even seen the detail of Vince Cable’s proposals.
“NUS supported the call for a move away from the ‘poll tax’ of top-up fees and towards a graduate contribution that is fairer for students. “Any analysis of [the] proposals must be based on robust data and realistic scenarios which take account of the complexities of the debate about the future of higher education and student funding.”
No justice for British children?
Family court system could implode, warns its top judge
The family courts system is in “grave danger of imploding”, Sir Nicholas Wall, the judge in charge of it, has warned. In a letter dated July 29, Sir Nicholas, president of the Family Division of the High Court, suggested legal aid cuts could mean that parents fighting to keep their children have to represent themselves in court.
He says he has been “inundated with expressions of serious concern” from judges about the cuts, which will almost halve the number of family law firms doing legal aid.
The letter, obtained by Community Care magazine, is his second stark warning of the crisis in children’s justice. Last November, in a professional conference unreported at the time, he gave one of the most outspoken speeches ever made by a judge.
“Neither I, nor any of my colleagues, has any wish to engage in politics,” he said. But “the time has now come when the judicial reluctance to go public … must come to an end.”
Sir Nicholas warned that the system was in a “parlous state”, in danger of collapse, and it was “the children who will suffer most”. It was funded by people “who know nothing about it, and have never practised it … Neither the court itself, nor the out of court facilities, are serving disadvantaged children as they should.”
It was, he said, “welfare, or farewell”.
The judge’s interventions are signs of unprecedented anger across the child protection world. Some parents say their children are being seized without cause by overzealous councils. The professionals say the error, more often, is leaving them with abusive parents – as, of course, with Baby P. Both groups may, in fact, be right.
Since the Baby Peter tragedy, the number of children subject to care proceedings has shot up by two hundred a month, a rise of more than 40 per cent.
Eight thousand children were taken into care last year alone. Yet, disturbingly, the number of infants not in care who died of neglect or abuse has also risen – suggesting that in some cases, the wrong children are being removed from their families, and the wrong children being allowed to stay.
In theory, there are many safeguards. No child can be taken from their parents without a court order, and later a full hearing. At the system’s heart lies a person called a guardian – an independent expert, with a social work background, quite separate from the local council and family. The guardian’s job is to get to know the child, investigate their circumstances, stand up for them in court and protect them against abuse of power by social services, or their parents.
“You look critically at what the local authority is doing, and you look critically at what the parents are doing,” says Alison Paddle, a guardian since 1991, who is also spokesman for their professional body, Nagalro. “You give the child a voice.”
Ms Paddle says that in her experience – she has done about 120 cases – it is rare for a council’s concerns about a family to be completely baseless. “You often ask yourself why they haven’t acted before. But unfortunately there’s also quite a number of situations where the local authority haven’t covered everything they should do to keep the child out of care. There may be relatives, for instance, who can offer something very positive but haven’t been asked.”
Another guardian fought off a local council which seized children for adoption after their parents left them home alone, caring for a disabled sibling. “The local authority overreacted,” the guardian said. “They also lied to the court about the experience of the foster-carer, possibly placing a very disabled baby at risk by placing him with a very inexperienced carer.”
The decision was overturned. Guardians can also get children placed in care where they think the social services have been too lenient.
In many places, however, the guardian system has effectively collapsed. At least 1,000 children going through care proceedings are now represented only by a constantly-changing stream of “duty guardians”, people who often never meet the children they are supposed to be championing, let alone visit their homes, and base all their judgments on the local authority’s paperwork.
Thousands of children never get a guardian at all, or have to wait weeks for one – by which time all the key decisions about their future may well have been taken, irreversibly.
The courts have no real investigatory capacity and tend to take the word of the experts. In some cases, say guardians, the course of a child’s whole life is effectively decided in one brief phone call.
“Duty guardians or no guardians at all were happening in every single case I handled for several months,” says Barbara Hopkin, a prominent family lawyer. “It’s a rubber-stamping exercise. I was told by some [duty guardians] that they were not allowed to talk to the parents.”
A family court judge, Graham Cliffe, said that the guardian service in his area, York, had “deteriorated at an alarming rate” and “reached crisis level – make no mistake about it, vulnerable children are being sold short.”
Cafcass, the government quango which runs the service, blames the problems on the post-Baby P care rush, as social workers play it safe. That, perhaps, is reason to scrutinise applications more thoroughly, not less. And Cafcass’s critics say the real problem is that it is a classic New Labour bureaucratic monster.
“In terms of funding, Cafcass has done quite well,” says Paul Bishop, vice chairman of NAPO, its staff union. “But only fifty per cent of people in Cafcass are actually doing the job and the other fifty per cent are monitoring them and filling out forms.”
Before Cafcass was created, in 2000, children’s guardians were lightly managed – and in most parts of the country, every child got a guardian within 24 hours. In the new era, when some children never get a guardian at all, staff say they have to fill out five forms for every action they take, swallowing a third of their working week.
Anthony Douglas, Cafcass’s chief executive, insists that talk of a meltdown is “alarmist”. “We’ve absorbed 30 per cent more work in a year,” he says.
Yet the legal aid cuts are a double whammy. “All the parties in a case have to use different firms, but after October, there will only be one family law firm doing legal aid in the whole of Devon,’ says Hopkin. ‘It’s a complete disaster’.
In April, the county’s child protection department was criticised by a judge as “more like Stalin’s Russia … than the West of England”.
Sir Nicholas’s leaked letter says that across the country, many of the new solicitors given legal aid contracts have no experience in family law, and may “not know fully what they are doing”. And these cuts are quite separate from new, further, reductions to legal aid being planned by the Coalition government.
It is fair to say that almost everyone involved with the children’s courts – the professionals, the parents and the children themselves – has never been unhappier. The real problem is not, perhaps, that social workers are evil, or that all parents are liars. The problem is that in cases needing very fine judgments, a dysfunctional system is making it harder to get those judgments right.
Baby boom creating ‘critical’ shortage of primary school places in England
The baby boom is a side effect of the vast influx of foreigners allowed by Britain’s former Labour government. Around half of the births are to non-British mothers
A baby boom is creating a ‘critical’ shortage of primary school places, it emerged last night. It will also affect class sizes, with more than half a million primary school children expected to be taught in classes of more than 30 from next month.
Schools are prevented by law from allowing classes in the first two years from exceeding 30. But that often simply means head teachers are forced to create much larger classes for older age groups.
The scale of the problems is such that thousands of pupils will be taught in temporary buildings when the new school year begins. A leaked Government report revealed new classrooms are needed immediately for as many as 60,000 pupils.
Ministers have attacked Labour for failing to prepare for the influx of new pupils, despite warnings schools did not have the places. Figures show the number of children at English primary schools will rise for the first time in a decade, to 3.96 million. And over the next four years they are expected to grow by another 320,000.
The report said: ‘A considerable number of local authorities [are] claiming that they have been “caught out” by recent changes in demographic patterns and [are] seeking additional central funding for some 60,000 additional pupil places.’
There is a new lot of postings by Chris Brand just up — on his usual vastly “incorrect” themes of race, genes, IQ etc.